I have read where Dr. Bowers leaves the Cowper's gland intact so it can provide vulva lubrication. Do some doctors not do this?
In all my research into anatomy and SRS procedures, I really have found no information on what doctors do in the perineal region. I did find mention of doctors who remove all the corpus spongiosus from the urethra. But do they remove all of the bulbospongiosus muscles also? Or do they spit the bulbospongiosus and keep the Cowper's glands that are there at the very end under the prostate?
Essentially much less in diameter, but in cis girls the corpus spongiosus forms a small erectile tissue around the vaginal opening. These are covered by the bulbospongiosus muscles. At the base of them exist the Bartholin's glands which open into the vestibule on either side for lubrication. These are the same glands in the male called the cowpler's glands but they connect into the urethra instead.
It seems important to ask if surgeons are keeping the cowpler's glands intact. Does anyone know what doctors do and what ones do not?
In my time spent reading and researching SRS, I can't say I've seen any comments from other surgeons, Bowers seems to be the only one I've come across to even mention it.
Most surgeons won't go near the prostate and probably will leave the Cowper's gland intact. As long as they don't find a way to transplant it to the spot of Bartholin's gland, I think leaving it is the best option.
I do think its important when leaving Cowper's gland that the urethra will get the proper position at surgery, otherwise, the only thing it will lubricate is the clitoris instead of the vagina.
Quote from: Stella Alexis on October 01, 2018, 12:48:31 AM
Most surgeons won't go near the prostate and probably will leave the Cowper's gland intact. As long as they don't find a way to transplant it to the spot of Bartholin's gland, I think leaving it is the best option.
I do think its important when leaving Cowper's gland that the urethra will get the proper position at surgery, otherwise, the only thing it will lubricate is the clitoris instead of the vagina.
Yeh that of course is the other issue I have read about. Seems many cases of not repositioning the urethra exit to the correct position at least in the past, causing incorrect pee angle for one thing.
I wonder if doctors remove the bulbospongiosis mucles completely or do they split them and leave than as they are in a cis girl, on each side of the vaginal opening /?
You are asking questions you need to be asking your surgeon of choice.. As it seems that no 2 surgeons do the procedure the same way.
Quote from: PurplePelican on October 01, 2018, 02:20:25 PM
You are asking questions you need to be asking your surgeon of choice.. As it seems that no 2 surgeons do the procedure the same way.
Yes I did email one surgeon's office today to ask about these things.
Quote from: PurplePelican on September 30, 2018, 08:03:51 AM
In my time spent reading and researching SRS, I can't say I've seen any comments from other surgeons, Bowers seems to be the only one I've come across to even mention it.
Dr Rachel Bluebond-Langner does mention it, but she didn't by name that I remember. She just referred to it as the gland underneath the penis. I have lots of lubrication from there both pre and post op.
Quote from: josie76 on October 01, 2018, 04:41:04 PM
Yes I did email one surgeon's office today to ask about these things.
Please share these answers if/when you get them Josie, these really are important questions and answers for all of us when considering a surgeon, it's actually pretty surprising that no one comments on this considering its importance.
Quote from: Sarah1979 on October 05, 2018, 02:08:13 PM
Please share these answers if/when you get them Josie, these really are important questions and answers for all of us when considering a surgeon, it's actually pretty surprising that no one comments on this considering its importance.
So far I only have one reply.
The surgeons Mumbia India when doing penile inversion:
Corpus cavernosa is removed of course
Corpus spongiosum is left on the urethra. Both are shortened to the new outlet (urinary meatus)
The bulbospongiosis mucles are left on the corpus spongiosum.
Bulbospongiosis mucles and the Cowper's glands are disconnected from the end near the rectum to make a path for the neo vaginal but left intact on the urethra.
Cowper's glands then do provide urethral lubrication to the vulva area.
I'm still hoping to get answers from any other surgeon's office.
The lack of replies is frustrating, considering how important this would be for choosing a surgeon, for me at least, this is a very important consideration. Thank you for the legwork Josie
Hugs,
Sarah
I received one more response today. Well not exactly a useful response. :-\
MoZaic Care, Dr. Wittenberg's office. Her patient care coordinator replied but stated that all my questions were great ones to ask the doctor during and in-person consultation (insurance or cash bill) or phone consultation ($250).
This is disappointing to say the least. ???
Why do we as the "consumer" need to pay a consultation fee just to find out what the doctor's standard procedure entails? Frustrating for sure.
Personally I think you're focusing on the wrong end of things. Unless you're a surgeon, and probably not even then, how do the details of the surgeons techniques relate to the end result? There's bound to be heaps of factors involved and its the end result that's important not the theory. I think that question is who does good lubrication?
I'm aware of 4 sets of post-op photo's posted from Wittenberg patients if you're interested in that kind of thing.
Quote from: AnonyMs on October 08, 2018, 10:30:09 PM
Personally I think you're focusing on the wrong end of things. Unless you're a surgeon, and probably not even then, how do the details of the surgeons techniques relate to the end result? There's bound to be heaps of factors involved and its the end result that's important not the theory. I think that question is who does good lubrication?
I'm aware of 4 sets of post-op photo's posted from Wittenberg patients if you're interested in that kind of thing.
This is a good point.. Also, from a technical POV, removing them would make no sense and I suspect moving them is the simplest option.
Dr. Whitehead wrote me back personally. He seems very personable from his email as a whole. :)
What he does in the perineum area.
"I'm happy to help answer some of these questions for you.
The bulbospongiousus muscles are completely dissected.
I do leave a very small amount of corpus left, which remains deep and buried, and gives a very small erectile sensation and heightens arousal and sensitivity during intercourse.
Cowpers glands are left in tact as they do contribute to neo-vaginal lubrication.
We do a scrotal graft and temporarily (the stitch comes out in a week or so) bolster to the anterior abdominal wall when creating the neovagina.
We find that this is sufficient in most transition surgeries."
Who is Dr Whitehead?
Dr. John Whitehead runs the Reed Center in Florida now.
Dr Harold Reed is quite well known. I'd reccomend you to do some further research on him.
So Dr. Whitehead is a surgeon listed at Aventura Hospital (also notice Dr. Daniel Weingrad is there). Seems he and a surgical partner who is a gynourologist, and Dr. Whitehead's husband who is an anesthesiologist have bought the Reed Centre.
Dr. Whitehead's specialty is listed as surgical critical care.
Dr. Keelee MacFee also wrote me back herself.
Hello Ms. Hinton,
Thanks for writing!
The Bulbospongiosum is split vertically in the middle when we dissect the urethra and corpus spongiosum off the Corpus Cavernosum. Spongiosum is not removed from the urethra. New opening of the urethra is positioned where it will have a straight exit from the perineum. Some of the bulbospongiosum is likely removed with the Corpus Cavernosum, which is dissected off the fascia protecting the nerve & vessels on the dorsum. Most of it is preserved at the base of the cavernosum, because it is used to suture well the "stumps" of the cavernosum and control bleeding. The urethra and vaginal canal will be immediately below the bulbospongiosum closed over the stumps. The vaginal tract dissection is done with a little bit of the corpus spongiosum to be sure the plane is safe and the perineal tendon & anal sphincter are not disrupted.
Dr. Brassard's office returned my questions.
He removes most of the corpus spongiosum from the urethra, +90% of it.
Most of the bulbospongiosis mucles are removed completely.
Yes he does leave the Cowper's glands (aka bupbourethral glands) intact for lubrication.
Also he currently offer penile inversion.
I've read a lot about SRS over the years and I don't see it mentioned often one way or the other. I always thought it was left intact and the exit tends to be around or just inside of the urethral opening. I mean all of these surgeons know that post op lubrication is a gray area at best, I can't imagine they would hinder people further.
But again, it can be difficult for some people to lubricate and maybe removing some glands like that could be the reason? I really don't know. I hope you find out soon!
I appreciate the research you have done on this, Josie.
For me, it may be a moot point. I never lubricated in the past, I don't suppose I will start post-op. :(