Dear All,

This is an initial post, and will be followed with a more detailed post in the next couple of weeks.

I was interested in talking with everyone about a topic a friend and I have been discussing and considering working on.  This is the absence of care/support post-op from a physical health perspective.   

For disclosure, I am about 9 years post-SRS with Dr Meltzer, and started my transition in 2006.   My own views are there are good resources to be found pre and during transition (endocrinologists, mental health experts/therapists, surgeons etc.), but that post-op the opportunity and level of care diminishes or is absent.   

It took me quite a while to find a gynecologist I felt comfortable with and was ok disclosing to fully.  She is good, but is poorly versed in post-op neo-vaginal care and overall care for a transwoman.  I have had to do most of the research and education of her myself and provided references and notes (I live in an educated and pretty metropolitan area too, not out in the sticks!). 

My question for everyone here is do you see a need/gap in post-op care, and if so where?   In my view there is a dearth of gyn's trained or aware how to provide us with care.  What about post-op self-care?  I know I got adequate instruction on dilation technique, but looking back I received little to no advice on how to care for or minimize scarring, how to clean correctly and safely, how to establish a good microflora.   I am now just doing more self-body work and physically connecting with my vagina and vulva (yes, years on, but that is another story!), and this too has made me think there could be some great value in better resources to help each of us live in our new bodies, to understand masturbation techniques, normal female function (and what is abnormal), care and love for our new genitals.  In my own case, the pain and stress of dilation never allowed me to connect and "bond" with my vagina, it always felt somewhat foreign and in some ways I resented how much care, effort and pain to maintain... silly I know, but at least in my case resulted in me not fully connecting and appreciating my new tissues for a long long time.  I think if I had better advice and guidance early on from somewhere things could have been very different.

How do you feel about this?  Is there a gap?  How might you have been better helped as you completed your surgical steps and what things did you miss or never get that looking back might have been helpful or of value.   

I would love to hear back from anyone that feels they have some views and perspectives to share.

Hugs

Sarah

I didn't find there was a problem post-SRS. If I had a problem, I would go see my surgeon, Dr. Brassard. That simple! He always listened attentively and checked to see if everything was fine. My vagina is in perfect health, works great. No issues for me. I live in a big city, close to my surgeon.

Thank you KayXo.

Sounds like location and also good aftercare was your experience with Dr Brassard.I found Dr Meltzer's office was helpful with phone questions but I'm on the east coast so not possible to drop in. 

How about physical sensation, nervous innervation and just the general "re-mapping"?   I am orgasmic, but it took a while to figure out how to stimulate myself correctly.  Perhaps more telling for me was a general disconnected feeling, but I think a lot of that was caused by a pretty rough time with dilation early on and it always feeling like a massive chore as opposed to a new joy.   

Part of why I am interested in views is that I have been talking with some sex educators about body/sex mapping and I have started working with a qualified professional that is helping me "relearn" my genitals and it is both amazing and fulfilling to finally start connecting and feeling empowered compared to where I have kind of been stuck for a number of years.   They help me understand the most sensitive and pleasurable areas of my vulva and vagina through a series of tactile touch and sensation sessions.  I'm very interested to know if others might benefit from this in particular.

Thank you again for weighing in.  I'd love to hear other's views and experiences.

Sarah

Sensations, tingling, engorgement when aroused, orgasms, all there. Took me a few weeks. Maybe there are indeed things I am unaware of when it comes to my vagina/vulva. For instance, it is nearly impossible for me to reach orgasm by just playing with my clitoris. On the other hand, I will have dreams while I sleep and orgasm without even touching myself. The dreams are very intense. It's been a fun and interesting journey, that's for sure!

I also HATE dilation with a passion! I haven't dilated in years but luckily, according to Dr. B, haven't lost much depth and can probably recover it if I start dilating it again.

I'm glad you are exploring and slowly finding your way...

So you want my tale of woe. I had surgery in 1982 with Dr Bibber and his post surgical care instructions were adequate however the additional week I had to spend in the hospital gave me additional time to deal with any issues that might have come up early on. After I was out of the hospital, my endo referred me to a gynecologist who was knowledgable abut bottom surgery on women so it wasn't difficult for him to deal with the yeast infection, proud flesh and regular inspections.

The problem is that I am asexual and not in a relationship. As the result, I haven't been strongly motivated to explore my bottom side. In addition, my clitoris is covered with the skin from the penis so there was no visible evidence that I had one. It might have been more visible if I had the second procedure but I wasn't even aware it exited for about a year after my surgery and I didn't really understand what changes the surgery would make. I only figured out that I had a clitoris in the last year or so when I located a old surgical report from about 1984 that told me how my bottom side is put together.

An instruction manual would have been very useful but as it stands, one of these days I have to get around to writing the last chapter about how to DIY operate your own bottom side. In a way it's so much better today because if you have questions, you  just get on the internet and you can talk with somebody who has a similar surgery and learn what you need to know. When I had my surgery, if I had a question, my only resource was the therapy group I was in and they ask post surgical members to attend one meeting a month for 6 months. Most if they kept the commitment most likely they hadn't engaged in sex by the time they finished their commitment.

Interesting thread.

I am a little over 4 months post op. I agree that finding a single doctor that can care for all of our needs is next to impossible. I live in the suburbs of Chicago so I would think it would not be so hard. However I have been able to put together a "team" of doctors that I am doing very well with. For a gynecologist I called a couple of offices that had good reviews or were recommended by other women and asked if they were willing to work with a transgender woman. There was one that was very willing, they had no experience with transgender women but said come on in. They have been fantastic to work with. I was introduced to everyone in the office and now feel like I have 5 gynecologists looking after me.

My GP whom I have been going to for many years still looks after me and takes care of my general needs and my yearly physicals. I also have my SRS surgeon who I can contact by e-mail or phone and get a response in a couple of hours. and lastly I have the doctors at the LGBT clinic that I have been working with for my hormones.

I know it seems like a lot of doctors and it is, but lets face it, there are not that many of us out here. The more people we can work with and help teach about our needs the better off we all are. For instance I now have 5 gynecologists and 3 nurse practitioners that are learning about our needs as is my GP. Until they start teaching TG needs in medical school I think it's up to us to help educate them.

With all of the people I've been to, from dermatologists to gynecologists I have never had anyone reject me or say they were not willing to learn. Maybe it's just the Chicago area, but the professionals around here are very willing to work with us.

Dena - thank you for your input.  I'm sorry the resources weren't very accessible or available back when you had your surgery. I agree things have become much better now and the online be resources are a huge advantage. 

Charley - Thank you for sharing also. Sounds like you have found/accessed some great resources in Chicago!  Any areas you stillfeel more information or services could help you?

Sarah