SRS advice

This is going to cover what might be uncomfortable for some. Stop reading if you don’t want to  hear about anatomy.

If you read about SRS, what you hear is that the neovagina is dry or at least non-lubricating, i.e. it doesn’t get wet. It’s hard to find good information about how long it’s going to need something to absorb that which exits, at that point as a result of the surgery. You can also get bad advice (in my opinion) about the need for douching and how often it should be done. I’m going to try and answer some of this in an effort to demystify the subject.

I suppose I should say neo on each thing, but it gets redundant after a while and it might not be the best way to think about that area. Despite some transphobic and ignorant comments to the contrary, the vulva and vagina are pretty much 100% what you would have had. The exception? A natal vagina has a different kind of base tissue and a type of epithelial cells that are different from your skin.

The anatomy

Most everything you find there is made of the same tissue it would have been. There’s a good reason for this. The surgery is taking the tissue from the male genitalia and moving it to where it would be on a woman.

The vulva you end up with has labia majora, usually constructed from scrotal tissue. At the base of the labia majora they end at the perineum. The inner lips (labia minora) are constructed of penile tissue. The vestibule (area between the inner lips) varies by surgeon. Mine uses  some of the urethra to line it, which provides a mucus membrane there.

The urethra is relocated with the meatus just above the vagina. A small second of the glans penis forms the clit.

The vagina itself is constructed of penile tissue, often with skin grafts from the scrotum to provide more depth. The depth is limited by internal anatomy, but is generally not an issue for intercourse.

The surgery itself is fairly interesting, but I’m going to refer you elsewhere. I personally have no trouble reading about the procedure, but that’s the engineer in me wanting to know how everything works, and having no real problem with either seeing or hearing about some rather bloody things.

Does the vagina’s lining change?

The lining starts as penile skin. Penile skin is not mucosal tissue. Some changes seem fairly inarguable. The outer layer of the skin, like most of your body, is covered with dry, dead skin cells. This not only provides a barrier, but some protection against abrasion.

One that skin is inside things do change. There are papers about histological changes (cell structure) that either confirm or deny that the tissue morphs to mucosal tissue resembling the vagina’s natural tissue. In anycase the skin loses that hard dry layer and becomes much like a mucus membrane. Whether the skin’s epithelium becomes identical to a natal vagina’s is  what’s argued about.

The natal vagina’s mucosa specifically helps to keep the vaginal environment a bit acidic, which is hospitable to the lactobacilli that live there. Other bacteria taking up residence and driving out the lactobacilli causes bacterial vaginosis. Candida overgrowing causes yeast infections.

The neovagina is different however. Some of the histology studies I looked at say that the bacteria more closely resemble those from bacterial vaginosis for most patients. Beats me, I wish they’d do a larger scale study and answer the question.

Post surgery

Immediately after surgery the neovagina is packaged with a condom filled with gauze. (all the ones I’ve  heard about). The bladder is emptying via a foley catheter, a flexible catheter held in place by a small balloon inflated with saline.

A week or so past surgery they take out the foley and packing. At that point the skin grafts forming vaginal canal have had a chance to vascularise, i.e. arteries and veins have grown into the tissue to supply it with nutrients and oxygen.

At that point you start dilating to avoid the vaginal canal shrinking due to scar strictures, and the body trying to get rid of this opening that “shouldn’t” be there.

For awhile, from surgery to (most likely) after the packing comes out the “stuff” coming out is absorbed by the bandages on your new genitalia. Then you go home and you need to take care of this on your own. Soon the incisions are entirely healed over and what’s left to make your panties gross is what is coming out of the vagina as the grafts heal, excess skin is sloughed off, and the tissue recovers. You might have blood and cerus coming from the  incisions as well.

Once you don’t need bandages, you switch to pads. You just buy exactly the same sanitary pads you would use for menstruation if that were an issue for us. How long do you do this? Until things are to a point where you can using something smaller like a panty liner. This is anything from 1-4 months (not weeks). It took several months for me to get to that point.

If you feel awkward buying pads then you can order them from Amazon online or a pharmacy’s only site. Amazon can save you a little money, and you can find whichever brand you want there.

After more months and more healing things subside.

Don’t throw away any extra pads. If you later develop a bacteria or yeast infection you’ll want them to deal with the leaking medication from your vagina.

Discharge

The neovagina is not a dry environment. It may or may not get damp from sexual stimulation. If it does then part of that is from the retained cowper’s  glands and some might, like a natal vagina, come from essentially leakage across the lining of the vagina.

Even after everything is healed, the vagina is never dry. It may well want lube to put something in it, but it can’t be described as dry. As a result, our panties get grody from what comes out just like our cis sister’s. We never deal with a period, but we do get to have crusty panties (oh boy!).

Douching

The instructions I had advised douching fairly often (every two days) at the beginning and had you continue at a lesser rate (1-2/week). Douching can certainly be handy early on in the healing process. I would used diluted betadine or vinegar.

Long term I stopped bothering. Douching washes out “good” bacteria and can leave you more vulnerable to infections. The advice from the gynecologist was exactly what she tells her cisgendered patients. Don’t douche. So far I see no ill effects to not douching.

Dilation

Starting with 3-4 times a day you have to insert plastic stents into your vagina. This stretches the vagina, and prevents avoiding the creation of strictures from the tightening of scar tissue.

There are a variety of instructions. Follow your surgeon’s directions.

To protect whatever surface you’re lying on you can use a number of things, but what I settled on were bed pads. The are large ( approx 3×3 ft) cloth pads lined with a water resistant lining on the outside. I have four of these but generally only go through one or two per week. I have a stack of hand towels that deal with the worst of it. A whole stack of white hand towels was quite inexpensive. As a bonus, washing the hand towels in bleach is fine since they’re white.

 

 

 

 

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