Thread by @_oatc_

@KatyMontgomerie 1/ Yes, I've been pushing for some years now for it to be used for us, but I'm not sure if anyone actually has done so, partly because surgeons wedded to the penile inversion technique they know are using the P tissue as free donor grafts, & mixing up the terms.

@KatyMontgomerie 2/ Actual PPV, also called Endoscopic Davydov📽️, leaves the tissue fully attached, eliminating tissue death risks, pulls it down to be sewn to the vaginal opening, then creates a pouch by purse-stitching higher up. Only dilation of the entrance is needed.

@KatyMontgomerie 3/ Papers on outcomes in MRKH 🚺 show high satisfaction, & success. Depths are adequate, although less than the deepest by penile inversion. The tissue does seem to become similar to OEM vaginal lining & is naturally moist, & odourless before natural vaginal biota establish.

@KatyMontgomerie 4/ There are MRKH-experienced surgeons willing to take trans patients, & #SRS surgeons willing to work with endoscopic surgeons as necessary. Other benefits generally should include less pain, much shorter bed time, & hospital stay, reducing costs, & risks. PPV seems…

@KatyMontgomerie 5/…ideal where a vaginal lining has failed & where there is inadequate tissue. In contrast to colon-resection, normally used in such cases, there is no effect on the digestive tract, less trauma & risk, no odour or irritation from digestive secretions, & no peristalsis😬 motion

@KatyMontgomerie 6/ The downside compared to penile inversion (where that's an option) is that the P tissue is not innervated, so other than the sense from surrounding tissue of being filled, sensation is limited to the entrance, as in OEM vagina. But a fully sensate vagina can be "too much" 😳

@KatyMontgomerie cc @threadreaderapp unroll please

bcc @transmum1 😄

@KatyMontgomerie 7/ It is important, when PPV is chosen because of shortage of "material", that it is done at the same time as vulvoplasty, otherwise, if a "blind vagina" were created first, then a PV attached, there would be wastage of precious skin at the vaginal entrance.