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12 month post-op penile preservation vaginoplasty
Since it's been a little while, as a reminder I had penile preservation vaginoplasty (peritoneal pull-through) with Dr Wittenberg in December 2021. You can read a little more about it in my first post , which also links to all my other posts.
Previous post , six months post-op.
I just had my 12 month post-op appointment with Dr Wittenberg this week, so I figured it was a good time for an update.
Since last time, I had my vesicovaginal fistula (hole between bladder and vagina) diagnosed by Dr Purohit and then fixed surgically by Dr Charles Ascher-Walsh of Mount Sinai's OB/GYN department in September. I did not go with Dr Purohit to fix the fistula because 1) he could not schedule me until January, but mainly 2) because he was excessively pessimistic about the possible surgical outcomes (he said "I'm not sure how to fix it without ruining your vagina," and suggested having a whole new vagina made by sigmoid colon method). Honestly, this was an entirely avoidable emotional rollercoaster, and if you have similar issues I would suggest going to a urogynecological surgeon first over a urological surgeon who also does vaginoplasties.
I'm about three months post-op from the fistula repair now, and mostly healed. I still have a lot of sensitivity/soreness when dilating along my urethra (front wall of the vagina), but Dr Wittenberg says that is not surprising given the time since surgery, the catheter, etc...lots of stuff to recover from. I should stick to the blue dilator for now because last time I tried green, I had some bleeding and irritation that felt like a UTI (which is now mostly healed). A few weeks ago I also had an actual UTI, but I don't think it was from the repaired fistula, and I don't expect it to recur.
Overall, I'm very satisfied. My vagina has a good depth, is wet, and is well on its way to being healed. All the sensation in my scrotum and penis shaft has returned (as of about 9 months post-op). The scar tissue around the entrance is starting to soften, and Dr Wittenberg had no concerns. I'm excited for it to heal more, though, so I can test it out (and also size up the dilators more).
I asked her about her thoughts on labiaplasty and she played around a bit with what tissue could go where, but ultimately said I should see what Dr Avanessian says (I told her I'm going to try to get Dr Bella Avanessian to do the labiaplasty). She's interested to see Dr Avanessian's notes so she can improve her own (external) technique too! And post-op pictures when I have them.
Lastly, she said everyone in the office enjoys my email updates and to keep sending them! And gave me a hug before I left. I think I'm her favorite patient 😅
Next post , three years post-op.
I’m so glad your fistula surgery was successful! 😁
Any updates you want to share on the micro biome down there? I’m in the process for this same surgery and I’ve been wondering a lot about how the smell/etc. might be and what I might expect in terms of long-term care down there.
I really appreciate your updates. You’ve given me confidence to pursue the body I’ve always felt I’ve had.
Thank you! It's wonderful to hear from all the people I have helped with my posts :D
Any updates you want to share on the micro biome down there?
I tried to seed a microbiome by taking regular oral probiotics for months, but prior to the fistula surgery it was getting washed out by urine all the time, then in September I had the fistula surgery and had to go on antibiotics while I had the catheter in, and then a few weeks ago I got a UTI and had to go on antibiotics again....so I'm not sure exactly how successful I have been at seeding a microbiome. I'm also still douching a couple times a week, so not much time for any kind of bad smell to build up. So most of the time it smells pretty neutral, although it does have a distinctive odor that is different from how a natal vagina smells. It also isn't acidic yet (just checked now). I'll spend more time trying to seed it though and try to include this in my next update.
Were you instructed to douche it? If so, why? I've only ever heard doctors strongly discourage douching (at least on natal vaginas)
Neovaginas are not as self-cleaning as natal vaginas, so sometimes they need some help. I was encouraged to douche by my surgeon at decreasing frequency as long as it doesn't start smelling bad.
Do you mind discussing this with me? We all DM each other 🙃
Yeah go ahead
Hi, Im thinking of getting a similar surgery and had two quick questions if you dont mind
1). Pleasure. My taint is by far the most sensitive part and i dont want to lose that. Are you sensitive in the new vagina?
2) Erections. Are these still possible without the testicles?
Hi! I haven't had this surgery (yet!) but i've had an orchiectomy 16 months ago and can thus confirm that erections are VERY possible without testicles.
Althoug, if they're possible after PPT, that's a question i'd love to know the answer to !
Wow, what I have dreamed of. Thank you for sharing.
This post gives me hope for my own future.
Thank you so much for all these updates, I am looking into bottom surgery, but I was terrified of it, but now I feel like it is still relly scary but I know more about it and plan on talking to loved ones about it. Thank you so much!
Good luck 💕
Since last time, I had my vesicovaginal fistula (hole between bladder and vagina) diagnosed by Dr Purohit and then fixed surgically by Dr Charles Ascher-Walsh of Mount Sinai's OB/GYN department in September. I did not go with Dr Purohit to fix the fistula because 1) he could not schedule me until January, but mainly 2) because he was excessively pessimistic about the possible surgical outcomes (he said "I'm not sure how to fix it without ruining your vagina," and suggested having a whole new vagina made by sigmoid colon method).
Thanks for much for sharing your experience! I am considering Wittenberg for SRS and was wondering if you went to Dr. Dr. Ascher-Walsh to have the fistula fixed because Wittenberg was unwilling or unable to fix it?
I read all of your posts and it sounded like you were speaking generally favorably about Dr. Wittenberg so it would be great to know if she let you down in the end or if the selection of the other surgeon was based on location or other factors.
Thanks again!
She would have fixed it, but the wait would have been really long because she's booked for a long time. Also Dr. Ascher-Walsh was local to me.
She would have fixed it, but the wait would have been really long because she's booked for a long time. Also Dr. Ascher-Walsh was local to me.
Got it, thanks for sharing!
I will probably cross post there
....if the mods allow me to....
Seeing that this surgery was possible was what made me start questioning my gender years ago. This is the kind of surgery I'm hoping to get eventually, I'm really appreciate your still posting your progress, there is no other place to get info of the time following the surgery. I would love to ask you some personal questions.
Thanks, I'm glad you got something out of my posts! Best of luck making this happen for you 💕
Oh also feel free to DM me or ask me any questions here
Yeah, it's remarkably hard to even find first hand binary transition stories, let alone ones like this. I'm currently only 10 months on hrt-e with plans to start getting hair removal done soon. I'm likely gonna go with a traditional vaginoplasty, but I do identify as salmacian.
Best of luck, whichever you choose!
This field is changing FAST. If you feel like a traditional vaginoplasty would be settling, then do research and hold out! If you feel like it's what would be best for you, then I wish you all the best luck :)
Edit: have you found the discord yet?
What discord?
There's a Salmacian discord server
The server has likely evolved a lot in the past year or two. However long it has been. I used to be a part of that server but was attacked for calling myself a herm to the point I was crying. I never insulted anyone, but my identity before I was comfortable using the term salmacian was attacked there and the mods never did anything to the ones who attacked me so I told them how I felt and left.
Want an invite to the discord?
So now you have both?
Yes!
Which one actually works, for everyday use.
They both work, although I have been limited in how much I can explore with the vagina because it's still healing from the fistula repair surgery. But I was able to have a vaginal orgasm early on and I'm looking forward to exploring that more once the consequences are no longer days of soreness.
So when you go pee how do you know wether to sit or stand, or even control where it discharges from?
I generally sit so that I can wipe the discharge. I had to pee in some bushes about a month ago though and I stood for that. I wear a panty liner so I can handle a small amount of discharge in my underwear without a problem, but it's preferable to keep everything dry if I can.
Edit: in case it wasn't clear, the pee all comes out of my penis
This is the first I've heard, seen this as an option. But I'm here to tell you there's no way I would be able to have this without strick adult supper vision. That opens up a hole new ball game for tucking. 😆 🤣
I'm impressed.
Ha it really doesn't come in handy for tucking unfortunately
How is your vaginal depth? I am planning to have the PPT technique and I would like to know your experience with this technique
I currently usually have three or maybe two dots visible when I dilate. I lost some depth while recovering from the fistula repair surgery, but I'm still very happy with the depth which is close to 5".
Hey, I know I'm very late to this, but do you eventually stop dilating your vagina if so, when?
Didn't know this was possible! I'm glad you have such an amazing surgical team. I'm curious to how the next steps will go!
I'll post updates as I have new information!
You're awesome! Wishing you the best!
Thanks!
I'm a salmacian through and through, but I've been on the fence about going with a ppv instead of just a pure vaginoplasty. I'm curious what your thoughts are. Do you identify as a salmacian as I do or what was your reason for going this route for your gender identity? What kind of labia do you think you can get with the future surgery? And lastly, what thoughts do you have regarding this over a traditional vaginoplasty?
Thank you so much for your time and updates.
I don't really "identify" as salmacian per se, it's not really an important label for me, but I was very glad to find the community because that was how I learned this surgery was possible. I also have never been very attached to gender, but I take feminizing HRT and pretty much go through the world as a trans woman. I chose this surgery because I was fond of my penis and didn't want to give it up.
For labiaplasty, I'll probably just get outer labia made from the scrotal skin. I'm not sure exactly what my options are yet though, but I'll have a consultation with Dr Avanessian in January.
I definitely wouldn't have wanted a traditional vaginoplasty myself, but if you're not that emotionally attached to your existing parts then it is certainly the easier option. More surgeons do it, and it's lower risk for serious complications if you go with PI or hybrid PI with a tunica vaginalis graft, versus PPT or colon methods which are the best options for PPV. On the other hand, I know of a couple people in the salmacian community who got a standard vaginoplasty and regret it a lot, so in the end it will have to be up to you and your priorities.
Best of luck with your journey! 💕
I’m wondering if you have a labiaplasty update? I am going in for a consult on ppv tomorrow and am planning on a secondary operation to do labiaplasty at a later date but haven’t seen any results from this process
I really appreciate your updates! Talk about encouraging! ❤ I'm glad to hear the repair went smoothly all in all. Can't wait for the next bit of news!
Thank you!
This is honestly cool af
Thank you!
Can I ask you some incredibly invasive and personal questions? For example— how is sex? Does your vagina work well for penetration? Does your penis still still function well? How does an orgasm feel? Can you orgasm from stimulation of either or both organs? Etc etc etc. I haven’t had bottom surgery yet and my wife and I are trying to weigh the potential outcomes….
how is sex? Does your vagina work well for penetration?
I haven't had much chance to explore receptive sex yet because of soreness from healing, but I'll post about it when I have more information. I had a complication that was fixed in September, and needs some more time to heal. But aside from that, there's a bunch of sensation inside. The urinary tract runs along the front wall of the vagina, and is super sensitive and detailed, and the gspot is part of that. I can also feel "full" when the dilator is in, and resistance when squeezing that.
Does your penis still still function well?
It functions the same as it did before.
How does an orgasm feel? Can you orgasm from stimulation of either or both organs?
It feels about the same as before surgery, but orgasm with something inside to squeeze against is a different level. Unfortunately, that irritates everything too much right now to really enjoy though. I had one fully vaginal orgasm early on, but I haven't repeated that yet because everything is still too sore. Hopefully things will be better in a few months though.
I haven’t had bottom surgery yet and my wife and I are trying to weigh the potential outcomes….
Good luck! I hope you are able to figure out what you want and make it happen! 💕
Do you think having taken spiro previously could have affected erectile function in the present? (Or know anything about ‘expected’ function after PPV?)
I ask because cypro is nuking my T to oblivion and function is more ephemeral and my one fear about getting PPV is if I don’t retain enough function to warrant undergoing the surgery for myself.
I think if anything, some function came back after the surgery because I stopped spiro and my adrenal gland makes a little T (around female levels last I had it tested). My BO came back, as well as some of my libido.
I've actually always had some ED, so I'm not sure that spiro had a long term effect on function.
Do you know anything about being able to keep testes?
What about erections
A couple of people have had PTSV's (Penile-Testicular Sparing Vaginoplasty). So it's possible. But no longterm data or experience yet.
Any idea which surgeon does that sort of operation
Dr Wittenberg has done it.
At least two people have kept their testes. You wouldn't be able to get labiaplasty though, since they would need to use the scrotal skin.
I'm still able to get erections with some effort and help from ED meds.
I don't see why erections would be affected since you would keep your penis with the erectile tissue and bloodflow to the penis shouldn't be affected either
You're right, since I was on spiro previously it's pretty much the same as it was then.
(Well, my T actually went up after this surgery since my adrenal gland makes some and I stopped taking spiro to suppress it.)
Do you think having taken spiro previously could have affected erectile function in the present? (Or know anything about ‘expected’ function after PPV?)
I ask because cypro is nuking my T to oblivion and function is more ephemeral and my one fear about getting PPV is if I don’t retain enough function to warrant undergoing the surgery for myself.
Are you a surgeon who has experience in this area?
Please play nice 🙂
Congrats on hitting a year!
Thanks!!
Did know this was possible 😲 Congrats!
Thank you!
I want this so bad. How long would you say would be good to go back to work after having this done. Like how much time off would someone need before going back to work.
12 weeks. Good luck making this happen for you!
Thanks for sharing and continuing to update, you’re one of the only resources pretty much for PPV results after considerable recovery time and it’s so promising to see such great outcomes.
I’m almost 100% set on pursuing PPV, at least if I can get it covered, and this takes even more fear out of it. Thank you 😊
I'm glad you got something out of my posts! Best of luck with your journey 💕
Thank you so much! And best of luck to you as you continue yours!
Thanks!
Thank you for sharing and updating. I am really wanting this proceedure myself, but besides you not much else is out there for resource or questions. How has the day to day experiance with everything been so far? When you shared that tucking hasnt been much of a benefit, is that because of the sorness or something else? How has sensitivity been? Once again, thank you so much for the info, you are amazing!
Glad my posts have been helpful for you!
How has the day to day experience with everything been so far?
Aside from dilating every morning, it is not something I have to think about much during the day anymore since having the fistula repaired. Even though I can pee standing now if I have to, I generally sit since that also seems to be when all the discharge likes to come out (that and when I blow my nose sometimes). Aside from that, I haven't had much chance to explore sexually yet since it's still healing from the fistula repair surgery in September.
When you shared that tucking hasn't been much of a benefit, is that because of the soreness or something else?
I'll start by saying I've never tucked for more than a really short time as like a novelty. I don't do it regularly, and I've never used tape or a gaff or anything. But I imagine if you do tuck, this is pretty much the same as the benefit you would get from just an orchiectomy. You can kinda try to push the tip up inside if you really want to, but it doesn't stay, and even if it did it would probably put you at risk for a UTI to do that and not pee shortly after.
How has sensitivity been?
The sensitivity is pretty detailed. The entrance is still kinda sore, and my bladder is pretty sore, but aside from that I can feel a lot of detail about where the dilator is inside me and what it's doing. Is there something specific you're wondering about?
Best of luck making this happen for you! 💕
this actually appeals to me, and I know this is a year old post so I have little faith that I'll actually get a response to this question but would it be possible for you to show a picture of you with an erection? I feel like it would give another perspective to the results of this procedure and I'd really like to see what it looks like when you're hard versus soft 😅
Hi! I understand why you might want to see this to make an informed decision, but I'm not likely to post that type of content on this account, since it borderlines on sexual.
Good luck on your journey! 💕
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Thank you, and good luck with yours! 💕
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Because some of us aren't dysphoric about our penises but want a vagina. Everyone is different and each of us has our own goals and desires.
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Dysphoria can be about anything. How you look, how you move, how you talk, how you feel, all of these are huge factors in how others see you and how you see yourself. What's in your pants is just about the ONLY thing that the general public will never see and only matters to you, your doctors and your lovers.
For me, I was on the fence about bottom surgery for a long time. Ever since I started my transition, I was mulling over that question and kept waffling. On one hand, my penis didn't really bother me (though tucking was a pain) and I enjoyed using it very much. On the other hand, anal sex really didn't work for me and I really wanted to have what I felt was that intrinsically feminine experience of bottoming for sex (I know it isn't inherently femenine but this is how it feels for me). I WANTED the vagina and to have sex using it but I didn't want to lose what I had either. That's when I saw another person who'd had a phallus-preserving vaginoplasty done and it was an inspiration! I knew that was what was right for me.
The word we have for it is Salmacian- the desire for mixed genitals. You can be MtF, FtM or Non-Binary and desire to be Salmacian. Hell, you could even be cis and want it, I ain't one to judge. However, there is significant overlap between transness and Salmacians, as you can see from the strong responses you see every time someone who got a phallus-preserving vaginoplasty or vagina-preserving phalloplasty posts here. There's actually a lot of people out there who want this but just didn't know it was an option.
Honestly people need to stop viewing penis and vagina as opposites, it’s too binary, a clit and a dick are the same organ on a huge gradient sliding scale of size and fusion, some people want big clit/dicks, some people want small ones, some people want them fused others don’t ect.
Congratulations 🎊 I just learned something new today at 55yo.
Thanks!
How painful was this surgery?
I didn't have much pain directly from the surgery, but the recovery has been bumpy. I still have pain during dilating, but I'm working on getting that treated (granulation needs to be cauterized, painfully). Most of my pain has been related to the vesicovaginal fistula (hole in my bladder) that I had repaired in September.
I saw the last one online. Do you recommend them? Was it good/successful?
Thank you OP
Btw I don't mean to sound rude im just asking it bc i genuinely consider getting ppv but are the wrinkles on the penis caused by the surgery
I have good news, it's always been that way for me
Thx sorry for not being mad at me
Do you have sensation down there?
Quite a lot.
Super beautiful. I think this is what I want too.
Congrats on the results! I hope all is well with you
If I may ask, how much discharge do you experience? Do you wear daily pantyliners or are the gusset of panties able to handle it?
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