Gender Affirming Surgery: Considerations for Vaginoplasty | UCLA Gender Health


Hello my name is Gladys Ng. I’m a
reconstructive urologist here at the David Geffen School of Medicine at UCLA
and today we’re going to talk about genital gender affirming surgery
specifically vaginoplasty transition from male to female
some considerations before and after surgery as well as the surgery itself so
some of some of the items we’re going to talk about today or are its what what is
going back to the basics what is gender genital gender affirming vaginoplasty
criteria for vaginoplasty as well as preparing for a vaginoplasty the
surgical overview and some relative anatomy and terminology and some
post-operative care so go back to the basics what is gender affirming
vaginoplasty it is a trans feminizing male to female procedure using the natal
male genitalia to create a functional and/or aesthetic vagina there’s kind of
two options a vaginoplasty with a canal for penetrance intercourse and then a
vaginoplasty without a canal or vulva plasti form or for the appearance we’ll
focus a little bit more about the full vaginoplasty with the canal today’s talk
what are the goals of an Adreno plasti it’s basically to attain an appearance
of indistinguishable from from other women and although there is no real
uniformity of appearance and in the vagina the vuelven insists woman it’s
also to create functional goals retaining erotic sensation as well as a
canal if desired for for penetrative intercourse and the benefits are that
after surgery you can have decreased secondary benefits are decreased hormone
requirements because the testicles are removed leading to no production of
testosterone so you don’t need blockers anymore after surgery and it just helps
with better aligning your your gender identity with your body to make you feel
more comfortable and you can feel a lot a lot of patients feel a lot of very
much comfortable after this procedure for that reason okay so some of the
criteria for for doing surgery kind of falls from the world professional
association for transgender health this is the International Organization or so
Association for health professionals it was first founded in in the United
Kingdom under the Harry Benjamin foundation he was one of the first
physicians and inner chronologist that treated patients with gender dysphoria
and soon this organization organization grew internationally into a big
Association were there they committed to ethical as well as safe treatment
healthcare treatment for transgender patients so some of the criteria
specifically for gender genital surgery is that there’s their needs there’s
documented documentation of gender dysphoria and keep in mind these
criteria are not to serve as barriers or our diagnostic tools in any way it’s
it’s just that the surgery itself is just it’s it’s irreversible
so none other another criteria is to have capacity to make informed consent
for treatment you have to be of a legal adult age as and then some kind of real
life experience with 12 continuous months of hormone therapy as well as 12
continued tanja continuous months of living in the gender role and then some
supportive letters of assessment from some of your health care professionals
that have been revolved in your care relate to you know support your progress
in in the the hormones and them and how the transition has been and then also
making sure that there’s no other medical major medical conditions that
would that would lead to bad outcomes from from surgery itself so making a
decision for for vaginoplasty it genders genital surgery can be complex and
really before coming to the surgeon you wanna you want to essentially ask
yourself as you all know is this surgery essential to you to
becoming feeling as a whole and integrated person and talking to a
surgeon in the consultation as I do with my patients won’t help you make that
decision but certainly we can talk about the procedure and the surgery itself the
risk and what it involves the procedure how much time involves you know the
whole process itself the risk and benefits and and possible complications
to any kind of surgery that kind of help you make that decision as well okay so
getting to to know your surgeon is very important and that’s why intern meeting
patients I like to like to get to know them on a more personal basis understand
their medical and social conditions as well and helping them make this
transition and also talk talking about them what their concerns about the
functional and also aesthetic concerns about the whole reconstructive surgery
in and of itself so this is all very important and very important prior to
the date of surgery to meet meet your surgeon and have have these have these
conversations I also like to discuss because it does it’s infertility is a
result of the surgery itself discuss reproductive options at that time you
know some some patients may have already have children have their own children
but for those that have not there are options out there such as banking sperm
or if further technologies are needed I have health care other providers that
are specialist in fertility that that I’m happy to send my patients to that
can discuss options of it if you do choose to do any kind of sperm banking
sometimes the the requirements for the hormones may be less or may need to be
decreased in order for production but this is also when we can discuss during
the consultation itself the other thing to consider in choosing a vaginoplasty
is the timing of things it does we do require it is about a four to five
hour surgery on average we do need some preoperative workup before we’ll discuss
it later on the prison tation in usually in the hospital for
like five to seven days and recovery takes about eight weeks and during this
time period you’re in the hospital we take care of everything we kind of show
you how to take care of yourself afterwards but when you go home there’s
a little bit of a dilation scheduled we’ll talk about that in a little bit
but you also want to have the support of family and and your partner as well and
helping you take care of things and we’ll also talk about a list of items to
to get to have on hand prior to coming into the hospital before surgery once
once you just pop the side upon the surgery itself so the preparation for
surgery and these I mentioned these specific items because it takes a little
bit time to set in it’s not something that you kind of choose the day before
the night before surgery and so it’s good to speak about it because typically
we ask patients to stop estrogen izing hormones about six weeks prior to
surgery and this is for the reason of decreasing the risk of deep venous
thrombosis or blood clots forming in your in your in your veins that could be
potentially fatal if they progressed to the lungs and so we want to decrease the
risk of all of that so we have the patient stop hormones at that time the
Estrin izing hormones at that time six weeks prior to surgery itself once the
date has been obtained and you know you can be started up about two weeks after
surgery once you’re a little bit more mobile but you know you also have to
keep in mind that there could be hormone because the hormone changes there could
also be mood swings that can be associated with being off these hormones
if you are smoker you prefer that you stop smoking
altogether but but definitely eight weeks before surgery then the reason is
that this can also increase your risk for the blood clots that I just
mentioned but also when we’re using the skin tissue to create the canal the
blood supply is very important and smoking is is something that can affect
the the health or the outcome of the of the vaginal canal in terms of using the
skin to to to reconstruct it and then the body mass index of 30
meaning that it typically means obese if you’re 30 and above and it’s just more
tissue to heal more more chances for infection and it’s also in the groin
area or in the area in between the legs where the surgery is being performed it
can also affect the ability to bring the tissues together to for the more
cosmetic part of things but if it’s if you know if there’s too much tissue
meaning subcutaneous tissue or you know a fatty tissue then it may be a little
bit harder to do reconstruction but you know that’s something that can be
assessed during the consultation itself with a surgeon sometimes it depends on
where the fat is also distributed but typically 30 and below is what we’d like
to go by in terms of criteria and then it’s good to understand that after the
surgery you’re you’re there’s going to be a lifelong commitment to dilation of
the vaginal canal because we’re using skin tissue or bits of skin tissue to
create that cavity but to put it you know initially after surgery is going to
be a little more intense it’s almost you know almost three times and we’ll talk a
little bit more about detail about that a little bit but you know to put in
perspective in about a year’s time it’s about two or three times a week and if
if you’re having penetrative intercourse then that can switch them for dilation
schedule so it’s not it’s not that cumbersome but it is something that
you’d have to continue on for the rest of your life to keep the vaginal canal
open and then the hair removal since we do use squirtle scrotal versus penile
skin or some around there or a combination of both do you three the
canal hair removal either by laser electrolysis takes some time to be done
part of the date of surgery we usually give patients on average about you know
four to six months so that’s something to keep in mind then in planning so this is just a list of items that I I
asked patients to purchase prior to coming in for their surgery so that
after your surgery when you’re when you’re discharged home you’re not on a
scavenger hunt to to find all these items with a fresh room and just fresh
wound and feeling kind of under the effects of you know just having a major
surgery performed so usually like papers patients do have on hand some
water-based lubrication and initially when you’re dilating three times a day
it’s good to have as much lubrication as you need to kind of to to ease the
dilator in and get a sense of things as you get more proficient you may not need
to use that much Lube but just to have on hand it’s better to map have more
than not enough initially also some disposable under pads because it could
get messy as you dilate and then also douche to clean the canal dilators we
ask that that the patients purchase them before the surgery itself I will show
you a picture of them there’s various sizes and various types we have
particular ones that we we suggest also a douche as well and that helps clean
the cap helps to clean the cavity some paper towels a good stock of paper
towels some strong absorbent kind some bacitracin antibiotic ointment to put on
the suture area some feminine pads and the best is the ones that are cotton
lines just because the sutures are still fresh and it’d be just more comfortable
and then also some throwaway large loose Underpants because they could get soiled
during this time period as you heal and then some and then a handheld mirror
because this will help you kind of understand your anatomy as you get used
to your Anatomy will teach you all this but this takes some time to kind of
settle in after surgery when you’re on your own after discharge from the
hospital so kind of what are that what are the main components of a
vaginoplasty now we’re going to talk about the surgery itself there’s really
six main components one is the penectomy or or what that means is removal of the
penis penis shaft the erectile bodies the orchiectomy
which we do on both sides which is removal of both testicles this is where
the testosterone was produced and this is this is where after it’s pretty
removed there’s no more no needful for testosterone blocking hormones because
of that the vaginoplasty portion which we’re just talking about creating the
vaginal canal using either skin or scrotal skin the clitoral plasti which
is create using the portion of the head of the penis as well as the nerves to
the head of the penis to create the clitoris I’ll show you a picture of all
this it’s kind of hard to imagine and then the original plastic portion which
is where we shortened the urethra and reposition it so that you’d have to sit
down and urinate from here on out after the surgery is performed but is
shortened also creates more of a pinkish appearance more of a vulva appearance
that sits below the clitoris and then finally the labia or the vulva which is
the outward external skin appearance of the the vaginoplasty and this is the
creation of the lips of the vagina and they the external appearance of the
vagina as I just mentioned and that’s using the skin so the the most standard
way of creating a vaginal canal just just want to talk a little bit about
creating the bedroom can now itself is using the penile skin the skin of the
penis but kind of inverted inwards like a skin graft and that’s why the whole
you know keeping healthy and no smoking is important as because it’s basically a
skin graft and in the area that we create for the skin to to to take into
so the benefits is that the penile skin is relatively elastic and and it’s
hairless and less likely to contract on itself and as Ana has really good pretty
good blood supply the thing is if that’s small or there’s error or from being on
estrogens or if patients have are circumsized which is non common then
there’s just less skin to work with there’s then there’s also a combination
and a penile and scrotal skin using the skin of the penis as much as you can as
well as using the other side of the scrotum or
flap of the graft of the scrotum on the top side we can use that to augment the
canal itself and basically the benefits is giving extra length and width to the
Badger to canal and then because it’s you’re still using the the penile skin
there’s less a tightening of the entrance of the vagina disadvantage is
that because we’re using scrotal skin then you’d have to use hair hair removal
and sometimes depending on how that flap is created for the scrotal skin you can
you you may be a little bit risk of prolapse in terms of the canal itself
and these are all things that you want to discuss for your surgeon during
consultation as they look at your anatomy and look at the skin and see
what there is to to work with so this picture is a picture of the female
anatomy itself it’s this female and the reason why I show it is just I want to
show we’re relatives structures are and how how they’re similar to what we what
we do in the reconstruction itself so you can see that the clitoris sits here
on the top the urethra is a little bit below it the vaginal canal is here in
the city male and we reconstruction will be in the in the in our reconstruction
will be a little bit lower here we don’t touch the anus part here so the labia
majora is here and this is what we also kind of create and the labia minora is
the inner lips and sometimes that may be more difficult to create depending on
the amount of skin that is present okay now going to the male anatomy there’s no
skin on this picture a skeletonized picture so typically what we use is the
this part of the the head of the penis this is what we use to create the
clitoris and the nerves that kind of course along here and the rest of the
shaft is removed and then the urethra that sits right below this is also
shortened so the clitoris sits right here on the top on right at the base of
the pubic bone which is right here and then the urethra is opened up up to that
area so it gives you more of that pink vulva appear
and then this is the anus where we don’t touch again but in between the space
right here is where we create the vaginal canal so given you another
perspective a cross-section picture you can see that this is removed this is
where the blood and the prostate is and this is the the the anal opening or the
were leads to the to the rectum of the bowels and this is the space that we put
the the vaatrik rate for the vaginal canal so in this picture you can see
this is the space right here where we create the vaginal canal I’ll give you a
better close-up picture in the next slide so you can see that the space that
we create was the anal opening again okay which we don’t touch and then this
is the space between the back of the bladder and the prostate and the rectum
top and front on the rectum and this is the space that we create where we put
the skin into to create the vaginal canal but you with either penile skin
itself there’s enough or penis grow to skin itself to create this this canal
I’ll just I’ll just put in a word about intestinal vaginoplasty as well that’s
not common and it’s really not the first resort to go to because there’s a lot
more to do to to use to a lot more organ spaces to go through it you use the bow
to bring it down but in select cases which you can discuss with your surgeon
on your consultation you it can be it may need to be used and and if there’s
not enough skin at all okay but but typically most common and standard is
using the penile skin and version technique so then here is where the
clitoris has been made and this is the urethral opening as I mentioned and and
this picture also shows in the creation of this and performing the vaginal class
sees there’s always a concern you know for complications with as with any
surgery of you know lower and surrounding organs and tissues and right
behind right next to the vaginal canal is the rectum itself as well as the
prostate and the bladder it is also worth noting that the prostate is not
moved in these vaginal classes so in older patients if there’s any concern
for prostate cancer prostate cancer screening still needs to be done
especially in older patients and if there’s any urinary problems the
prostate could over grow within the channel itself causing urinary symptoms
so those are things to think about because the prostate is not not removed
okay all right so post-operative care as I mentioned earlier that you being you’d
be in the hospital for five days and it’s really for that for that grafted
tissue that the skin to take and during those five days we’ll have packing in
the canal and it’s just to allow the blood vessels to realign from that skin
down to the cavity itself and then on the fifth day we will remove the usually
I will remove the vaginal packing itself and also teach the patient how to dilate
and Uche this is just one example of diet of a dilator set and we would go up
sequentially start with a certain size for ten minutes and then you go up to
another size for fifteen minutes and we’ll start with that kind of moving
sequentially up to whatever’s comfortable for you there are other
dilators as well but this is just one example of one and then the catheter
will also be removed on that fifth day just because you’ll be more mobile and
kind of and you can you know what we’ll make sure that you can urinate with no
difficulty so during that time we’ll teach you how to dilate and also how to
clean the canal ISM as well with it with it with the addition device bulb and
then once you go home from the hospital we’ll set up what your post-operative
return to clinic schedule is at that time so afterwards your hospital stays
is usually about sorry six to eight days not weeks please excuse that error up
there and the recovery time I’d say about eight weeks just because for the
first eight eight weeks ask that patients do dialate three times
a day and that’s why I may be difficult if
you’re you know and you don’t want to be running our going on the hustle-bustle
of going to work and stuff like that so it’s it’s better to just take that time
off from surgery onwards to the eight weeks afterwards just to take that in
consideration because I do ask the patients to dilate three times a day
just to maintain the canal and then it gets less intense after that and then we
usually see you after it and then we can kind of go down maybe two times a day
and this is an example of a in enema douche and it’s made out of medical
grade silicone because it’s soft you don’t want anything that’s hardened and
you know it can have sharp edges so this is soft and pliable but basically you
fill this up with mild soapy water and you just after you dilate you you insert
the enema and and clean the canal and that’s just to maintain that the hygiene
in in this and the vaginal canal the skin lined federal canal okay so with as
with any kind of major or any kind of general to surgery or majors or a
complex surgery there are potential for complications and some worse than others
but more common on the ones listed here you can have one changes to the area
below just because it’s also a dependent area meaning sometimes you can have
collection of blood like a hematoma or sometimes it may look the sutures may
come undone but everything heals up on its own it just take it
taking it takes a matter of time and some wound care and that’s why we you
know we see you in the clinic and we ask that you stay in within the vicinity and
each surgery may be different but I ask that my patient stay within the vicinity
of Los Andres for at least four weeks afterwards so I can make sure that
things are going well and I usually see my patients with them one or two weeks
after surgery to make sure that dilation is going well and the wounds are healing
well enough but revisions I’m sorry so the wound changes can be common and it’s
usually just wound care really need to get back to the operating room to fix
those things longer term if things are not you know
what you expect and then revisions can can be done and they’re usually not in
minor surgery minor genital surgery and initially after surgery the urinary
stream when the catheter comes out could countess play to a certain side or spray
all over but that’s just because their sutures and the urethra itself to kind
of tack things up and keep things open so that was usually self resolved that
could be expected also because of the the section four to create the clitoris
we dissect the nerves often off the shaft of the of the the penis shaft
sometimes the nerves can be in a sense shocked from that dissection and it
could be numb for up to 18 months afterwards so it may take some time and
also has initially when the t-shirt of the ball swollen think they’re gonna are
you’re not you may not have sensation as you leave the hospital okay so it just
may take some time to get back to to functioning again and then there could
be post-operative pain which will manage with pain medications and pain control
and then also sometimes minor bleeding and that’s why I asked you you know for
you to purchase those cotton panty pads or panty liners so that because some of
the wounds are still healing and and depending on movement it could some of
those sutures could could you know still be fresh and and and this gaps can come
off and cause a little bleeding and so and and so but a lot of its just wound
care and we can certainly take care of that in the clinic when we see you back unless I wanted to show when I was I
wanted to show this picture because you know it kind of gives you shows you the
variability of the vaginas out there and this is created by an artist in in in
Brighton United Kingdom by the name of Jamie McCartan McCartney he consented
woman and did a body casting of all the vaginas and and it just shows the
variation in in in all the vaginas are there out there there
one standard look and that’s why you know me also meaning the surgeon to kind
of talk speak about what do you expect what you would like the external
appearance with and also with what’s your anatomy that you have is very
important but just to just to show there isn’t one standard conforming look to
the vagina to the vagina and and really the vagina is the canal this is more the
vulva itself so lastly general de surgery is is as likely life-changing
surgery but it’s just one part in your transitioning care and so I wanted to
say that I do work with a whole team of physicians in in the UCLA gender health
program and every in not just physicians itself there’s all there’s all other
supportive health care workers and members and everybody’s dedicated and
and fabulous in in in supporting care for transitioning for transgender
patients and so here are some of the services that our program offers other
specialty surgical services as well as just hormone I mean hormone therapy and
also primary care as well and also case management and care coordination and so
I want to thank you very much for your attention today
um and we look forward to helping you we want you to feel the most comfortable
being you thank you very much

About the author

Comments

  1. There is more than one way to have Gender Confirming Surgery. Certain doctors in Thailand do things differently than other doctors in Thailand. Surgeons in Sweden do things differently that in other places in the world. Surgeons in Chicago, Philadelphia and California do GCS in a variety of ways. There are ways that require extensive and perhaps years of Electrolysis on penile tissue and surrounding tissues. There are ways that employ part of the intestine to create the vaginal canal. There are ways that provide for lubrication of the vaginal canal and ways that do not provide for lubrication. There are ways that are more a risk for intestinal/vaginal tearing. There are ways that are merely creating a dark place in the body that is easily susceptible to yeast and bacterial infections. None of these complications or processes are discussed in this lecture.
    Say you are a trans women seeking the best kind of GCS surgery that is safest, with a vagina that is self lubricating, that is not massively vulnerable to bacterial infection, that will last a lifetime, even when you reach 80 years of age, this is not a helpful video. Sorry. Where are the full explanations? Where are the books that help trans women understand the short as well as the long term issues? Where are the comparisons of different surgical procedures done by different doctors. Personally, I am sick of the self serving surgeons who talk about what they are doing but not about the options in any kind of comprehensive and helpful way. Is there any wonder that trans women have to go through years of therapy before surgery. You, as a trans woman have to be prepared for the worst of surgical errors and misinformation. This is a horrible state of affairs for a trans woman either surveying her options or trying to find doctors who are doing the best surgeries.

  2. I am an electrologist and have worked on people who had numerous prior laser treatments. Doctors are generally ignorant of what happens to hair when laser is used. Laser may not destroy the follicle permanently. Laser may make the hair much more difficult to have a lubricated hair follicle. Laser can make electrolysis much more difficult.

  3. good video, although its worth pointing out, if you stop dilating after youve fully recovered, the vaginal canal is not going to seal shut. it might close to a minimum size and penitrative might not be feasible but can always restart the process if you ever want to have penitrative sex again. (this comes from several transwomen ive spoken too who have had the procedure. you can also find many testimonials online. ) just remember that everyone is different and YMMV (your mileage may vary)

  4. thanks for the information.A very informative video for health professional who provide service for patients who have undergone transition related surgery.

  5. Very fascinating how far we have come! The fact that we can create a a vagina out of a penis is so interesting ๐Ÿ˜ฑ๐Ÿค”

  6. So now it's called gender AFFIRMING surgery?
    Great material for George Carlin's "Soft Language" bit:
    https://www.youtube.com/watch?v=o25I2fzFGoY
    "Americans have a lot of trouble dealing with reality so they invent soft language to protect themselves from it."

  7. Can't believe there needs to still be 2 Hogwarts letters in 2019.

    OFC THEY ARE BARRIERS.

    I can legally go smoke cigarettes until I die. I can buy a motorcycle or get tattoos or get CRISPR in someone's garage.

    It's just thinly veiled bigotry, stop making excuses! This is killing people and it IS a barrier; And an arbitrary one. You're not protecting people anymore if the entire system malfunctions and you need a second opinion on your own bodily autonomy.

    'A decision for vaginoplasty' AHAHAHAHAHAHAAHAHAHAH, ok.

    Specialists and surgeons, for all they educate and take stigma away… You people own my life.

    I do not own my life. I have seen almost zero improvement in ten years in WPATH or really anything. I've seen steps back. And yeah, protecting trans people is good. Pretending you're our saviors is so evil, though.

    I had a urologist, tell me to my face, that I couldn't deal with the pain of an orchi… After almost 3 decades of actual Hell.

    DO BETTER.

  8. Itโ€™s must be a medical malpractice nightmareโ€ฆ.or it should be! Iโ€™m certain UCLAโ€™s School of Medicine & its surgeons performing unnecessary vaginoplasty, have already, begun to collect data LONG-TERM? It certainly would not be within the scope of the Hippocratc Oath of: "At least do no harmโ€, to have not prepared a 20-30 year long-term outcome study for physiological, psychological and of course, endocrinological outcome with this insane surgery. What is incredible to me as a medical professional, why any surgeon would consider this surgery without at least 2-3 year pre-op suitability considerations. Why not spend the time and money invested in this surgery, to study improved methods of ureto-genital plastics for patients with GU carcinomas & improved methods of stomal reconstruction. After all, there are many more โ€œpaying patientsโ€ who are in need of corrective stomal surgery, than there are for sexual reassignmentโ€ฆ.NO?! Remember when youโ€™re in court 10 years from now, losing your licenses, โ€œAt Least Do No Harmโ€!

  9. She says, " there is no real visual uniformity in the vagina's of cisgender women." The dishonesty is amazing. There's no real visual uniformity in the human eyeball either, as everyone's eyes are slightly different. But, at the same time, there is visual uniformity in the human eyeball in terms of all eyes are more of less circular, has a white part around a dark part in the middle, they all have an iris, etc. This is word play, it all depends on how you define "visual uniformity". All vagina's have visual uniformity in terms of having a clitoris, lips, vaginal canal, all of various sized within a specific range. Vagina's at the same time are not visually uniform, as some are deeper, wider, some have bigger lips, smaller lips, some have big clitoris's some are little, etc. Again, it depends on how you define visual uniformity. It would be a lie to say, "well no one vagina in cis women are identical so if a trans vagina happens to not fully function like a cis vagina, or look much like one, it does matter because all vaginas look different. That would be a major lie, and this lie is constantly said to make transwomen happy, all for business and making money.

  10. I am a little sissy transgenedr and a bisexual ๐Ÿ˜‡ un ๐Ÿ‘ญ ๐Ÿ‘ฌ ๐Ÿ’— ๐Ÿ’š ๐Ÿ’˜ ๐Ÿ’› ๐Ÿ’ ๐Ÿ’œ ๐Ÿ’ž ๐Ÿ’“ ๐Ÿ’Ÿ ๐Ÿ’• ๐Ÿ’– ๐Ÿ’™ โค ๐Ÿ’‹ ๐Ÿ‘… ๐Ÿ‘„ ๐Ÿฉ ๐Ÿถ ๐Ÿ• ๐Ÿผ ๐Ÿผ ๐ŸŒธ ๐ŸŒธ ๐ŸŒˆ ๐ŸŒˆ ๐ŸŒˆ ๐ŸŒˆ ๐ŸŒŒ ๐Ÿ‘ญ ๐Ÿ‘ฌ ๐Ÿ’… ๐Ÿ’— ๐Ÿ’š ๐Ÿ’˜ ๐Ÿ’› ๐Ÿ’

  11. The biggest issue is this abnormality is pushed to our kids heads as normality…. Wait for 10 years and we will see a huge demand of this procedures but wait another 10 years and see how most operated will scream that it was the biggest mistake of their life….

  12. Good presentation!

    I do want to note that the requirements are absolutely constructed as barriers though. It's kind of silly to say "a requirement isn't a barrier."

    WPATH and HBIGDA codified the explicitly gatekeeping practices of the 1960's and 1970's. While they have liberalized, there are still barriers trans people have to face that cis people don't. If you want insurance, doubly so as their standards are stuck in 1970 because it means less people can achieve them so they have to pay less.

  13. Thank you for the wonderful information, I'm get my surgery the 6th of next year, but don't be so nervous girl!

    I'm always looking for good information to share for those whom want or need it and you've got plenty, thanks.

  14. Thank you for sharing the informational and educational video. Good luck and best wishes to all your transgender clients. Love from Canada.

  15. To any one considering this surgery — you don't have to do this. Changing our sex is impossible. But changing our minds is not impossible. Sometimes we get mixed up, or other people mix us up through abuse or confusion, and we end up believing things to be true that are false. The problem is not our bodies — our bodies are healthy and normal. The problem is our minds — our minds have come to believe things that are not true. Surgery of the body cannot repair a problem in the mind.

  16. Doctor's should not play the roll of our creator. Why is it if I decide remove my arm I'm considered to be crazy but if I have my penis removed I get put on the cover of a fashion magazine.

  17. Mostly similar to practices here in the Netherlands ๐Ÿ™‚ but i didn't have to stop taking HRT till surgery day and had no negative effects because of it (only stopped taking blocker the day before surgery because i wouldn't have balls after anyway). Perhaps that was experimental?

  18. The MTF's desire to be loved as a woman is very real, Most do not realize that the male parts are their lover. It is the unwanted male ego that must be consigned to the past. The original anima brought forward as the true persona for the future. SRS is the death of her lover..

  19. (out of 222 cases)' At the first clinic visit 174 (88.3%) patients were โ€˜happyโ€™, 13 (6.6%) were โ€˜unhappyโ€™ and 10 (5.1%) made no comment. Of the 233 patients, we successfully contacted 70 (30%). All had had penectomy and labioplasty, 64 (91%) had a clitoroplasty and 62 (89%) a neovagina. The median age was 43โ€ƒ(19โ€“76)โ€ƒyears and the median follow up was 36โ€ƒ(9โ€“96)โ€ƒmonths. Overall, 63 (98%) had a sensate neoclitoris, with 31 (48%) able to achieve orgasm; nine (14%) were hypersensitive. Vaginal depth was considered adequate by 38 (61%) and 14 (23%) had or were having regular intercourse. Vaginal hair growth troubled 18 (29%), four (6%) had a vaginal prolapse and two (3%) had vaginal necrosis. Urinary problems were reported by 19 (27%) patients, of these 18 (26%) required revision surgery, 14 (20%) complained of urinary spraying, 18 (26%) had an upward directed stream and 16 (23%) had urethral stenosis. The patients deemed the cosmetic result acceptable in 53 (76%) cases and 56 (80%) said the surgery met with their expectations.'
    -Jonathan C. Goddard, Department of Urology, Leicester General Hospital,

  20. I wish all the surgery fees were funded paid for for free you'd have more people living happier lives and being More able to be a valid community member just a thought

  21. To all those people filled with hate, you don't really know what it's like to be a transgender unless you are one, that's a very good presentation by the way, thanks

  22. Thank u sooo much for alll this important information im planing on geting my top surgery and my srs. Surgery and this is great to know you explain it's so good I feel like a doctor that knows everything now im ready๐Ÿ˜˜๐Ÿค—๐Ÿค—โค

  23. So does a man-made vagina feel better, just as good, or worse than a real vagina? Guess I gotta find a trans gal to experiment with

  24. This has NOTHING to do with hate, but has everything to do with history. If you decide to undergo reassignment, and decide to have DNA history preserved (Ancestry, 21 and me, etc) your future generations will have questions about you. While all other evidence- photos, documents, etc will identify you as your reassigned gender, DNA and chromosomal evidence remains unchanged. It is unalterable, no matter what else can be changed surgically or medically. Attempting to do so meet with the same outcome- fatal mutation.

  25. This will be a life changing time of my life and I'm naturally scared as anyone would be of any surgery but I know that the results will be more than worth it for being my authentic self. This is a process and I need to remember just to take things one day at a time. I only just began hormones a week ago, after all!

  26. To all facing SRS , MTF… GET your life together before your surgery.. NO it won't fix Any depression NOR any work issues..it should be thought as the last step in your life changing experience not the first. Vaginoplasty is not REVERSIBLE, PAIN and MUCHO discomfort will affect your recovery . .. NOR does it repair BRAIN issues.. It's very Painful and you must FIND A GREAT Doctor and Hospital for your CARE. Do take care of yourself and your home Responsibilities
    No added stress needed.. YOU should have all Legal required changes already DONE. I/e Name and Gender change, license and social security..work insurance documents and whatever else YOUR state requires. Have a good Network of caregivers for your recovery time..bout 2weeks with no complications, adhere To your DR.s Aftercare.. HOME should be ready for quietly resting. Dilate and be careful it takes time…took 2yrs for sensation to change from pain and discomfort to actually having Earth Shattering Orgasms,. frustration of two years built up…then a Tsunami OF lovely Orgasmic sensational release OF JOY instead of pain….. Be patient if you have a lover , be very Gentle and loving…. your body knows what it must do…scar tissue is pain for some who suffer from Keloid..use vitamin E and if moisture is an issue…having opted for Sig transfer..it's a bit to get a handle on. . not having any previous experience with a Vagina…….it's got its positive post op benefits..no dryness…but all are different and You may never have issues ..it's changed from a scary RED angry labia to a Beautiful lotus FLOWER.. amazing ! Thanks to Kaiser …. But electrolysis on your Scrotum is something that is nesescary and PAINFUL…THE PENIS MAY NEED IT ALSO…. USE YOUR TOPICAL CREAM AND Get a good Electrologist and go TO YOUR HAPPY PLACE……CAUSE ITS PAIN.!! NO DENYING it !! You will be thrilled with your NEW Pussy… DON'T just give yourself AWAY… you have an opportunity to be in control of you and your NEW Cherry……be mindful and respectful of others I hope LIFE is fulfilled and happiness and joy as a WOMAN follow !! I give GOD thanks for all he has brought into my spiritual LIFE..and all his Mercy and Grace.

  27. November,13th/2019 is my day for GRS…Iโ€™m sure my vagina will be designed just exactly how God intended to be for this spiritual lovely ๐Ÿฆ‹woman, think I will marry Our Living God and become a nun! Sex is a big turn off for me anyways… vomit ๐Ÿคฎ steadily about it..!. Give myself time to heal and Iโ€™m sure things will just come together and truly begin to move forward from this point on. 12yrs old would have been nice to begin transitioning, but 45 is better late nevertheless ๐ŸŒธ๐ŸŒผ๐ŸŒป๐ŸŒž๐ŸŒ

    No more TRYING to PRETEND of faking it till you made it to be a man, my gosh Iโ€™m beginning to feel that huge amount of anxiety being lifted, at the same time relief… it is โœ… done! Taking part of my flesh away and forming me connecting me to my brain ๐Ÿง  much better..! Thankful for this moment in my life, to finally be here…preparing for this moment now more than ever, very happy.

    This video was awesome ๐Ÿ˜Ž and extremely well performed & educational..! Thank you. Mine is in Canada ๐Ÿ‡จ๐Ÿ‡ฆ, there are minor differences which found interesting… xoxo. Ttyl.

  28. Can this be done without the cavity and do more focus on doing a well functioning clitoris? I am trans lesbian, so I dont want a cavity. Thanks!

  29. I think the whole confusion on 'gender identity' was created by The Psych Industry years ago and has saturated our schools etc. Our Planet didn't just suddenly have thousands of young people objecting to their biological bodies. I personally do not care if someone is interested in the same sex but to go to such extremes to change your body seems unnecessary.

  30. "Cis" Women ????? No, you mean Women, REAL Women. This is not a "Vagina". It is an open wound that needs to be kept open with a dildo to keep that wound from healing itself shut. Stop lying to people. Stop promoting ideas that gender is a made up this. You can't change genders. There is no gender neutral either for that matter. Gender neutral..HAH ! It's just a way of saying someone is gay but not ultra gay. Stop the insanity. You are harming children and promoting mental illness as a birth right.

  31. That is everything anyone could ever want to know about vaginoplasty i.e sexual reassignment surgery but were afraid to ask. thank you.

  32. I am not worried about loosing my penis.The uttermost important thing too me is whether I will be able to keep my strong libido and orgasms after surgery.

  33. Grateful for the time this surgen took to explain the proccess "freely" were im from in the uk i cant even get an explanation on how to live off ยฃ300 per month while being unfit for work due to ill health and why i have to live in a dangerous,serious health hazzard..slum landlord propperty being a full uk citizen

  34. I just hope this cosmetic stuff isnโ€™t covered by insurance or at least government funded health care, unless weโ€™re going to start covering ALL plastic surgery.

  35. Isnโ€™t it easier and more effective to treat the underlying dysphoria with SSRIโ€™s? Cheaper too. But that would be too easy and wouldnโ€™t allow doctors to get rich off people with this condition. The Hippocratic oath mandates, โ€œDo no harm.โ€ You take perfectly functioning organs and surgically remove and/or alter them irreversibly.

  36. Gave me a real appreciations for the commitment and courage for trans women to transition fully. Im of the opinion now that a trans girl is more woman than woman. Rest assured ladys and asoiring ladies that this herro bloke wiukd havd no issue having a neaningfull rekatiinship with you. And no i dont fetishise oeople that to me is insulting and cruel.

  37. Thks You so Much for your video In riching of this mtf. Like this we know to. Proceed how to do this transformation. Make to. Female. Very intersting this study very important for. Ours welness. And comfort s personal… After the surgery.. Take care with you teacher. Laetitia from Belgium transg..

  38. I had heard that there would be a lot of pain so I was surprised that there wasn't. I suppose that we are all different when it comes to pain. My VP was a Failure, the surgeon said it was me but he was at the end of his career and needed to feel that he had 'done his best'. In France doctors are embarassed to do this sort of work although they are not embarrassed to get paid for it ! I then had a Colovaginoplasty by another surgeon who operated on the thousands of Biological women born WITHOUT a vagina !! yes there are many ! Unfortunately they nicked a blood vessel and I had internal bleeding so I had to go back into surgery for another 4 hours ( after an initial 6 ) to find the cause. Then the anaesthesist messed me up and convulsions set in destroying the work. Several attemps were made to repair me. Results being a closed sphinter situation entrance to my vagina that no one has been able to correct. I have regularly to go Under GA to have it prised open and cleaned and checked for problems. It goes to say that this ruined any hope of a Relationship and ended up shutting me down. I was Simply the small % of unsuccesful ones. On the other hand I looked great from day one and was even Lucky enough not t otake hormones! Doctors are now telling me to have the whole thing amputated and for the moment I cannot bring myself to do it despite it being non functional. That is life ! Win some lose some, or in this case lose some then lose some more!

  39. All the salty Haters/Chasers in the comments,bless.
    We're here living our best lives,youre here at 3 am having to troll you tube to feel any sort of satisfaction,bless your hearts.

  40. Very easy to tell a natural female from a fake one. You were born in the wrong body, so why do you have a prostate and I don't have one? Why do you have 3 holes below your waist and I have 2? If prostate cancer is peculiar to males, how comes you, born in the wrong body, have prostate cancer? That's the difference between living in reality and unreality. The Creator can only sit back and laugh at the stupidity of humans. Look at the pain and inconveniences of trying to recreate what is already created. The coroner is calling the police station: "Yes, this is the coroner calling about the body that was discovered at…. I'm afraid that's not a female but a male." "Gosh, I could swear it is that of a woman", responds the police officer on the phone. "If you look at the cheek bones, the rib cage, the hips- the first obvious structures and I haven't examined the body yet. There will be other clues from the various surgeries."

    No one is going to win the gender wars, except the natural genders living and content with "as is" male and "as is" female. "I was born in the wrong body"; I was born this way", why is reproduction peculiar to heterosexuality? Logic, commonsense and reality! Being stupid is a human choice, too.

  41. please tell me who do I contact my insurance companies will pay for it I have keystone first in Pennsylvania and they just started paying for it and I also have Medicare and Medicare pays for it to together I can get the surgery done I'm 62 I'm healthy and I need to get the surgery done as soon as possible please help me someone? ๐Ÿ˜

  42. The majority of people that go through with this horseshit will live to regret it. Statistics show a high incidence of suicide after the surgery.

Leave a Reply

Your email address will not be published. Required fields are marked *