Raising the Bar for SRS Surgeons: The Lack of Quality Care in the SRS Industry, Legislation’s role, and Presenting the Worst and the Most Promising Techniques for SRS article by Staci Rivera; IG: murdering.beauty Original doc available, looking to have article published.

What is “transgender”? The terminology used to describe a woman born with the genitalia incongruent to her true gender and vice a versa to describe a man born with genitalia incongruent to his true gender is known as “transgender”. Although widely accepted, the word implies that someone who is “transgender” changes from one gender to another, which is not the case. In fact, this phenomenon is actually a physical disorder rather than a mental one. Gender dysphoria is the state in which a person feels trapped in the wrong body, which is the body of the sex that does not register or resonate with them. How this PHYSICAL disorder ended up being perceived as a mental disorder is beyond many intellectualists that know better. The concept itself is not complicated yet, conservative, misinformed, and ignorant opinion prevails to this day. Studies have already concluded that transsexualism is usually a result of a hormonal imbalance during fetal development; very similar to being intersex. “Transgender” is used for lack of a better word, but for the sake of understanding it will have to do for now.

SRS is an acronym for Sexual Reassignment surgery and is also known as Genital Reconstructive Surgery (GRS) in which the genitalia that corresponds to their true gender are reconstructed from existing genitalia that is incongruent to their true gender. “MTF” patients undergo vaginoplasty and “FTM” patients undergo phalloplasty. However, the primary focus of this discussion is addressing “MTF” vaginoplasty, providers in the U.S that perform this operation, poor techniques offered and outcomes, and promising techniques that are available as alternatives that many patients and even providers are unaware of. The purpose of this discussion is to argue that patients and legislators ought to raise the bar for trans healthcare, more specifically regarding SRS operations and implementing regulations that would prohibit surgeons who cannot meet or exceed expectations of care from performing SRS on patients.

According to a small study, between 56-84% of patients were happy with the functioning of their new genitalia after undergoing SRS. Although this sounds promising, the results could improve drastically if patients received different technique options that were more than likely not even presented to them prior to undergoing SRS. The options for SRS surgeons in the U.S to choose from are very limited, with the most popular names being Dr. Loren Schecter, Dr. Toby Meltzer, and Dr. Kathy Rumer. The most commonly performed technique is the Penile Inversion method in which the penile skin is used to line the new vagina. Some surgeons also use scrotal skin in conjunction to the Penile Inversion technique, but if they do, they use the scrotal skin to create the vaginal lining. The Penile Inversion technique is regarded as the “Golden Standard”; but this a very subjective lie that they used to alleviate any possibility of objection from patients, who deserve better. Penile skin keratinizes more than other options available that could serve as a vaginal lining. Potential for lubrication is very minimal, if at all. Hairs can also grow inside the vagina if laser hair removal prior to surgery is ineffective, and elasticity is very limited. Aesthetically speaking, the lining is not mucosal or pink in complexion, nor is the possibility for epithelialization when exposed to estrogen. Histologically speaking, the reconstructed vagina using the Penile Inversion method is as nothing close to an average, fully functional vagina. In addition to that, the inner labia is ALMOST NEVER constructed of mucosal tissue which should be Build-a-Vagina 101 and is something every functional vagina needs as it aids in accommodating to objects or partners for penetration. The neo-vagina often times isn’t even cut in a vertical-slit fashion. Yes, all vaginas are different, and come in different shapes and sizes, but poor surgeons really take advantage of that statement. As far as orgasms are concerned, it can usually be achieved through neo-clitoral stimulation and some report vaginal orgasms as well, yet penetration can be somewhat of a challenge. This is especially so with well-endowed partners, as elasticity is not a strong suit of the Penile Inversion method.

As a secondary option, if not enough depth is achieved through the P.I method, a sigmoid graft can be used to line the vagina. The pros include a considerable amount of lubrication; sometimes in excess, more elasticity, and greater depth. However in rare cases, the discharge can have an unpleasant smell, and just like the P.I method, routine dilation is required to prevent the vagina from closing up. These two methods do NOT meet or exceed expectations for SRS neither aesthetically nor functionally.

A more progressive, yet much older older technique available is the use of the peritoneum to line the vagina. This peritoneal skin is pink in complexion, mucosal, moist, self-lubricating, elastic and capable of epithelialization which is what gives vaginas that elastic, rugged, cushion. Considerable depth is also achieved using this technique. This method does meet or exceed expectations for SRS. Fenestrated buccal mucosa is another tissue some surgeons use to line the neo-vagina with acceptable results as well with the same outcomes as the last technique mentioned, minus the considerable depth.

If you think those techniques were encouraging, the Autologous, Fibroblast-Seeded Amnion technique (Seyed-Forootan, 2018.) takes home the trophy for the most superior technique performed. The procedure is relatively simple, inexpensive, minimally-invasive, and the results are what one would regard as the “Platinum Standard” if they viewed the P.I technique as the “Golden Standard”. Studies done on both “trans” and cis women have concluded that vaginoplasty using an amnion transplant showed superior results and reported that patients had a fully functional, aesthetically acceptable vagina. All patients’ vaginas had epithelialized. The patients were “trans” women in one study and cis women with vaginal agenesis in another study. The women with vaginal agenesis in a separate study, (not as recent as the 2018 publication on trans women) received amnion grafts to form a vaginal canal. (Sarwar, Iram, 2010.) Most patients were able to stick two fingers in their vaginas effortlessly within 48 hours post-op. This technique eliminates the need to dilate to prevent the vagina from closing up and is not regarded as a wound by the patient’s body. Long-term follow up was recorded and the results are outstanding.

There is not excuse for trans healthcare to not meet or exceed expectations of providing patients with a fully functional vagina for “trans” women. When caring for “trans” patients, the healthcare industry does not treat vaginoplasty with the same level of regard and urgency as they do for women who suffer from vaginal agenesis. To further complicate matters, U.S surgeons that perform these procedures on trans women are Board Certified yet are not up to date on the medical advances made that are mentioned in medical publications. A functional and aesthetically acceptable vagina has a sensate clitoris, sensate vestibules, which can be constructed with the erectile tissue present in MTF patients, a vaginal opening with a vertical appearance, an inner/outer labia; with the inner labia being mucosal, mucosal tissue surrounding the urethra, and a vaginal lining that is mucosal and capable of epithelialization, self-lubricating, elasticity to accommodate penetration, a minimum depth of 3.5 inches, and does NOT require lifelong dilation to prevent the vagina from closing up. This has been done before, and should be offered more frequently today. If these expectations cannot be met by the SRS surgeon in at least 90% of patients that undergo SRS, then surgeons should be prohibited by law from offering or performing SRS operations in the U.S. The SRS surgeon should be able to fully identify the female anatomy before even considering entering the SRS market. This, in return, will deter uncaring surgeons from performing these procedures on trans women; an already vulnerable population, only to deliver poor results and monetize from these poor results. SRS is a very open market in the U.S with very little competition. This attracts many surgeons into entering the market, especially as the number of insurance companies that cover SRS procedures continue to rise.

Aside from poor surgical technique, there are some surgeons in the U.S such as Dr. Loren Schechter and Dr. Katherine Last whose communications skills are lacking. That can be burdensome for many patients, and in rare cases could mean “no surgery” if too much time has been wasted, and insurance coverage runs out. This of course does not apply to patients who have $40,000 to pull out their ass. Dr. Loren Schecter and his team don’t just provide offensive-in-appearance outcomes when performing SRS, he also adds salt to the wound with red tape, a frigid demeanor, and a condescending team to aid him in his dirty work. Expect cancellations, rescheduling, and long waits. Do not expect the receptionist to do their job, as they require you to hold their hand when submitting documents for a pre-determination of coverage to your Insurance Company. Do not expect a call back when the results are in either. Furthermore, do not expect Dr. Schechter and his team to care.

Dr. Ting is known for his attention to detail, and offers the Peritoneal Technique as an alternative to P.I. His bedside manner is lovely, but the flip side is the long waiting list, and communication is non-existent. Scheduling an appointment for a consultation could take months, if not, years.

The quality of the outcome directly affects the trans patient’s satisfaction with undergoing SRS. When outcomes are poor, which in most cases, they are, this can be misconstrued by many ultra-conservative policy makers that the patient “regrets” undergoing SRS and that SRS does not alleviate symptoms of dysphoria. This would further complicate and diminish the progress that the trans community has already made to obtain better healthcare for the “trans” community. If the outcomes meet or exceed the patient’s expectations, the reports of feelings associated with regret would decline dramatically. “Trans” women need to make a decision as to whether or not they are going to continue to let the medical industry mistreat them; or come together and meet with state and local officials to put pressure on lawmakers to raise the bar, set higher expectations, and demand that the medical industry provide better care for the trans population.

References:

Sarwar, Iram,Vaginoplasty by Using Amnion Graft in Patients of Vaginal Agenesis Associated with Mayor-Rokitansky-Kuster-Hauser Syndrome.” Journal of Ayub Medical College, Abbottabad : JAMC, U.S. National Library of Medicine, 2010, www.ncbi.nlm.nih.gov/pubmed/21409892.

Seyed-Forootan, Kamal, Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-Vagina in Male-to-Female Reassignment Surgery.” Aesthetic Plastic Surgery, U.S. National Library of Medicine, Apr. 2018, www.ncbi.nlm.nih.gov/pubmed/29383415.

What is “transgender”? The terminology used to describe a woman born with the genitalia incongruent to her true gender and vice a versa to describe a man born with genitalia incongruent to his true gender is known as “transgender”. Although widely accepted, the word implies that someone who is “transgender” changes from one gender to another, which is not the case. In fact, this phenomenon is actually a physical disorder rather than a mental one. Gender dysphoria is the state in which a person feels trapped in the wrong body, which is the body of the sex that does not register or resonate with them. How this PHYSICAL disorder ended up being perceived as a mental disorder is beyond many intellectualists that know better. The concept itself is not complicated yet, conservative, misinformed, and ignorant opinion prevails to this day. Studies have already concluded that transsexualism is usually a result of a hormonal imbalance during fetal development; very similar to being intersex. “Transgender” is used for lack of a better word, but for the sake of understanding it will have to do for now.SRS is an acronym for Sexual Reassignment surgery and is also known as Genital Reconstructive Surgery (GRS) in which the genitalia that corresponds to their true gender are reconstructed from existing genitalia that is incongruent to their true gender. “MTF” patients undergo vaginoplasty and “FTM” patients undergo phalloplasty. However, the primary focus of this discussion is addressing “MTF” vaginoplasty, providers in the U.S that perform this operation, poor techniques offered and outcomes, and promising techniques that are available as alternatives that many patients and even providers are unaware of. The purpose of this discussion is to argue that patients and legislators ought to raise the bar for trans healthcare, more specifically regarding SRS operations and implementing regulations that would prohibit surgeons who cannot meet or exceed expectations of care from performing SRS on patients.According to a small study, between 56-84% of patients were happy with the functioning of their new genitalia after undergoing SRS. Although this sounds promising, the results could improve drastically if patients received different technique options that were more than likely not even presented to them prior to undergoing SRS. The options for SRS surgeons in the U.S to choose from are very limited, with the most popular names being Dr. Loren Schecter, Dr. Toby Meltzer, and Dr. Kathy Rumer. The most commonly performed technique is the Penile Inversion method in which the penile skin is used to line the new vagina. Some surgeons also use scrotal skin in conjunction to the Penile Inversion technique, but if they do, they use the scrotal skin to create the vaginal lining. The Penile Inversion technique is regarded as the “Golden Standard”; but this a very subjective lie that they used to alleviate any possibility of objection from patients, who deserve better. Penile skin keratinizes more than other options available that could serve as a vaginal lining. Potential for lubrication is very minimal, if at all. Hairs can also grow inside the vagina if laser hair removal prior to surgery is ineffective, and elasticity is very limited. Aesthetically speaking, the lining is not mucosal or pink in complexion, nor is the possibility for epithelialization when exposed to estrogen. Histologically speaking, the reconstructed vagina using the Penile Inversion method is as nothing close to an average, fully functional vagina. In addition to that, the inner labia is ALMOST NEVER constructed of mucosal tissue which should be Build-a-Vagina 101 and is something every functional vagina needs as it aids in accommodating to objects or partners for penetration. The neo-vagina often times isn’t even cut in a vertical-slit fashion. Yes, all vaginas are different, and come in different shapes and sizes, but poor surgeons really take advantage of that statement. As far as orgasms are concerned, it can usually be achieved through neo-clitoral stimulation and some report vaginal orgasms as well, yet penetration can be somewhat of a challenge. This is especially so with well-endowed partners, as elasticity is not a strong suit of the Penile Inversion method.As a secondary option, if not enough depth is achieved through the P.I method, a sigmoid graft can be used to line the vagina. The pros include a considerable amount of lubrication; sometimes in excess, more elasticity, and greater depth. However in rare cases, the discharge can have an unpleasant smell, and just like the P.I method, routine dilation is required to prevent the vagina from closing up. These two methods do NOT meet or exceed expectations for SRS neither aesthetically nor functionally.A more progressive, yet much older older technique available is the use of the peritoneum to line the vagina. This peritoneal skin is pink in complexion, mucosal, moist, self-lubricating, elastic and capable of epithelialization which is what gives vaginas that elastic, rugged, cushion. Considerable depth is also achieved using this technique. This method does meet or exceed expectations for SRS. Fenestrated buccal mucosa is another tissue some surgeons use to line the neo-vagina with acceptable results as well with the same outcomes as the last technique mentioned, minus the considerable depth.If you think those techniques were encouraging, the Autologous, Fibroblast-Seeded Amnion technique (Seyed-Forootan, 2018.) takes home the trophy for the most superior technique performed. The procedure is relatively simple, inexpensive, minimally-invasive, and the results are what one would regard as the “Platinum Standard” if they viewed the P.I technique as the “Golden Standard”. Studies done on both “trans” and cis women have concluded that vaginoplasty using an amnion transplant showed superior results and reported that patients had a fully functional, aesthetically acceptable vagina. All patients’ vaginas had epithelialized. The patients were “trans” women in one study and cis women with vaginal agenesis in another study. The women with vaginal agenesis in a separate study, (not as recent as the 2018 publication on trans women) received amnion grafts to form a vaginal canal. (Sarwar, Iram, 2010.) Most patients were able to stick two fingers in their vaginas effortlessly within 48 hours post-op. This technique eliminates the need to dilate to prevent the vagina from closing up and is not regarded as a wound by the patient’s body. Long-term follow up was recorded and the results are outstanding.There is not excuse for trans healthcare to not meet or exceed expectations of providing patients with a fully functional vagina for “trans” women. When caring for “trans” patients, the healthcare industry does not treat vaginoplasty with the same level of regard and urgency as they do for women who suffer from vaginal agenesis. To further complicate matters, U.S surgeons that perform these procedures on trans women are Board Certified yet are not up to date on the medical advances made that are mentioned in medical publications. A functional and aesthetically acceptable vagina has a sensate clitoris, sensate vestibules, which can be constructed with the erectile tissue present in MTF patients, a vaginal opening with a vertical appearance, an inner/outer labia; with the inner labia being mucosal, mucosal tissue surrounding the urethra, and a vaginal lining that is mucosal and capable of epithelialization, self-lubricating, elasticity to accommodate penetration, a minimum depth of 3.5 inches, and does NOT require lifelong dilation to prevent the vagina from closing up. This has been done before, and should be offered more frequently today. If these expectations cannot be met by the SRS surgeon in at least 90% of patients that undergo SRS, then surgeons should be prohibited by law from offering or performing SRS operations in the U.S. The SRS surgeon should be able to fully identify the female anatomy before even considering entering the SRS market. This, in return, will deter uncaring surgeons from performing these procedures on trans women; an already vulnerable population, only to deliver poor results and monetize from these poor results. SRS is a very open market in the U.S with very little competition. This attracts many surgeons into entering the market, especially as the number of insurance companies that cover SRS procedures continue to rise.Aside from poor surgical technique, there are some surgeons in the U.S such as Dr. Loren Schechter and Dr. Katherine Last whose communications skills are lacking. That can be burdensome for many patients, and in rare cases could mean “no surgery” if too much time has been wasted, and insurance coverage runs out. This of course does not apply to patients who have $40,000 to pull out their ass. Dr. Loren Schecter and his team don’t just provide offensive-in-appearance outcomes when performing SRS, he also adds salt to the wound with red tape, a frigid demeanor, and a condescending team to aid him in his dirty work. Expect cancellations, rescheduling, and long waits. Do not expect the receptionist to do their job, as they require you to hold their hand when submitting documents for a pre-determination of coverage to your Insurance Company. Do not expect a call back when the results are in either. Furthermore, do not expect Dr. Schechter and his team to care.Dr. Ting is known for his attention to detail, and offers the Peritoneal Technique as an alternative to P.I. His bedside manner is lovely, but the flip side is the long waiting list, and communication is non-existent. Scheduling an appointment for a consultation could take months, if not, years.The quality of the outcome directly affects the trans patient’s satisfaction with undergoing SRS. When outcomes are poor, which in most cases, they are, this can be misconstrued by many ultra-conservative policy makers that the patient “regrets” undergoing SRS and that SRS does not alleviate symptoms of dysphoria. This would further complicate and diminish the progress that the trans community has already made to obtain better healthcare for the “trans” community. If the outcomes meet or exceed the patient’s expectations, the reports of feelings associated with regret would decline dramatically. “Trans” women need to make a decision as to whether or not they are going to continue to let the medical industry mistreat them; or come together and meet with state and local officials to put pressure on lawmakers to raise the bar, set higher expectations, and demand that the medical industry provide better care for the trans population.References:Sarwar, Iram,Vaginoplasty by Using Amnion Graft in Patients of Vaginal Agenesis Associated with Mayor-Rokitansky-Kuster-Hauser Syndrome.” Journal of Ayub Medical College, Abbottabad : JAMC, U.S. National Library of Medicine, 2010, http://bit.ly/2HWgFR7, Kamal, Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-Vagina in Male-to-Female Reassignment Surgery.” Aesthetic Plastic Surgery, U.S. National Library of Medicine, Apr. 2018, http://bit.ly/2W6mHs5. https://ift.tt/eA8V8J http://bit.ly/2HYegW3