Research on transgender health and wellness after gender affirming surgeries can be helpful for transgender people who want to learn more about what their options for medically transitioning are.
Knowing the potential outcome of these interventions can help inform and guide the decisions of people who are considering getting these surgeries— and it can also help inform cisgender healthcare providers too.
As someone who had bottom surgery myself (I had ALT phalloplasty) I took a deep dive into the current research on the procedure before making my decision, and while the research was helpful, talking to people who had the surgery I was planning to have equally important.
That being said, if anyone is considering getting peritoneal flap vaginoplasty, this new study should have interesting results and is worth reading!
There isn’t enough knowledge out there about this topic, especially given the relative newness of the peritoneal pull-through procedure as a vaginoplasty option.
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Here is the primary author’s Twitter summary of the study:
“Retrospective review of 199 peritoneal flap vaginoplasty patients
⏲️Median time to orgasm = 6 months
Any smoking history = correlated with less orgasm recovery
Among those with minimum one-year follow up (89%):
Orgasm pre-op not significantly correlated with orgasm post-op
Rate of post-op orgasm was 86%, however,
Not all anorgasmic patients were attempting to orgasm
Patients continue to become newly orgasmic past one year
Interventions for anorgasmia post-surgery include:
Pelvic floor physical therapy for scars, hypersensitivity, or dilation difficulty
Testosterone rx (orchiectomy is hormone intervention!)
Sex therapist with ️⚧️ competency
❤️Trauma informed care
We examined a rudimentary outcome (orgasm: yes/no). There is so much more to learn about the sexual health of transgender women and nonbinary people after surgery! It is a privilege to work for this community under the mentorship of Dr. Zhao and Dr. Bluebond-Langner at NYU Langone”
(It costs $31.50 to purchase access to the full article, but if you are in school you can request that the research librarians help you gain access to a copy of the full text of the study)
Here’s my (bad) diagram of what my body looks like.
I’m post-op from ALT phalloplasty with scrotoplasty and glansplasty without vaginectomy or urethral lengthening.
Things that the drawing doesn’t really show very well:
If you’re standing directly in front of me, you can’t see the scrotum behind my penis shaft unless I lift up my penis or move it to the side.
If you’re standing directly in front of me and I’m holding my penis up or to the side, you’d only see my scrotum, you can’t see my clitoris/vagina while looking at me from the front.
You can only see the original bits if you look up between my legs when I’m standing, or if I spread my legs while I’m laying down.
The labia majora are gone, they were turned into the scrotum.
The labia minora were used to cover the area where the majora used to be so it looks like they’re gone because they were flattened out and don’t stick out. It’s hard to explain this one.
I don’t know where my urethra is but it is in the same place as where it was when I was pre-op so I have to sit to pee, I’ve just never bothered looking for it. I might try using an STP at some point. So no, I can’t pee through the penis or ejaculate through it.
It took several months, but I have some level of sensation in about 90% of my penis now. It feels like a bigger less-sensitive clitoris to me.
After I get the pump erectile implant in June, I’ll be able to have an erection with my penis which will make it easier to top and penetrate my partner during sex, and my vagina still works like it used to, so I can also bottom and be vaginally penetrated if I want to.
I colored the donor site and the split thickness skin graft site in as one red square because I have hypertrophic scarring that makes it hard to find the line between the two since they were touching even before the scar growth so I just drew it as one block, but technically there are two different things happening on the same thigh.
I’ve gotten a few questions about how I can have a penis and a vagina, so hopefully this drawing helps answer that question by showing the gist of the set-up.
not read the article but the whole thing about trans bucket being name dropped is so bad :( we need safe spaces, there are down sides to visibility!
i’ve heard that they’ve since got NYT to remove the namedrop and will be checking their security before putting the website back up again, so fingers crossed all is well
I’m starting to actually look into bottom surgery, which is a little terrifying to me. My bottom dysphoria has gotten pretty bad, and a metoidioplasty may be in my future to help relieve that. It’s amazing how much better my overall quality of life has become since top surgery, and I really wish I could just stop there… but I’m starting to think that a meta might really give me some relief down the line.
I’ve vaguely toyed with the idea of phalloplasty, but I don’t think I could handle it - the stages, the cost, and most of all the creation of a new body part and use of an erectile device… I don’t think phallo is for me, although it would be amazing to have a larger penis.
I think that the two things I need most are the ability to pee standing up without some kind of aid, and to have my penis be fully external and free. The meta appeals to me because it is less invasive and uses what I’ve already got. Additionally, I don’t want a vaginectomy, which is an option with meta.
The fact that I’m actually writing this stuff down is a big step for me - I’ve been avoiding these thoughts and this research for a long time now. I’d love to hear from any followers who have had a metoidioplasty if you want to share some advice etc.
Yesterday, I had a consultation at Fairview Electrolysis in Vancouver. They have a lot of experience working with trans folks including phalloplasty patients which is exactly what I wanted. I wanted to be able to go with someone who understands the procedure already because explaining just seemed awkward. I was really impressed overall and she gives great rates and discounted block rate options for trans folks.
After she explained how she does hair removal and all of that she did three test patches to see what my hair was like. I was optimistic because I don’t have very course or thick arm hair. She confirmed that this is true and apparently my arm hair is quite weak which means that removal will be easier. The hair on the underside of my arm, where the urethra will come from, is especially minimal and thin. She thinks she can clear the arm in three hours so I’ve booked in for three, one hour sessions next week. After the arm is clear, it’s about keeping an eye on re-growth and removing any hairs as soon as they start to come back in.
I’m excited to be moving forward in this regard. I’ll be interested to see how much and how quickly the hair grows back. She was happy that I came in now because I have over a year until my surgery date and the more time the better. I took some pictures of my arm yesterday, so I’ll do some comparison photos after the sessions next week.
I received a call from Trans Care BC today and I have a tentative date with Dr. Crane - January 30th 2019! It’s tentative because they have to confirm with the aftercare facility that I can be there at that time, so fingers crossed. I also said that I would be open to taking a cancellation spot, if one comes up that works for me.
It’s sort of a perfect time. It’s long enough away that I have time to complete hair removal, save up some money, and make sure my health (in terms of my lupus) is in check. At the same time, it’s pretty close which makes me feel really excited. I was actually expecting a date in mid to late 2019, so this is a nice surprise. It’s very strange to think that I’ll only have to deal with being pre surgery for just over a year. Unbelievable and exciting.
