Granulation and scar tissue

[Guest Mikkiapolis]

I am looking for responses from transwomen who are at least 3 months post-op.

I'm feeling very down about my situation. What I need are real-life responses to my questions at the end below. Thank you.

My situation:

I am 8 months post-op tomorrow. I seemed to be healing well for the first few months. By month 4 I had increased girth from blue to green to orange (using the Soul Source dilators). I felt pretty happy and proud of my GCS results.

Then the pain started. It was like having pieces of broken glass up inside during dilation -- an utterly awful, horrible feeling. It started low on the pain scale, but over a few weeks worked its way up to about 8 or 9 out of 10 for pain. And I was dilating 2-3 times per day.

My surgeon was half a continent away, and my e-visits with her and her staff (including good photos) didn't help with this issue. By the time I got in to see the local GYN (who almost all transwomen see in my area) I had dropped back to the green dilator due to pain, and it still hurt a lot every time.

My GYN said I had moderate granulation tissue in the neo-vaginal area. My body apparently was overly enthusiastic in healing in several spots, and the overgrowth of tissue there was extremely sensitive. The usual treatment is to cauterize them, which she did (using silver nitrate) over the course of several visits.

I continued to have substantial pain during dilation. A few of the granulated areas have healed, but some persist. I've also lost girth at my neo-vaginal opening due to how the scars of stitches healed, causing tightening of the opening. I'm back down to the blue dilator, which is very disheartening.

My GYN now has me using a steroid cream to help tamp down the remaining granulation and loosen up the scar area. She claims to have seen some progress in recent visits. But I still can't imagine sizing-up from the blue dilator due to the pain.

I know it can take "a year to fully heal" and that sometimes it takes longer. I also know that many of my transwomen post-op personal friends have had MUCH better outcomes than mine: no granulation issues, no scar constriction, no dilation pain. At 3-4 months some of them were exploring penetrative sex.

I am feeling really hopeless, sad, and frustrated. I am worried that things won't ever get better. My GYN says she's seen MUCH worse, and most of those eventually healed. She also says that about 90% of the transwomen she sees have granulation. My surgeon says she only sees 10% with that issue. I'm not sure what to believe any more.

What would help me the most is to hear other, real-life post-op healing stories related to granulation and loss of girth during GCS healing.

My questions: (for post-op transwomen)

• How long ago was your GCS?
• Did you have granulation? When did it start? When did it go away? What helped?
• Did you experience a loss of girth? When were you able to restore it? What helped?
• At what point were you able to have (pain-free) penetrative, vaginal sex?
• How helpful was your surgeon with your post-op issues? Were you able to see them in-person?
• How helpful was your GYN?
• Any recommendations for me?

Thank you!

[VickySGV]

OK, 2 years and 6 months post op here. Let me see what I can help you with. Big item is that it took me nearly 18 months to have some of my scarring go away and other little problems go away. I missed the granulation, but did have a yeast infection that made it feel like my dilator was dipped in sand. The scarring is YOUR body trying to do what it's healing system does best, also the granulation fits in that category. I know one 14 month old who posts here on occasion that took nearly the full year for the granulation to heal. Another friend on Face Book is going into 9 months of silver nitrate every three weeks, and may be 4 months out from the end of the story by her Gyno's guesstimate.

I recently (2years and 3 months) had a problem develop where it was painful to dilate and at first thought it was a return of my yeast problems, which it probably was in the first two weeks (it was diagnosed that way) but it kept on for over a month, and my Gyno told me it was just severe tissue dryness (maybe due to the fungicide I had used) but she put me on a intra vaginal Estrogen cream, and we both got my Endo to up my Estrogen which has helped things immensely. The dryness issue did make my green friend (who is my largest one) very uncomfortable and it did seem like I had a constriction, I did revert to the blue one for a while, but three weeks of the E cream, and it is fine, and green one is nice and loose again. It may not hurt to have your estrogen levels checked, but from the sound of it you have a very good Gyno, listen and take regular breaths. PM me if you have other questions that are more personal.

[Guest DesiB]

My questions: (for post-op transwomen)

• How long ago was your GCS?
• Did you have granulation? When did it start? When did it go away? What helped?
• Did you experience a loss of girth? When were you able to restore it? What helped?
• At what point were you able to have (pain-free) penetrative, vaginal sex?
• How helpful was your surgeon with your post-op issues? Were you able to see them in-person?
• How helpful was your GYN?
• Any recommendations for me?

My GCS was about 3 & 1/2 years ago and I did have granulation tissue as soon as the healing process began. My surgeon treated it with silver nitrate at my 2 month, 5 month, and 1 year follow up visits. I could not get my local doctor during that period to do the silver nitrate treatments though she was well qualified and I asked repeatedly and it is certainly not difficult. Anyway, my surgeon's office also told me to apply hyrocortisone cream after each dilation to help with the granulation tissue as well. And at my 5 month follow up, I was given a year's prescription for Estrace cream to be applied vaginally twice per week.

I was always diligent with my dilation schedule and it was never a burden for me. I moved up to the large orange dilator in about a month and never went back--never even used the others again at all, except that I keep the green one in my shower and use it in there. With the location of my granulation tissue, I never had any loss of girth or really even painful dilations. But I did have full sensation and had my first climax just a few days past a month after surgery. I feel like I could have had sex about anytime I was comfortable with it. But since I never got to complete the surgeries I had planned with my surgeon before she violated my trust and refused to explain why she had done exactly what I told her not to do and then refused to follow up on it, I doubt I'll ever be comfortable.

All of my granulation tissue healed fairly well and reasonably quickly with the treatments I mentioned above, except for the area which was in the deepest part of my vagina. That part still causes minor occasional bleeding. I've just dealt with it on my own, since I no longer had a patient-doctor relationship with my surgeon following what she did to me at an in-office revision procedure (1 yr & 3 mos. post-GCS) and then refused to follow up on that (which is why I've still never had the follow up labiaplasty/full-revision I still need). I have been seen for a pap smear (inconclusive) and vaginal biopsy (negative) with a more recent gynecologist, who said it looks like I have two vaginas and asked if I've ever had my urethra dilated, but I did not risk opening up to her about my full history after the bad experiences I had with my previous GP/GYN and anyway nothing obvious was noticed about any granulation tissue at that particular time. I don't know what kind of deformed freak she thinks I am or how I got to be this way--guess she's just glad I don't have cancer cells. Anyway, I just got into the habit of wearing dry liners daily--just in case. Some days it turns out they are needed, other days they aren't.

[~Nova~]

I am about 3 years post op. I'm not sure exactly.

I had a lot of issues post op and luckily my surgeon was close so I was able to see him (Dr Reed) often. I had a lot of bleeding and I wouldn't heal. He used silver nitrate every week for a few months and it healed.

I haven't dilated in a while so I'm not sure where I am on the color scheme. (Maybe ill do it tonight and report back).

I hade my revision surgery about 6 months post op and I haven't had any issues since then. I guess I'm lucky.

Best of luck, please feel free to pm or ask questions here

nova