Long term Neo-vagina care and douching

50
u/Icy-Yogurt-Leah
Mon Mar 13 20:55:51 2023 UTC
(46 comments)

I had penile inversion vaginoplasty 16 months ago and not happy with it at all. I was not told at any point pre-op that i would need to douche it for the rest of my life or it would smell disgusting.

I was prepared for the dilation part and while painful and just plain boring now i can just about put up with it.

My problem is douching, it is a lot more to ask compared to just sticking a dilator in once a week. Now i have been told to do it several times a month with betadine ? The original surgeon didn't mention it at all and it is not on my paperwork like the requirement to dilate.

What are your experiences? Were you told this pre-op ? Do you do it ? Does yours smell ok if you are not douching ?

all 46 comments


29
u/calloutfolly
Mon Mar 13 21:43:48 2023 UTC
(6 children)

I think they're unsure of best practices. It's not clear what is most safe or effective. Douching too much or with the wrong solution might mess up your microbiome and raise your risk of health problems.

"Frequently the use of a vaginal douche after dilation is recommended with varied solutions including water, soap, vinegar, or povidone iodine solutions (Goddard et al., 2007; Deutsch, 2016; Pan et al., 2019). Douching and the use of soaps or lubricants can promote molecular BV in the EDV of cF, but their effects on the neovaginal microbiota are unknown. Regular use of hygienic products and even boric acid [to lower the pH, promote colonization with Lactobacillus, and treat vaginal yeast infection (Donders et al., 2010; Iavazzo et al., 2011)] are also frequently reported, however, such efforts would be in vain, and potentially disruptive, if the optimal neovaginal microbiome is found to be dominated by Corynebacterium (penile skin-lined) or Bacteroidaceae (sigmoid-lined)."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814107/

15
Tue Mar 14 00:37:35 2023 UTC
(1 child)

Lol... that is quite an explanation you have there flying 10m over my head. That article is a review of studies, and it's as close to unreadable in layman's terms as I've forced myself to read in a while. Unfortunately, in its desire to cover the gamut of surgery techniques and FtM non-surgery, its main conclusions are > --We don't know much about the actual microbioms of mtf and ftm vaginas, so we're speculating based on other people's data

The absence of data isn't surprising, given the many different types of surgery available and the difficulty in collecting this type of information. But what struck me is how far off the intent of the article feels compared to my own experience after 6 years. I'm just referring to the microbiom issue here. Overall, my PIV surgery was the worst experience I've ever faced, but not because of anything related to this.

I've never douched with anything other than water or had a UTI. I dilate once every 3-4 weeks while maintaining the same depth. Once I got all the problems revised, I stopped worrying about it. More importantly, I've never discovered any foul smell emanating from my vagina. --That I know of!

The only thing I use for dilation or lube is virgin unrefined coconut oil.

7
Tue Mar 14 09:48:42 2023 UTC
(0 children)

It's good to see someone down on my level once in awhile. 10m over my head.< Lmfao. 😆 🤣

5
OP
Mon Mar 13 22:07:25 2023 UTC
(3 children)

Thank you for your reply.

I have spent over a year researching this and my conclusion seems to be the same that you have written ?...

Diluted Hibiscrub / clorohexadine does get rid of the smell for about a week. Im guessing Betadine will be the same. Killing everything up there.

Just wish i had been told beforehand that i would need to do this.

I'm not sexually active penetration wise as I'm lesbian but it's horrible that i have to do this. Basically disinfect the skin tube.

I have to live with permanent BV and just put up with it treating it forever :/

14
Tue Mar 14 01:04:28 2023 UTC
*
(2 children)

Disrupting the microbiome is going to keep you in a vicious cycle. We know douching in natal vaginas is disruptive and can cause dysbiosis (i.e., BV), and it's highly likely the same in any neovagina, especially when you're using antiseptics like CHG or betadine that add a dash of broad-spectrum disruption.

With you being well healed, I encourage you to get off the sterile lubricant and try lower pH lubricants, preferably something with lactic acid, and try to apply probiotics intravaginally. This isn't a once and done thing, so keep at it. The goal should be to get to a state where you don't need to douche to "fix" something.

Additionally, while we don't have evidence that lactic acid bacteria can self-support in neovaginas (and it's probably least likely in PI in particular), you should be able to get to a neutral state by discouraging the stability of baddies through your habits, which LAB can do through their antimicrobial compounds (like lactic acid), even when they're dead.

This is much less nuclear than CHG and betadine, and LAB and their compounds select for good microbes who can also survive in their preferred environment.

I don't have any specific recommendations for which probiotics to try, but all typical OTC choices should be safe. Some are mentioned on this subreddit. Just avoid unnecessary (and potentially disruptive) additives like oils, fragrances, homeopathy, glycerin, etc.

1
Mon May 15 15:50:26 2023 UTC
(1 child)

Do you have the name of a internal probiotic that I could purchase and a lube with lactic acid that I could purchase ?

4
Tue May 16 20:00:21 2023 UTC
*
(0 children)

There are no clinically validated recommendations. There is an active clinical trial in PI neovaginas with Good Clean Love's products, but we don't know if the natal vagina-sourced strains in their probiotic are appropriate for the keratinized epithelium that makes the PI neovaginal canal.

Lactobacillus species (and specific strains) that have high avidity for the neovaginal epithelium and/or mucins (in the case of mucosal neovaginas) are in general likely to be more effective, depending on the specific morphology. They are not specialists for non-mucosal tissues, however.

For example:

  • L. rhamnosus GG can bind to intestinal tract epithelial cells in a petri dish, but in reality it appears to be a temporary resident.
  • L. reuteri RC-14 and L. rhamnosus GR-1 are a pair with high avidity for the natal genitourinary tract and can protect against UTIs and BV in natal vaginas. They are likely effective on the limited urethral tissue (a mucosal epithelium) that makes up the neovulva and urinary tract in postop anatomy.
12
u/mspv3xtreme
Tue Mar 14 07:09:43 2023 UTC
(0 children)

Yea…….if you got penile inversion yur gonna need to douche. The other methods dont really have to……mainly peritoneal. You can get infection if you dont douche regular cuz things will grt trapped in there

10
u/JanelleMTX
Tue Mar 14 02:37:21 2023 UTC
(0 children)

Try just douching with warm water. Nothing in it.

Also, maybe look for a non bacteriostatic lube, and make sure to wash your dilator throughly after each use.

https://health.clevelandclinic.org/feminine-odor-problems-what-you-should-know-about-douching/

9
u/Princess_Kushana
Tue Mar 14 10:02:38 2023 UTC
(0 children)

I had suporn method and stopped douching after about 3 months? It took a few weeks forit to settle, but after that I've never douched and never had smells.

6
u/Own-Dragonfruit-6164
Tue Mar 14 00:56:07 2023 UTC
(1 child)

My paperwork says to douche everyday but fuck that noise. I usually just douche after my dilations (2-3 times / week)

3
Sun Apr 9 06:52:42 2023 UTC
(0 children)

Its up to you ofc ... here might be some resources that could help you too.

hugs

u/[deleted]
Tue Mar 14 19:04:36 2023 UTC
(4 children)

[deleted]

3
OP
Mon Apr 17 18:46:15 2023 UTC
(3 children)

I see that yours was done using peritoneal tissue. Mine was a penile inversion and I can honestly say the worst mistake of my life.

Mon Apr 17 19:02:33 2023 UTC
(1 child)

[deleted]

1
OP
Mon Apr 17 19:47:31 2023 UTC
(0 children)

Whatever it is its obviously significantly better than mine.

6
u/Megan-Knees
Mon Mar 20 06:37:16 2023 UTC
(3 children)

You definitely should not douche constantly at all. I am a cis female and douching causes yeast infections, bv and can throw the ph off really really bad. Anything promoted for vaginas down there should not be used. I understand it’s probably different than being born with a vagina (sorry if that is offensive not my intention) but what I do know is that douching, bubble baths, soap down there, anything scented, not good for the vagina.. it can really cause major problems in cis women and can definitely do the same for a trans woman.

10
Wed Mar 22 09:16:42 2023 UTC
(1 child)

We started to say natal vaginas and neovaginas, so we clarify delicate topics while being polite to everyone.

9
OP
Mon Apr 24 18:27:53 2023 UTC
(0 children)

The problem with this is that my girlfriend has never used a douche, she had never needed to either.

I just want to enjoy what I have without it smelling like something crawled up there and died.

The surgeons office has told me to use betadine now. That's not what I want to do or have to do for the rest of my life. Why the hell didn't I get told all this crap before I had it done.

2
u/bigthurb
Tue Mar 14 10:00:33 2023 UTC
(2 children)

I haven't reached my goals or as far as you have made in transition but I'm working on it. Now you got me curious 🤔 When you say smell can you narrow that down a little? Is it in the smell zone of a cis women and trust me I've smelled some rough one's I'm talking dry heave. Stop the party I can't do this all while there asking what's wrong 😕 Let me think🤔 what's wrong is apparently you've got a plugged up nose . No seriously a coochy infection is about king of stitch and this would be my luck to be honest with you but as long as it is hovering somewhere around cis stinch and not something new or beyond I'm still good and will deal with it .

4
OP
Wed Mar 15 01:19:06 2023 UTC
(0 children)

Like something crawled up there and died.

1
Sun Apr 9 06:54:14 2023 UTC
(0 children)

goals

Here may be more concerning surgeries.

And here might be some resources that could help you too.

hugs

2
u/Unecessary-Pen
Tue Mar 14 11:53:13 2023 UTC
(1 child)

My instructions were once or twice a week for the first 3 months, then as needed when there is an abnormal message of discharge or it smells. They said don't over do it cause the body will form its own microbiome over time.

1
Sat Nov 11 10:32:56 2023 UTC
(0 children)

So you don't have to forver douche with PIV method?

2
u/Main_Turnover_7061
Tue Mar 14 18:32:39 2023 UTC
(0 children)

There isn’t one “correct” study on how to douche unfortunately :/ Usually douching 1-2x a week with warm water and gentle soap is okay… have you gotten antibiotics for the BV? Maybe if you do the antibiotics (while douching 1-2x per week), the biome will become neutralized and won’t smell with normal upkeep!

2
u/DNLLA
Sat Mar 18 02:16:42 2023 UTC
(0 children)

I have a peritoneal inversion. a few rounds with half vinegar half water about 2x a month, never have any issues. nbd. if you notice any smell just do that.

2
u/writingprobably
Sat Mar 18 03:22:49 2023 UTC
(0 children)

I have colon graft, not PI, but I do not have to douche often, and only do so with water, usually a day before I expect to have an extended sexual encounter, or right after using a bunch of lube for penetration. My biome and smell stay good with eating an occasional cup of yoghurt, and using a boric acid suppository every two weeks or so before bed.

5
u/Kuutamokissa
Tue Mar 14 03:40:47 2023 UTC
(5 children)

I had peritoneal pull-through (non-hybrid) and was told to not douche, as I'm self-cleaning. Smell is not a problem.

I was told that before surgery, and again on discharge.

1
Mon Oct 9 00:12:57 2023 UTC
(3 children)

How’s your depth so far? Are you satisfied?

1
Mon Oct 9 01:05:44 2023 UTC
(2 children)

After some months'hiatus after breaking up with BF I'm down to a little less than 6" from the original 7". After starting to dilate again, I seem be gaining it back slowly.

I self-lubricate enough to both have sex sex and dilate on my own.

And yes... I'm satisfied. I do seem to have a bit of superfluous erectile tissue left on one side, though, and may ask for that to be removed when I'll get some cosmetic tweaks.

2
Mon Oct 9 01:09:16 2023 UTC
(1 child)

How was the recovery? Was it difficult?

2
Mon Oct 9 01:20:11 2023 UTC
(0 children)

I would not say it was difficult, although it did take longer than originally told by the doctors. I could have started sedentary work in maybe six week to two months, and was able to do some moderate physical work in three months.

However, I was recommended to take it easy for six, and to recommence all-out physical effort only after one year. So I did... and am glad I did.

The swelling took about a year to subside pretty much completely. I also did not ride a bicycle for a year, and I can tell my sensation is still improving even two years after surgery.

3
u/Laura_Sandra
Sun Apr 9 06:50:23 2023 UTC
(2 children)

A number of surgeons recommend to try to install a natural flora, and to phase out douching eventually after all is healed. It may disturb the buildup of a natural flora, more was here and also here and here .

And concerning a BV here was a discussion.

I´d say talk it through with your med persons in case.

And for local aftercare some people ask at lgbt places or support groups for med people who are experienced with trans people. And here was also a discussion.

hugs

2
OP
Sun Apr 9 08:59:39 2023 UTC
(1 child)

I spent several months doing this even to the extent of measuring the ph. It still smells awful, is dry and the skin pulls painfully no matter that lubricant I use.

I´d say talk it through with your med persons in case.... you are joking right? They just say douche it without any guidance on how often or with what. They are completely useless and more interested in covering their own arse than they are helping me.

5
Sun Apr 9 09:23:40 2023 UTC
(0 children)

It may be necessary to get rid of infections first.

Here might be an overview.

And as said concerning a BV here may be more.

And here may be more concerning an UTI.

Otherwise a number of surgeons recommend to eat unsweetened organic yoghurt regularly to help repopulate the digestive tract and also a neovagina after antibiotics. And some people use probiotic pessaries like Intrafresh etc.

And concerning dilation some people use organic coconut oil. It has small molecules and may penetrate deep into the tissue, and may also make for a softening effect. It is necessary to use non latex condoms in case because oil dissolves latex.

And as said looking for local aftercare may be a good idea. It may be an idea to ask at local lgbt places and support groups. A number of people found some supportive med people, and some also were experienced with trans people, and could give hints.

1
u/[deleted]
Mon Mar 13 22:56:19 2023 UTC
(2 children)

No shade but my pussy don’t stink and I rarely douche. I can see you having to douche if you f’ing and the dilating … and you probably have to spread your lips and wipe the creases. It’s not a lot love bug. It stunk in the beginning but forever girl ? No

8
OP
Mon Mar 13 23:07:43 2023 UTC
(0 children)

The only thing that has been up mine is dilators and sterile lube. 16 months of it.

The rest of me smells awesone lol

1
Sat Nov 11 10:31:21 2023 UTC
(0 children)

Did you have PIV method?

1
u/enihilator
Tue Mar 14 07:09:37 2023 UTC
(0 children)

I had my surgery 3 years ago. douche like once every two weeks with summers eve soap for the vaginal area and I havent had any problems. Ive had some smell but it clears right up after douching which takes less than 2 mins in the shower. Hell you dont even have to dilate anymore, just get a vibrator of comparable size and you can do that 1-3 times a week and have fun

u/[deleted]
Tue Mar 14 08:14:40 2023 UTC
(1 child)

[deleted]

1
Tue Mar 14 11:24:13 2023 UTC
(0 children)

My instructions were similar.

1
u/NewBits2022
Tue Mar 14 11:22:23 2023 UTC
(1 child)

I still douche after every dilation. About to go down to dilating every other day so will reduce my douching to that as well and see how it goes. I just use warm tap water. I wash/rinse the douche spout with antibac soap before, and always clean afterwards with femfresh zero soap and the showerhead.

If I do get a smell then it's from the clitoral area rather than from inside.

1
Sun Apr 9 06:55:21 2023 UTC
(0 children)

reduce

Its up to you ofc ... here might be some resources that could help you too.

hugs

1
u/Glass_Accountant2189
Tue Mar 14 11:47:03 2023 UTC
(2 children)

Who was your surgeon?

1
Wed Mar 15 11:41:57 2023 UTC
(0 children)

Bellringer United Kingdom

1
u/[deleted]
Fri Apr 7 21:57:20 2023 UTC
(1 child)

I saw u can’t climax. R u on antidepressants still? cause I took one antidepressant last week by accident again and I couldn’t climax for 2 weeks till it left my system fully. And I still have my penis. It’s impossible for most of us to climax on those things. U have to get off 100% fully if u want to climax ever again. It’s just a fact.

1
OP
Sat Apr 8 16:23:13 2023 UTC
(0 children)

Sorry trying to understand what you wrote.... You took an antidepressant a week ago and it took you two weeks to be able to orgasm again ? Can I borrow your time machine please lol