I am 6 months post-op and was wondering about long-term care and maintenance.  I have no experience with vaginas, and honestly could not tell a 'good' smell from a bad smell.  I know 'fishy' is bad, but if it just has a scent that is not fishy, I do not have any idea if it is normal or bad.  Even the small amount of discharge I have is questionable, since I do not know if it is just residue from dilation/douching, or is it actually discharge?  I know that the only way to be sure is to see a doctor, which I plan on doing. But that brings up a whole different set of problems, such as choosing a doctor (primary vs obgyn vs urologist, etc), and finding a doctor with experience with trans women is not terribly easy.  So when I do see a doctor, I need to be able to explain the situation to them, which is never really fun, and hope they don't prove worthless out of fear or ignorance on the subject.  Despite the beliefs of some of us, a neo vagina is NOT a regular vagina, so what is true for one may not be true for the other. 

I have been reading about how the pH level in neo-vaginas is higher than natal vaginas, which I have confirmed for myself, since mine is around 6.5, while a healthy vagina is around 4.5.  In a natal woman, this would be indicative of an infection, but it seems to be somewhat normal for us (especially for those of us that are still dilating 1-2 times a day).  I have also heard of some women who have had their doctors give them some sort of lactic acid supplement, or some other form of lactobacillus, which is supposed to lower the pH to a more acidic (healthier) level, where the healthy bacteria can keep the unhealthy bacteria in check. 

Even if I did have a minor infection, and the doctor was able to clear it up with antibiotics, I fear that the underlying cause (high pH) would still be present, leading to more infections down the road.  And constantly taking antibiotics is never a good idea for anyone, as it can cause more problems than it fixes over time.  Mainly, I was looking for anyone else who has any experience or knowledge in this area.  I am wondering if something as simple as eating yogurt or taking acidophilus pills could remedy this situation. 

Thanks for any feedback.

Extreemly well put questions.
I agree, a neo-vagina is not a natal vagina, and so, balances would be different.

I take acidophilus daily and have not noticed any problems.

I was wondering how you tested the Ph level.

They sell test kits at pharmacies/drug stores, screening kits for vaginal infections. They are sold alongside the cremes for yeast infections,etc.   I got one by Vagisil, but any of them would work, since pH is such a simple test, as all you need is some litmus paper and a reference.  They come in 2-3 packs, for $10-20.  All they really are is a piece of litmus paper, on a plastic stick.

LOL. I haven't used litmus paper in 20+ years.
Good information. Many thanks.

I've seen those kits. It would be interesting to try but the price is ridiculous.

Try Edmund Scientific 100 strips for $1.95

When I talked to my regular doctor (family physician), he said if I was concerned I could use Monistat and that using it when I didn't need it wouldn't be a problem.

I can smell myself sometimes under certain conditions - usually when I pull out the dilator and my legs are still spread.  I never can smell myself under normal conditions (legs relaxed).  I would get some pings of pain, kind of like an itch, when I was healing.  Someone said that's the nerves re-attaching themselves, but that's why I asked the doctor whether I had an infection.

Don't wash the area with soap, which can wash away the good bacteria.  I wash with Summer's Eve feminine wash, but there are other products that won't affect the pH.  I also take acidophilus pills.  I've had no problems so far.

For a long time I had spotting on my panties around the area of the clitoris as it healed and shed whatever.  It had a slight odor but not noticeble unless I stuck my nose up to it.  (I have a pretty good sniffer, too.)  That seems to have stopped now at about 10 months.  Early on I got some slight discharge from the vagina, but it seemed like healing rather than infection and wasn't smelly.

In my Vaginas 101 lecture after the operation, the nurse said to wear cotton panties because moisture is the enemy of a healthy vagina.  She also said to stay out of hot-tubs because the temperature is just right for bad bacteria to grow and give one vaginitis.  Wipe downward after peeing, always front to back to keep the bad stuff from the back getting in the good stuff in front.  She also said I should never have to douche if the area stays healthy, which it has.  With a shorter urethra it is easier to get a bladder infeciton, but if you keep everything clean you should be fine.

I've never tested my pH - maybe I'll try that - but so far everything down there is happy, which makes me happy.

I sometimes wish I had learned how to care for all this from a very young age, but not all women do.  The nurse who gave me the vaginas lecture also works with Planned Parenthood.  You might try them.  They have experience talking to women who didn't learn how to care for themselves but want to.

- Kate

All good information, thanks everyone. I'll have to ask my doctor about those acidillic pills or whatever they were.

I'm also curious about probiotics. Do any of you use them and what do you use?

I'm using probiotics (inner health) but there are so many different brands they all more or less do the same thing.. just as long as they are stated as being probiotics. Yogurt has good bacteria but the amount is really more for maintenance, for something like surgery you want pills to counteract the more strenuous effects that antibiotics have had on your body.
I've read that washing the opening up into the ring muscle (name?) with warm soapy water using your finger is fine while in the shower, a lot of odour can come just from this opening area. And douching with just warm water once every so often (each month) is not harmful between six and 12 months... more so if you have discharge.
I've read a lot of people go on and on about how douching is bad and you shouldn't do it and it messes with your natural bacteria but it's still technically a surgical site in healing for the first 12 months so you can't expect too much perfection.
If this was after the 12 month mark then yeah consider it an issue but otherwise. If you have blood or sloughing or anything else coming out of the vagina after dilating then it's a good sign to douche as lube and dead skin etc can ferment and cause odour, once you find that you have no discharge (other than small amounts of clear water like liquid) then you douche less and less. Sounds perfectly normal and to be expected (for some).

I honestly think there are other things to worry about than the pH of your vagina.  Besides, yours is made out of different tissues than one who's owner was born with it.  Plus, your vagina doesn't have openings to other organs inside your body and thusly not as pressing need to have a lower pH to fight infection.

I know of plenty of post-op women who have no problems with infection down there because they have a neo-vagina instead of having been born with one.  They take no supplements and lead happy healthy lives.  Try not to be such a worry wort. 

BTW, how were you able to test the pH of your vagina anyway?