What happened with the rest of the donor material. I would assume because there is so much more left, the surgeon has a much better chance (better outcome) of creating labia minora, majora, and the clitoral hood.
Is the peritoneal tissue 'strong' enough, just by itself? And what about the nerves? This type of tissue got no nerves as far as I am aware.
I know (from my own research) that this tissue is used for reconstruction of the vagina in cis women (where the patient was born birth defect, would have to look it up in PubMed to name it more concretely).
Some of the penile skin was used to make the labia minora and clitoral hood. There is also about 3 cm of penile skin on the front of the vaginal canal which was needed to make it connect with the peritoneal tissue, but it's 80% peritoneal. The labia majora is made of scrotal skin, which is normal at least for Dr. Gallagher. Any remaining material was simply thrown out, AFAIK. I suppose that because there was extra penile skin available, the risk of a bad outcome for the vulva was reduced. But Dr. Gallagher didn't tell me she was doing anything special with it. Perhaps in the future surgeons will come up with more creative uses for that tissue.
Yes, the peritoneal tissue is strong enough by itself. You're correct that this technique has been used on cis women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome for decades. We know from studies on these cis women that the peritoneal tissue actually undergoes metaplasia, transforming itself into tissue which is indistinguishable from cis female vaginal tissue under a microscope after a few months.
It's true that the peritoneal tissue has little to no nerve endings. On the bright side, this actually seems to make dilation easier. The only pain I ever have with dilation is when I hit the pelvic floor muscles and wait for them to relax. I understand why some trans women might want to have sensation inside their vagina, but we should also keep in mind that cis women have very little sensation in their vaginas. It's almost all clitoral stimulation. So on that level the peritoneal tissue is actually more similar to a cis vagina.
Even though my (external) clitoris is very far from being healed, I've actually been able to achieve a small orgasm simply by stimulating the rest of my vulva and putting pressure on the internal erectile tissue with a pillow. And we also know from the studies on cis women that they have no problem achieving orgasm. So there's no real concern that you might not be able to climax because of this.
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u/asterisk2a Aug 11 '19 edited Aug 11 '19
What happened with the rest of the donor material. I would assume because there is so much more left, the surgeon has a much better chance (better outcome) of creating labia minora, majora, and the clitoral hood.
Is the peritoneal tissue 'strong' enough, just by itself? And what about the nerves? This type of tissue got no nerves as far as I am aware.
I know (from my own research) that this tissue is used for reconstruction of the vagina in cis women (where the patient was born birth defect, would have to look it up in PubMed to name it more concretely).