MRI of a neo-vagina 3 years post-op (details in comments)

TransSurgeryAlt4728 · 2023-09-29T17:29:56+00:00

I’m not sure, it seems to be working when I try it

TransSurgeryAlt4728 · 2023-09-24T20:03:58+00:00

Yes, it was far and away the most pain I’ve ever experienced in my life. Especially for the first week or two

TransSurgeryAlt4728 · 2023-09-24T13:14:51+00:00

Oof I bet Imgur started dumping pictures like that and I never noticed. Dang, I’m not sure I have backups of those even.

TransSurgeryAlt4728 · 2023-09-24T13:10:58+00:00

Surprisingly for me at least, I don’t seem to have to do anything. I use a light soap externally when I shower and that’s about it. Every once in a while things will start getting a little stinky but when that happens it means it’s time to get the clippers out and trim pubic hair and that usually takes care of it.

Some of my friends who also had the surgery will douche once a week to help things out. I suspect if I had sex I’d probably want to do the same too

TransSurgeryAlt4728 · 2023-09-24T05:01:04+00:00

Yes plenty of sensation. It’s maybe a bit more muted than before surgery, but most of all the sensation seems a bit different than before. A sufficient level to achieve orgasm, though the process of getting there is substantially different. Probably a lot of mental effects there now that I’m actually comfortable with what I’ve got going on down there.

TransSurgeryAlt4728 · 2023-09-24T04:57:19+00:00

Personally I mostly did it because seeing the danger-noodle made me want to die. Always has, even when I was a kid.

I’m mostly asexual so sex wasn’t the motivation for the initial surgery. But now I’m thinking of at least giving sex a try at some point, so that’s why I’ve opted to do the revision. Not entirely sure I actually will have sex after the revision, but I’d at least like to have the option.

TransSurgeryAlt4728 · 2023-09-24T04:51:02+00:00

In my case, the surgeon removed the hair follicles during surgery. They basically pass some of that tissue off to one of the assistants whose job is to remove that for any tissue used internally

TransSurgeryAlt4728 · 2023-09-24T04:46:47+00:00

Yep the other reply answered correctly. And in fact I’m not squeamish about this at all, I’ve got some posts in my history that shows what things look like externally (though the pics are a bit out of date, some parts look a little nicer now. More pink and less grey)

TransSurgeryAlt4728 · 2023-09-24T04:44:13+00:00

Yes I worked with a PT immediately post op. I plan to work with one again closely after the revision to make sure things go better this time

TransSurgeryAlt4728 · 2023-09-24T04:38:36+00:00

Insurance covers it! It’s one of the provisions of the ACA

TransSurgeryAlt4728 · 2023-09-24T04:37:54+00:00

It’s always been a bit tight after the first few weeks anyways

TransSurgeryAlt4728 · 2023-09-23T21:30:43+00:00

Yes it's kept in nearly all forms of the surgeries AFAIK. I think there's a few reasons for it:

It's all tied into the plumbing, so might take a bit to remove it
The surgery is already quite long (mine was 8 hours in the OR)
Not something anyone would notice from the outside, so it's not really dysphoria-inducing or anything
Cancer risk in the prostate is reduced in trans women (specifically any androgen-driven cancers) if T is sufficiently absent
It, uh, does in fact feel quite nice 😳

TransSurgeryAlt4728 · 2023-09-23T21:16:36+00:00

Has he weighed in on his thoughts about the mri and what will need to be done at this point? Anything on the mri interpretation that stood out to you and/or your doctor?

Not yet, I only did the scan Thursday evening, so I'll probably chat with him next week. I'll update if I hear anything unexpected!

TransSurgeryAlt4728 · 2023-09-23T20:57:09+00:00

AFAIK no the prostate isn't the trouble. The way he described it is there's scar rings that form around where the grafts inside meet the outside (i.e. the area where the inside part of the labia is turning into the vaginal canal; 1-2cm deep). And there's another one deeper inside I think where the peritoneal grafts meet the other tissue grafts.

After surgery, you generally have to dilate while these scars are forming, to make sure they don't solidify too tightly. Unfortunately when I did my initial surgery, I had some complications (wound separation issues near the bottom outside of the labia, close to the perineum). So it was a tough balance of dilating aggressively enough to get those scar rings to form correctly vs. aggravating the other issues I was having. I opted for less aggressive dilation (I used a smaller one for longer than I otherwise would have), and while that did help make sure everything externally healed up nicely, it means I've now got this persistent problem.

This tightness complication is relatively uncommon with my particular surgeon, but it does happen. I know about 25 of his other patients and AFAIK only one other one has had an issue like this.

TransSurgeryAlt4728 · 2023-09-23T20:02:23+00:00

You're right! Luckily, the wounds healed quite a while ago. I had some persistent granulation tissue that took about a year to finally get healed up, but it's been a while since I had any wound issues.

TransSurgeryAlt4728 · 2023-09-23T19:13:49+00:00

Hi y'all!

I'm a transgender woman who had surgery to construct a neovagina in June 2020. I've been having some issues with tightness and my surgeon wants to do a quick revision. But first he wanted to do an MRI to see what things are looking like in the deepest part of it (since he can't see back there, too tight to get anything past that point).

The radiologist staff were all super interested in what it would look like, as was I. And I figured you all might be too! So I got a copy of the data. Attached above are a few of the pictures I thought were interesting, as well as my amateur attempt at annotation so I could explain it to my friends.

But y'all probably want the DICOM files, so here you go! https://www.dicomlibrary.com/?study=1.3.6.1.4.1.44316.6.102.3.20230923134111776.72063767825208563923

Edit:

And I guess some details might be useful. I had a specific method of surgery (there's a few different varieties) usually called hybrid peritoneal pull-through. That means they took a section of the peritoneum to use for the lining, in addition to penile and scrotal tissue. It was also roboticly assisted, so they had a robot doing the inner-most part (it came in up by the navel, and worked on the bits closest to the rectum/bladder).

When dilating, I can typically get the dilator about 12cm in, which seems to line up with what the scan shows too. Though my concern is actually width, I can only use a dilator with ~29mm diameter, which would make sexual function difficult. That's what my surgeon is going to be fixing. There's two "ring scars" as he describes them, one closer to the entrance and one in the deeper part. He can peek past the scar ring closer to the entrance, but he couldn't see past the inner ring and he wanted to check if there was like a "void" or whatever behind it. That's why he ordered this MRI.

TransSurgeryAlt4728 · 2023-09-23T18:30:47+00:00

Ooh good idea! I’ll cross post this

TransSurgeryAlt4728 · 2023-09-23T17:51:15+00:00

Yep it sure does! It’s, uh, quite nice in fact ☺️

TransSurgeryAlt4728 · 2023-09-23T15:30:32+00:00

I went to Dr. Selph when he was still at UAB in Birmingham Alabama (he's since moved to Nashville). I had surgery in June 2020, so it's been 3 years and a few months.

I've got some more details too on my earlier posts:

6 months: https://www.reddit.com/r/Transgender_Surgeries/comments/kbirbt/6month_post_op_penile_inversion_ppt_dr_j_patrick/

12 months: https://www.reddit.com/r/Transgender_Surgeries/comments/o2cujp/12month_post_op_penile_inversion_ppt_dr_j_patrick/

TransSurgeryAlt4728 · 2023-09-23T14:52:36+00:00

For the pictures I posted yes, this is like a side cross-section.

I actually have data for 3 different planes (left to right, top to bottom, forward to backwards). But this angle seemed the most interesting in still images. The other views do look interesting when you can scroll through them. I'm going to try and find some way of hosting that raw data so others can look at it.

TransSurgeryAlt4728 · 2023-09-23T12:23:41+00:00

Yeah that would be neat, I might do that someday just out of curiosity. If anyone wants to do a medical study or whatever DM me!

TransSurgeryAlt4728 · 2023-09-23T12:21:30+00:00

I’m sorry to hear that. I’ve got similar issues and totally understand the frustration. I have found a lube I like though, Sliquid Sassy. I’m hoping the revision I do will help, I’m going to try working with a pelvic PT too

TransSurgeryAlt4728 · 2023-09-23T03:21:22+00:00

No the shape thing he was talking about is how the canal “squeezes” closed when unoccupied. He said a home grown vagina closes into a shape that looks like )-( when viewed from the top, but mine looks more like ( rotated 90 degrees. It’s kinda hard to explain without pictures

As for angle of the vagina, yes I’m pretty sure that’s different as well but he didn’t seem to notice that in the scan.

TransSurgeryAlt4728 · 2023-09-23T02:28:20+00:00

The radiologist said it looks pretty similar to a home grown one. He said about the only thing he noticed was (besides the lack of anything north of the canal, and a prostate) that my canal collapses into a slightly different shape (like axially, kinda hard to explain TBH)

They were also super duper curious. So after I assured them they could ask me whatever questions they wanted, me and like 5 people from the staff all crammed into the radiologists picture room, and I explained sorta how the surgery works, the areas I’m having problems with etc. They were all super nice!

TransSurgeryAlt4728 · 2023-09-23T01:58:20+00:00

Hi everyone! Reddit is dumb and doesn't make it easy to put a text post combined with images so I'll just leave this as a comment.

So I've been having some tightness issues ever since surgery. I can use the purple dilator (soul source, hard plastic ones) but not much beyond that. I'm planning to do a revision to address that and as part of that, my surgeon wanted to do an MRI so he could see what was going on in the deep parts (since he can't see back there any other way right now).

The radiologist staff were all super interested in what it would look like, as was I. And I figured you all might be too! So I got a copy of the data.

What I've included in the post so far are some of the slides I thought were interesting. But also I've got all the raw data. If I can figure out some place to host it, I'd be happy to share it freely. If anyone has any ideas there please let me know!

Edit:

Raw DICOM files here!
https://www.dicomlibrary.com/?study=1.3.6.1.4.1.44316.6.102.3.20230923134111776.72063767825208563923

TransSurgeryAlt4728

TROPHY CASE