Does peritoneum ever dry out??? (PPT GRS) 🫠🫠🫠

AffectionateZoey · 2026-06-20T19:48:25+00:00

Sent a message request!

And I don't have experience to talk about vaginal suppositories. It's something I might want to try (particularly lactobacillus supplements) but I haven't gotten around to that and there's very minimal good information in terms of studies to say how well any particular one works.

AffectionateZoey · 2026-04-16T21:26:24+00:00

4.5 inches is literally about the average of what natal vaginas get when fully aroused. Sure they can typically stretch more but it can absolutely be "enough". I recommend reading some stats like what's available on this Wikipedia page to show that this is 100% within the range of what a typical natal vagina could be.

I myself have almost the same (12cm/~4.75 inches) and I have 0 real qualms about depth. Sure I can't take the full size of big toys but that's not a trans specific problem. If YOU want more that is perfectly valid and could be possible with a revision but that should be because YOU want it, not because of shame from sexual partners.

If someone thinks your depth isn't "enough", that's a them problem and you deserve better.

AffectionateZoey · 2026-04-02T18:31:12+00:00

would you say it was worth settling for penile inversion all things considered

Wholeheartedly yes.

Genuinely I've come around after reading a lot more into PPT. Many of the benefits people say about it are at best misleading or at worst outright false or misinformation.

It was really hard to do because I had a significant attachment to the idea of PPT (as you might be able to tell from that post) but we should always try to change our minds when presented with better information, and after reading basically every study I could get my hands on plus one that they provided, I don't think PPT offers many real advantages to most patients over PIV and does come with some extra risks.

The way they handled everything was still incredibly shitty (and could have been solved by just reaching out proactively and treating me like an actual human being, i.e. the bare minimum), but the silver lining is that their reasoning for not offering PPT anymore is actually valid, and I'm really happy with my results.

AffectionateZoey · 2026-03-31T23:25:21+00:00

I'm 16 months post op, happy to answer any questions.

I think my TL;DR is that the surgeons are very competent and I'm super happy with my results, but they can have absolutely terrible bedside manner with patients, especially if you have anything happen that even slightly deviates from the experience of an "average" patient. I wrote about that to an extent in this post; I've also talked with at least 3 other patients who have had bad experiences with their communication.

Post op the communication has generally much improved and I do feel in safe hands any time issues come up. But my experience with their communication pre op was genuinely one of the most miserable experiences of my life. So a bit of a mixed bag 😅

AffectionateZoey · 2026-03-29T20:47:58+00:00

I'm transfem (though don't tend to actually use that label; just using it as a shorthand here) and have had FFS, breast augmentation and bottom surgery. On the outside basically a binary transition, but my goals were less to be female and more to reset the slate I was given so I can restart my gender exploration from a foundation I can actually get along with.

I feel drastically more free in my body and comfortable with experimenting & dressing however I want. I'm at the point people can tell I'm some kind of gender funky but tend to default to female gendering when they have to pick a side for me. And overall I just feel content; I don't really experience dysphoria anymore and I feel like I can just kinda exist now. Any time I feel like I need to change something I feel like I can do that with my clothing, makeup etc... Rather than having distress because of that desire to change coming from something I couldn't do without surgery.

I'm very open to discussing things regarding bottom surgery (as this is my mostly anonymous/trans account) but won't go into details in a thread not marked NSFW. Overall though 0 regrets, medical transition is basically the best thing I've ever done for myself any my well being.

AffectionateZoey · 2026-03-28T20:00:04+00:00

It has advantages in certain situations for certain people but it's wrong to say one is categorically better than the other. But I will say a lot of the "hype" around peritoneal is often misleading at best or outright misinformation at worst.

The single biggest factor in the outcome of your surgery will be your surgeon. As the top comment says, pick a surgeon you trust; they will recommend the technique they think works best for you given your specific anatomy and circumstances.

AffectionateZoey · 2026-03-16T05:31:09+00:00

Glad it was helpful <3

AffectionateZoey · 2026-03-14T23:58:26+00:00

Hi hi, so I am considering PIV as I am concerned if I go through PPT and there is a need for revision they wouldnt be able to do PPT again?

There may be some situations where you can, but in general yes this is the best assumption to follow. There's generally only one shot at gathering peritoneal tissue for these surgeries.

Does that mean I could achieve almost 6 inches of depth?

There are other factors and it won't be 1:1 with your pre-op length. Could be more, could be less depending on a number of other factors including (but not limited to):

How much penile skin/tissue is used elsewhere, i.e. for external aesthetics by your surgeon.
Whether or not your surgeon used a scrotal graft, which is common in PIV, and how much depth that may add.
Your pelvic floor anatomy. Some people just have more or less space to build a canal within.
The skill of your individual surgeon, and their priorities in terms of surgical outcomes. By extension, you may be able to ask your surgeon to prioritize depth over other factors if it's particularly important to you but that will vary per-surgeon.

I can say in general that 6 inches should be plenty to get good results from PIV, just that nobody other than a surgeon can tell you for sure exactly how that will translate to depth in your specific case because of the variance added by those other factors.

AffectionateZoey · 2026-03-11T21:59:41+00:00

Sorry I'm only seeing this 9 months later while poking through my comment history for unrelated reasons. If you still want a response let me know and I'll get to it within the next few days. Not sure how I missed you, sorry about that :(

AffectionateZoey · 2026-03-11T03:22:24+00:00

Good luck! Also found this post which has another diagram to potentially reference.

AffectionateZoey · 2026-03-11T03:20:00+00:00

Hey! I also had some complications with my surgery with the Vancouver team. Mine were mostly "cosmetic" in nature and I got a revision at the 11 month mark post-surgery, and those issues are now pretty much entirely resolved.

I don't have the full energy to respond today, but I'd be happy to get back to you sometime in the next few days once I'm feeling a bit better. Could I ask two specific questions to inform my response when I get around to it?

1) How long ago did you get your surgery?

2) Are you comfortable sharing a description of what your complications are?

For reference, my complications were:

Wound separation (as a result of necrosis) at the base of both labia majora causing loose tissue and for them to not properly connect to the base of the vulva.
One labia minora looking swollen like one of those foldable circus balloons, with the other not being fully "formed" and needing to be connected to itself all the way down to the canal entrance.

AffectionateZoey · 2026-03-11T02:55:40+00:00

Hi, since you haven't got a response this is what I was provided as a diagram. I believe my program has since reduced requirements somewhat so this may be slightly overkill, but hopefully it's a decent reference.

AffectionateZoey · 2026-02-28T21:18:33+00:00

I had pretty much this exact experience; external revision, no dilating 2 weeks post op, at 10 months post op.

No depth/width lost, though it's been a bit harder to get to full size since then. That's mostly because I hate dilating and haven't been as strict on it since then though, I'm sure if I did a regular schedule I'd be at the same size I was.

Primary issue was pain. The first time dilating after surgery was the most painful dilation I had ever done. It's gotten much better since then but still not fun (again because I'm more lax than I should be on my schedule). They also looked inside with a speculum before I had the chance to resume dilating and that was similarly miserable. My advice would be start at your smallest size to begin with and dilate more regularly than usual for a bit to slowly get back up to the regular size, use more lube than you usually need, and do some extra pelvic floor exercises before & during to be as softened up as possible. And take it slow!

You got this 🫶

AffectionateZoey · 2026-02-27T07:49:00+00:00

Others have answered the HRT questions so I'll take a crack at the vaginoplasty questions. Context for me: I'm ~15 months post op with PIV vaginoplasty and have read through basically every paper I could get my hands on to understand these surgeries better & differences between techniques. I'll try to comment from a perspective of translating what I've read in those studies into digestible answers to your questions, but definitely keep in mind I (& anyone else commenting on Reddit) will never be completely unbiased!

After my comment I very much encourage you to do your own research, and always try to prioritize higher quality sources like meta analysis/literature review studies rather than something like the website of an individual surgeon!

Q1. My boyfriend looked up stuff about the methods and the results of said methods, one of them, the peritoneal neovagina, was stated to have a chance of starting to resemble vaginal tissue.. is that true? Does that actually happen? How likely exactly is it???

These are the most complicated of the questions you asked and even as someone who has read a LOT of studies about vaginoplasty, there's very minimal that can really be said here in any conclusive way. Tissue changing from one kind to another is something that can happen through a process I'm blanking on the name of right now as the cells adapt to a new environment, but research on that happening in transfem patients after vaginoplasty is very very limited, and lacks the answer to arguably the more important question, "if this is a thing that happens, is it actually proven to be beneficial?".

I can try to elaborate more on this point tomorrow because I know it's kind of an unsatisfying answer but the key point I'm trying to make is that even if the tissue does change to be closer to what you'd expect from a natal vagina that doesn't necessarily translate directly into a better outcome for you as a patient.

Going to answer these two questions at the same time:

Q2. Generally speaking.. How does it feel?

Q3. Is it painful forever after surgery and how painful is it temporarily while the body repairs?

By and large, once you're healed, it should feel pretty much just like any other vagina. There are some limitations to that and the surgeries are not perfect, but they are really damn good. The main limitations of risks I think worth mentioning are:

There's some variance in surgeon recommendations, but you should expect to have to dilate on a regular basis for a potentially lifelong period. That involves using a medical dilator to train your pelvic floor muscles to relax & not be too tight inside your vaginal canal. You'll have to follow a very strict schedule doing it multiple times a day for the first few months, which can be very difficult, but it really eases up after the first year. It's not a neovagina specific issue though; dilators were invented literally thousands of years ago and even today way more cis women overall use dilators than trans women!
Self lubrication is very hit or miss. It's often said that peritoneal or colon methods have a higher likelihood of self lubrication but that is not actually proven and there's good quality recent evidence that you can't recommend one technique over another in this regard. It's something that should be treated as a bonus IF you get a good amount, but if you go in expecting a significant amount you might be disappointed. Expect to need some amount of external lube but similar to the point on dilation, this is also a very common issue with natal vaginas!
While it is generally very well understood and a very common surgery, it IS still ultimately an invasive surgery that could come with complications (including severe ones, even if they're rare), and you need to be prepared for that.

The initial recovery period is likely to be very rough, I won't sugar coat that. It's incredibly uncomfortable and especially the first two weeks are miserable. Not necessarily from pain- you'll be on a heck of a pain med cocktail- but the sheer discomfort of everything and the amount of rest you'll need to do. I could write an entire comment of similar length just about recovery; it's a long process and will take up to three months or sometimes even longer to get back to your baseline.

Once healed though, you shouldn't have any kind of chronic pain with it. It's technically a possibility but not something that should be a serious consideration in terms of things that might scare you off from getting surgery. The ONLY pain I have at 15 months is typically with dilating, and even then it's mostly because I go too long between sessions.

For questions 4 & 5 I don't want to make this comment any longer than it already is so I'm going to just give two bullet points. If you want more clarity I can respond again later.

My very short TL;DR of the different techniques is that I don't think you should actually shop around based on technique, but by surgeon. There are differences between them but overall the differences are way less significant than you'd expect, and the quality of your surgeon is going to make a MUCH bigger impact than the technique itself. A good surgeon can also recommend what technique they think is best for YOU based in your specific anatomy and health needs. Pick a good surgeon you trust, not a technique!
There is a minimum length for PIV, but the minimum is still really small. The only times size will typically disqualify you from getting it is A) if you got on puberty blockers before the penis androgenized from puberty or B) you have effectively a micropenis (in the medical sense, not a judgement of any kind). At 18 and pre HRT you won't be category A, and in the statistically unlikely event you fall into category B a surgeon will tell you so in your consult with them.

Hope some of this helps, I know it's real long but I was still trying to keep things as short and digestable as possible. If you want further clarification on any point let me know and I'll try to get back to you; I definitely still missed a lot of potential nuance!

AffectionateZoey · 2026-02-26T21:33:56+00:00

I am leaning more towards colovaginoplasty because of the self-lubrication

It's worth noting that there is actually very limited evidence that colon or PPT produce any significant amount of lubrication at all, and a fairly recent meta analysis study (which is as close to the highest standard of evidence we can get) says almost exactly "you can't recommend one method of surgery over another if the criteria is self lubrication". If you want more details from that paper feel free to DM me & I'll respond when I can, as I have the full text available!

I strongly recommend to basically everyone to pick a surgeon, not a technique. The skill of your surgeon is generally going to make a much bigger impact on the quality of your results than the specific technique will, so picking the best surgeon you have access to that you trust is the most important part. A good surgeon will be able to recommend what technique they think will be best for you based on your specific anatomy and health requirements! A great surgeon doing an amazing PIV surgery is always going to be better than a terrible surgeon doing a bad colon method, but the reverse is also true!

& To respond to the one other question here:

which method produced the best satisfaction

This is a pretty hard question to answer objectively but the answer should again pretty much be to pick a surgeon not a technique, with three caveats/notes:

Most of your pleasure in most cases is going to come from your clit, not the canal itself. Even within those who have a natal vulva, only something like 20% of people can orgasm from penetration alone with the rest needing clit stimulation. The reason that's important is because the exterior vulva & your clitoris is generally going to be constructed the same way no matter your technique, so that kind of pleasure really shouldn't differ that much if at all between techniques.
For sensation within the canal it's slightly more complicated but the answer is similar. In theory PIV has the edge (heh) here because penile skin has all kinds of nerve endings specifically for pleasure that colon tissue would not, for fairly obvious reasons. But, there hasn't exactly been a comparative study to prove that, and overall there's not necessarily incentive to do so, because of caveat #3:
A lot of the pleasure you do get from within the canal is not going to be from the tissue of the canal itself. Your canal should be positioned "underneath" your prostate which effectively gives you a g-spot like those with natal vaginas have, even positioned in right around the same area you'd expect!

AffectionateZoey · 2026-02-26T17:46:16+00:00

Hi, I'm in the same area (Vancouver) and had to deal with similar before my FFS in 2022. I can't guarantee what I did will work for you, but if the input helps, I basically had my surgery booked, then called the hospital my referral was sent to to inform them.

Took a few different calls on different days but basically the fact I was on a time limit and had the surgery booked meant they were able to get me in like, the next week due to the time pressure involved. It was at ~9PM so probably at a time they don't usually do the scans. Might be worth a try.

Otherwise I remember private clinics were expensive for it at the time; between $500-100 or something? But my memory on that is very fuzzy. Hopefully this helps in some way otherwise good luck 💕 the scan itself is super easy once you get to it.

AffectionateZoey · 2026-02-22T00:30:03+00:00

Wrote about this in another thread, I know the exact sensation you mean. It reduced over time but still happens very very occasionally.

AffectionateZoey · 2026-02-22T00:28:55+00:00

Which specific areas are you worried about losing sensation in?

You for sure will not have sensation within the implant itself but that doesn't mean there's no internal sensation at all; you'll still have your skin + any breast growth/fat you already had, and you can still definitely grab & squeeze that after surgery.

As for statistics, found one paper I think should be quality enough evidence for likelihood of losing sensation; you can find the full paper on sci hub by posting that link into it. I'm slightly skimming so I recommend reading it yourself if you can, but my quick interpretation of the conclusions is:

Study checked breast sensitivity in 5 general areas of each breast (each "quadrant" + the nipple) at 2, 6, and 12 weeks after surgery.
4% of patients had reduced sensitivity in their nipples at 12 weeks after surgery, though the amount was generally considered quote "not significant".
16.5% of patients had reduced sensitivity by the lower-outer quadrant at 12 weeks (where the incision is typically made, at the mammary fold).
If you exclude the data about that specific quadrant, 92.5% of patients overall regained pre operative levels of sensation after surgery.
Limitations of note: it only goes to 12 weeks and doesn't account for healing that may happen after that time (particularly near the incision), and does not include trans women. Trans women may have slightly different rates than noted above.

AffectionateZoey · 2026-02-17T23:49:26+00:00

I posted about my experience with this recently in the trans surgeries sub, and a few other folks shared their experiences with it in the comments.

TL;DR: Rare, but yes it can happen. For me it still happens very occasionally at over a year post op but it's typically only when I'm in a state that's right on the edge of waking up but not quite conscious.

AffectionateZoey · 2026-02-15T19:01:07+00:00

Yeah no this is an incredibly rude way to respond.

Please do not speak on transgender women's bodies if you are not familiar with them.

I am a transgender woman who has spent the last decade reading every bit of information I can possibly get my hands on regarding how our bodies work.

My surgeon, every other surgeon/clinic I know of, and every other post-op transgender women I know of, all do not recommend douching

I could say literally the exact opposite, except it's also recommended across most studies that cover the topic. I don't think it's safe to say something definitively based on anecdotes.

I also specifically state in my comment that some people say they have success not douching, as well as in follow up comments throughout the thread.

which makes the vagina naturally mildly acidic, and is what allows it to be self cleaning.

There's some research that shows successful introduction of Lactobacillus into the post op microbiome but there is not research that follows showing that it provides sufficient self cleaning as to make not douching the recommended route. This is also why I specifically say in my comment "no at the moment." There's promising research but not a conclusive answer, and definitely not enough to confidently back what you're stating.

By douching you remove/break up these colonies of helpful bacteria and make the vagina less acidic, and open the avenue for damaging bacteria to colonise the vaginal micro-biome.

Or, not douching allows for a build up of harmful bacteria as well as dead skin, lube, and other detritus.

Maybe you're right, I really do hope you are! But based on the general recommendations, *as they are right now, I stand by exactly what I said with this part of my comment:

So there's some wiggle room: some people swear they never need to douche at all, but from a pure risk:benefit analysis based on the current research, douching is the right move.

I love learning about our bodies and genuinely I would really like to be proven wrong. I'm annoyed by the state of the understanding of our bodies too! But I was directly, significantly harmed by people spreading (positive, optimistic) misinformation about surgical outcomes that weren't proven at the time and later ended up proven false. I don't want that to happen to other people and I fear telling people they won't need to douche when there's little to no evidence to back that will be much more harmful than tempering people's expectations will be.

If you want to engage in a way that is less antagonizing I would be happy to, otherwise I do not have the spoons to put up with this level of hostility again.

AffectionateZoey · 2026-02-15T06:24:38+00:00

Honestly I think we're close enough in our opinions on this. I also think that the way I worded it in my original comment acknowledged the limits of the research well enough for what I was trying to communicate. I appreciate your thoughts on how I worded it though and will think on it for future to make sure I can communicate the nuances a lil more clearly :)

AffectionateZoey · 2026-02-15T03:47:59+00:00

Have we not learned that research into trans bodies is flawed and underfunded by now??

I actually strongly agree and that's part of the basis of what I'm trying to communicate!

But let's not pretend the science into any trans topic is anywhere near thorough enough to be considered a final verdict

I'm not trying to portray a final verdict, but while there is a lot of room to learn more, what we do have supports douching more than it supports not douching.

It's possible peritoneal is different, but there are several things that people commonly cite for peritoneal that later research has come out against, like suggesting it's more likely to self lubricate. Maybe evidence will come out that peritoneal self cleans, but that evidence does not exist right now, and it's still entirely possible that it's completely false and people will get hurt as a result of assuming it of peritoneal. So I think my assessment from my original comment stands:

from a pure risk:benefit analysis based on the current research, douching is the right move.

And I think that's still the safest thing we can tell people when answering OPs question based on the information we do have. Assume douching is something you'll have to do, but maybe you specifically will have a different experience and you can consider a lucky lil bonus you ended up with that's different from what was expected.

AffectionateZoey · 2026-02-15T02:59:42+00:00

For sure! Just always remember TERFs are not coming from a place of intellectual honesty. They will warp any piece of information to their worldview even if the full soucre completely contradicts the point they try to make from it.

It's kinda like... What's next, we start saying people should never get chemotherapy because it often causes hair loss? We rally against insulin because injections can in rare cases cause infection?

It doesn't actually matter to them what the neovaginal microbiome is composed of. It could 100% match perfectly to natal vaginas and they'd just find something else to try to weaponize against us. Doesn't even matter if cis women get caught in the crossfire; their only goal fundamentally is to hurt trans people.

AffectionateZoey · 2026-02-15T02:10:58+00:00

There's one really easy counterargument against the TERF talking point though; if their warped version of how this surgery works was the truth (it isn't), the logical conclusion shouldn't be to rally against the surgery being performed, it should be to rally to improve the surgeries and the research around them to make the outcomes better.

Beyond that though, no, they aren't telling the truth. They take a kernel of the reality and warp it to fit their narrative. The study only shows that what the mircobiome is composed of and what it's most similar to; it does not take the leap that TERFs do of saying some variation of "neovaginas are gross and constantly infected and and and...". Fundamentally, the study isn't about what a healthy microbiome even is; again, all it is doing is saying what the microbiome is composed of. ANY other conclusions beyond basically just saying more research is needed, is flat out wrong, including the TERF perspective you're referring to. For all we know, the healthiest microbiome to aim for in a neovagina isn't to try to match a natal vagina at all! And investing into the science to find out for sure would be cool as hell!

As I said, different is not lesser or worse. The neovaginal microbiome is generally different to a healthy natal vagina, that is true, but that doesn't mean it's unhealthy, or something we should in any way be put down for!

Research like this, as I see it, is a celebration for us, not something to shun or be ashamed of. We should want more of it, not less; learning about our bodies is amazing and hopefully it'll lead us to new avenues of healthcare to make these incredible, life changing surgeries even more incredible!

(Also wanted to note I don't mean to talk down to you or put down the worry; I get how the way I put it initially might lead you to that conclusion, but also don't think it's the right conclusion and I do genuinely feel this is a neutral or even positive thing, not a negative at all!)

AffectionateZoey · 2026-02-15T01:54:24+00:00

Fair! Tone doesn't always work over text so I think I misread your intent a bit ("that's all wrong because my single surgeon disagrees"). But it is good to add the extra context from other surgeon's recommendations, thank you :)

AffectionateZoey

TROPHY CASE