My main source of anxiety was that something would mean that surgery wouldn't happen - so being in the hospital waiting was actually kind of relaxing, like - okay, now very little can go wrong, it's okay. Plus I had my fiancée there to look after me and keep me grounded.

In terms of special things, the one thing that I almost forgot about was the chlorhexidine wash. Getting hold of that late at night in NYC was less hard than I thought, but don't run the risk of forgetting!

Regarding pain, there are a number of hard things about being in the hospital postop and my pain levels now are pretty low. I don't really remember what it was like before, and for me it is very much like I put something down and didn't pick it back up again. I bet the full weight of it will hit later, though. I'm so profoundly glad I went with her, and the postop support and dilation education is second to none.

Omg having SRS with local anesthetic sounds like a nightmare!! I’ve only ever heard of that with (I think) Brassard?

1. General!

2. Yes, but not so much. The surgical pain is low and is pretty manageable with Tylenol and ibuprofen. The worst pain is the gas pain - so they use a robot, and use gas to give the robot visibility. It's not like laparoscopic surgery because they're able to remove most of it, but I did have some remain that gave me nausea and made me pretty uncomfortable. It goes away by the third day though. The overall hardest part was the pretty consistent stream of people through your room! It made it difficult for me to sleep solidly - but I had an orchi a year ago and so, I was hot flashing a lot which didn't help. On the plus side, everyone without fail was so kind, and the facilities are outstanding . My (private!) room was better than many apartments I've lived in. It had a fold out couch that one person can sleep on - it made it infinitely better having my fiancée with me 💖

3. UHC, out of pocket max $1250, it was all of that. I paid for it via my FSA account.

4. My consult was on October 2018, without letters, so I waited 16 months from consult to date.

5. You're in the hospital 6 days from admission to discharge, 5 nights. They want you within an hour's drive until after your second weekly postop, so if you don't live in NYC, expect to be there for just under 3 weeks total.

General.

Afterwards but you’re kept up with Tylenol and ibuprofen and that’s really all you need after the first day or so. But they will give you stronger if you need it.

I had Cigna. And 100 bucks.

October 2017. July 2018. But rescheduled to July 2019.

1 week.

💙!

She uses penile and scrotal skin grafts to construct the canal and attaches it to a flap of peritoneal tissue, forming a longer canal with a 'cap' of peritoneal tissue - helps extend the length of the canal and gives you some of the benefits of including that kind of tissue.

SRS-PPV Penile Peritoneal Vaginoplasty : Penile Peritoneal Vaginoplasty (SRS-PPV) is the newest and most advanced SRS technique for Gender confirmation / Sexual reassignment surgery and Kamol hospital is one of the few hospitals in the world performing it. Peritoneal tissue is tissue that lines the abdomen. It is the most vagina like of all body tissues. It self lubricates in the same way as a cisgender vagina, it’s elastic, it doesn't need a lifetime of dilation, It has the least pain of any SRS technique and has the quickest recovery time and also the least risks. It is by far the most advanced technique with many advantages over other techniques. The procedure uses a small amount of penile inversion combined with a peritoneum pull through technique to create the neovaginal canal. Using a peritoneal pull through to create the vaginal canal is not in fact new, it’s just new for transgender women. This technique has been used in cisgender girls for over 60 years. Known as the Davydov technique it is the only treatment for girls born without a vaginal canal. Known as “MRKH Syndrome” this congenital defect affects a huge one in 4500 girls. Peritoneal tissue is the only tissue used to make a vagina canal to connect the vulva to the womb of girls with MRKH. After 9 month in cis girls this peritoneal tissue is indistinguishable from vaginal tissue under a microscope. A Note "This technique has been used in cisgender girls for over 60 years." And that have been done in Europe and USA j ust as long... so why is the ppv Options so limited for USA and EU ??. In this technique the outer labia and visible vagina is made using penile and scrotal skin whilst the inner vaginal canal is made using the peritoneal. SRS-PPV is less like having a neovagina and more like having a natal biological vagina. It behaves the same way and no other technique comes close to the function of a biological vagina . This technique is not only the most advanced method for a realistic, functional vagina but it is also extremely good revision surgery for patients who have previously undergone sex reassignment surgery and who are unhappy with the result or who simply want a more functional realistic, elastic, self lubricating vagina with significant advantages over other methods.

Advantages of Penile Peritoneal Vaginoplasty SRS-PPV:

● The vagina has a self-natural lubricant with no unpleasant odour.

● The vagina is elastic and stretches like a biological vagina

● Less chance of vaginal prolapse and shrinkage compared to all other types of SRS..

● Vagina is elastic and does not require dilation after a year unlike all other techniques.

● Natural lubrication is extremely similar to vaginal lubrication unlike sigmoid colon which often has an unpleasant odour.

● Recovery is significantly quicker than both penile inversion and colon vaginoplasty.

● Significantly fewer risks of intestinal issues compared to the sigmoid colon vaginoplasty.

● No visible scars on the vagina itself (it looks completely natural) and due to laparoscopic (keyhole) technique there are only 4 tiny, virtually undetectable scars from the keyhole surgery- (They look like small freckles and fade after 12 months to be more or less invisible)

● Significantly less painful than other techniques.

● Most similar functionality to a biological vagina.

● Peritoneal pull through (davydov technique) has been performed on cisgender girls for over 60 years and is well understood.

Disadvantages and limitations Penile Peritoneal Vaginoplasty SRS-PPV:

● The patient may experience dyspepsia / indigestion symptoms 2-3 days after the surgery.

● This technique is not suitable for those who are overweight or have fatty abdomens as the laparoscopic (keyhole surgery) can’t reach the correct parts.

The SRS- PPV Technique Requires:

● Hospitalization: 7 nights

● Duration time of surgery: 6 hours

● We recommend you to stay in Thailand for recovery for 3-4 weeks. We have our own hotel next to the hospital where you can recover.

Yes, and not at all to my knowledge.

1. Definitely being nauseated and bloated and hot-flashing and emotionally overwhelmed and physically exhausted all at the same time, running on snatches of sleep (ya pun intended). The second night was hard to get through. On the other hand, the packing removal felt weird for me, not unlike the cath removal, until the end where it Hurt but then it was over. They gave me a 5mg oxy an hour before at my request and were happy to do that, so, you can definitely take the edge off. It various from person to person.

2. I had about 12 hours of electro and was completely clear on the shaft and maybe 80% clear on the scrotal tissue. You don't need to be totally clear but, it helps. She does follicular scraping and had no issue with my level of removal - don't panic if you don't get it all but do do what you can, just stop a month before your date.

3. I saw RBL before I went in, after I came out, and a couple times during my stay. She is no-nonsense and not, like... cuddly , but she is super nice and I really liked her manner. She was happy to spend time answering my questions and was consistently friendly and pleasant. My confidence was high because I had seen some photos (via Reddit) of her results and they were great, plus a number of friends had been through her and had rave reviews, plus I read her paper about her method ( https://www.ncbi.nlm.nih.gov/m/pubmed/30707129/ ) I picked her over Ting because I wanted her method and my friends who had been with her said great things.

4. Stopped E and prog 4 weeks before, no wiggle room, she wants you off spiro one week before, same.

5. Yes*, but she doesn't put them online or transmit them over the internet for privacy purposes, and you have to ask to see them unless you attend in person one of their vaginoplasty classes. Honestly, their support system is one of the best things about their program.

6. Thank you so much <3

Outstanding questions! Just what all us inquiring minds want to know, thank you!

Thanks, I'm thrilled, she was so awesome and the new hospital is amazing .

My life is now dilation, bathroom breaks, food and netflix 😅 but more interestingly, my more general dysphoria has lessened. Like, my facial dysphoria has gone down and I like my body more holistically now.

Hi! Sorry for the delay in answering, things have been hectic here. Here are all the answers but from a pre-COVID perspective, so, this information may not be relevant anymore.

1. So, they keep you in the hospital 5 nights/6 days before discharging you, and you need to stay within an hour of the hospital until they clear you for travel, which usually happens at your second follow-up. This worked out for me to two weeks following discharge, so assume you'll be in the city for two weeks after. They gave me a list of places but I found my own, a long-stay hotel. Having access to both towel service and a microwave/hot plate/room service really helped. Try to have someone travel with you if possible - they can sleep in the hospital with you, and it really helps with being in the hotel after.

2. My insurance didn't cover it. I went to a large volume place with a lot of experience with trans women - it was about $500 per session in total, including numbing shots, and I did five 3ish hour sessions, that was apparently just fine.

3. I usually communicated via MyChart, their app - calling the office for scheduling was fine, nothing unusual to report, and they did all the communication with my insurance so I didn't have to. Everyone I interacted with has been really, really good.

1. Her office handled all the insurance wrangling, all I had to do was get her office my letters and then wait. I never once had to call my insurance company but YMMV.

2. Sucked! It was hard especially in conjunction with my menopausal sensations too. It only last a few days though.