#initial hypospadias surgery

[hypospadiasclinics]

My talk at the Hypospadias International Society (HIS)meeting

I had the great privilege to take part in the HIS meeting held in Brazil a few months ago. I couldn’t go there physically due to some family commitments. So, I attended the virtual meeting for 3 days. In the meeting, I delivered a talk on 2-stage repair for complex failed hypospadias cases with the use of oral mucosal graft. I was among the very few doctors from India to attend this meeting and deliver a talk at this prestigious meeting.

Hypospadias is one of the most common congenital anomalies. Unfortunately, there is not much awareness in the general public or even among many doctors about this problem. There are several reasons for this:

Hypospadias is an external anomaly and is not usually life-threatening. So, most people think that it is a minor problem.

Many doctors also don’t realise that hypospadias surgery is a technically demanding operation and has to be only done by the best surgeon.

Most people have little awareness about the far-reaching complications of hypospadias, which not only affects urination but can potentially disrupt the normal adult life of the person and the family.

The social and psychological stigma associated with hypospadias. Being a genital problem, most parents are not ready to share the information with family and friends and take their help to search for the best doctor for hypospadias surgery.

Once the child grows older, he becomes shy and doesn’t discuss the problem with the parents anymore.

Most parents and many doctors think that hypospadias is a minor problem and seek a solution from the local doctors; if the surgery is successful, it is ok. But more often than not, the operation may result in failure, and only then do the parents start looking for an expert. This results in the child undergoing multiple operations, including more complex reoperations, which could have been avoided if an expert surgeon had been involved from the beginning.

Thus, hypospadias remains a common and neglected problem. In addition, many surgeons of many specialities perform hypospadias surgery, and there are hundreds of techniques for hypospadias repair. This makes things more complicated for parents to choose the best surgeon and for family physicians to refer these cases to the best surgeon for hypospadias!

The purpose of the Hypospadias International Society (HIS) was to disseminate proper knowledge about hypospadias correction techniques among its members. Many enthusiastic surgeons from across the globe participate in its annual meetings. The latest meeting in Brazil was attended by over 100 hypospadialogists. Various techniques of hypospadias repair, including primary and complex failed hypospadias repairs, were discussed by experts. The pros and cons of various techniques were debated by experts in a scientific atmosphere. The long-term follow-up and results of hypospadias repairs were also discussed. 

My talk in the HIS meeting was about the most complex cases of hypospadias, which come after multiple failed operations elsewhere. These cases are very complex and require the expertise of the best hypospadias surgeon. Typically, a 2-stage (sometimes 3-stage) repair is performed utilising the skin taken from inside the oral cavity (mouth) as a graft to prepare the deficient urinary tube (urethra). We have done more than 100 such cases over the past 8 years in Hyderabad, with over 90% success of such complex operations. Our patients come from all over India, including Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, Kerala, Orissa, West Bengal, Bihar and UP. We also performed complex redo hypospadias repairs on international patients who underwent their initial failed hypospadias operations in other countries.

My talk about the technique and results of complex hypospadias reconstructions at the HIS meeting was highly appreciated. I received positive messages from many surgeons across the world congratulating us for our work and the good results. However, an ideal situation is where no child requires such complex reconstructions for failed hypospadias. This is possible if the initial hypospadias surgery is performed by experts only. When choosing the best hypospadias surgeon for their child, parents should spend some time identifying the best surgeon with the best results in hypospadias repair. Remember, even the best surgeon can have complications (like the best driver can have an accident), but the complications will be a small percentage, usually minor and easily treatable. I discussed a few tips for parents in my earlier blog about how to choose the best hypospadias surgeon for their child. That blog may be referred to by those interested in knowing more about this.

[medtour2023]

Hypospadias Surgery: Correcting a Common Congenital Anomaly

Hypospadias is a common congenital condition in which the opening of the urethra is located on the underside of the penis instead of at the tip. It is estimated to affect around 1 in 200 newborn boys. Hypospadias can vary in severity, with the urethral opening positioned anywhere along the underside of the penis, from the glans to the scrotum. Surgical correction is typically recommended to restore normal urinary and sexual function. In this article, we will explore hypospadias surgery in detail, including its indications, surgical techniques, considerations, and postoperative care.

Indications for Hypospadias Surgery

Hypospadias surgery is typically recommended for the following reasons:

1. Urinary Function: Hypospadias can affect the direction and flow of urine, making it challenging for a boy to urinate standing up. Surgery is performed to reposition the urethral opening at the tip of the penis, allowing for improved urinary function.

2. Cosmetic Appearance: Hypospadias can result in a penis that appears abnormal, with the urethral opening located on the underside. Surgical correction aims to enhance the cosmetic appearance of the penis, creating a more natural and symmetrical appearance.

3. Sexual Function: In severe cases of hypospadias, where the opening is located near the scrotum or perineum, sexual function may be affected. Surgery can help restore normal sexual function by repositioning the urethral opening to the tip of the penis.

Surgical Techniques for Hypospadias Correction

There are different surgical techniques available to correct hypospadias, and the specific approach chosen depends on the individual case and the surgeon's expertise. The two primary techniques used are:

1. Snodgrass Technique: The Snodgrass technique, also known as tubularized incised plate (TIP) repair, is the most common surgical procedure for distal and midshaft hypospadias. It involves creating a tube using the inner lining of the foreskin or other available tissue to extend the urethra to the tip of the penis. The tissue is shaped and sutured to form a neourethra, restoring normal urinary flow.

2. Mathieu Technique: The Mathieu technique is commonly used for distal hypospadias. In this technique, the urethral plate is incised and flipped to create a tube. The edges of the incised plate are then sewn together to form a neourethra. This technique is particularly suitable when the urethral plate is healthy and of adequate length.

Considerations and Preoperative Care

Before undergoing hypospadias surgery, certain considerations and preoperative care steps should be taken:

1. Age of the Child: Hypospadias surgery is typically performed when the child is between 6 and 18 months old, depending on the severity of the condition and the surgeon's recommendation. Early intervention allows for optimal surgical outcomes and helps minimize psychological and social impact as the child grows.

2. Anesthesia: General anesthesia is usually used for hypospadias surgery to ensure the child remains still and comfortable throughout the procedure. The anesthesia team will provide specific instructions regarding fasting and any necessary preoperative testing.

3. Circumcision: In some cases, circumcision may be performed concurrently with hypospadias surgery. The decision to perform circumcision will depend on the surgeon's recommendation and cultural or personal preferences.

Postoperative Care and Recovery

After hypospadias surgery, proper postoperative care is crucial for successful healing and optimal outcomes. The following guidelines are typically followed:

1. Catheter Placement: A catheter is often placed to allow urine drainage during the initial healing period. The catheter may be left in place for a few days or weeks, depending on the surgical technique and the surgeon's preference.

2. Dressing and Wound Care: The surgical site will be covered with a dressing, which should be kept clean and dry. Specific instructions will be provided on how to care for the dressing, clean the area, and apply any prescribed ointments or medications.

3. Activity Restrictions: Strenuous physical activity, such as running or jumping, should be avoided during the initial recovery period to prevent damage to the surgical site. The child should be encouraged to engage in quiet play and avoid straddling activities.

4. Follow-up Visits: Regular follow-up visits with the surgeon are essential to monitor the healing process, remove any sutures or catheters if necessary, and address any concerns or complications that may arise.

Outcomes and Complications

Hypospadias surgery generally has favorable outcomes, with high success rates in achieving normal urinary function and cosmetic appearance. However, as with any surgical procedure, there are potential complications to be aware of, including:

1. Fistula: A fistula is an abnormal opening that can occur along the surgical site, leading to urine leakage. It may require further surgical intervention to repair.

2. Urethral Stricture: Urethral stricture refers to the narrowing of the repaired urethra, which can cause difficulty with urination. It may require additional treatment or surgical correction.

3. Cosmetic Irregularities: Despite efforts to achieve a natural appearance, minor cosmetic irregularities may occur, such as mild curvature or differences in skin coloration.

Cost in India

The cost of hypospadias surgery can vary significantly across different countries due to variations in healthcare systems, economic factors, and local pricing structures.

Hypospadias surgery in India is generally more affordable compared to Western countries. The cost can range from approximately USD 1000 to 3000 or more, depending on the hospital, the surgeon's expertise, and other factors. India is a popular destination for medical tourism due to its lower healthcare costs.

Conclusion

Hypospadias surgery is a common procedure performed to correct a congenital anomaly in which the urethral opening is located on the underside of the penis. Surgical correction aims to restore normal urinary and sexual function and improve the cosmetic appearance of the penis. Various surgical techniques are available, and the choice of approach depends on the severity of the condition and the surgeon's expertise. Proper preoperative care, surgical technique selection, and postoperative care are crucial for successful outcomes. With early intervention and appropriate management, hypospadias surgery can effectively correct the condition, allowing affected individuals to lead normal, healthy lives.

[indianhealthguru]

Urethral Renewal: A Deep Dive into Urethroplasty Surgery!

What is an urethroplasty surgery?

Urethroplasty is a surgical procedure designed to repair and reconstruct the urethra, the tube responsible for carrying urine from the bladder out of the body. This surgery becomes necessary when the urethra is damaged due to trauma, strictures, or other medical conditions, leading to difficulties in urination and potential long-term complications.

Urethroplasty is typically recommended in cases where less invasive treatments, such as dilation or internal urethrotomy, have proven ineffective. Common conditions that may necessitate urethroplasty include urethral strictures, hypospadias, and urethral trauma. The decision to opt for this surgery is made after a thorough evaluation of the patient's medical history, symptoms, and diagnostic test results.

Benefits of urethroplasty surgery?

Bold advancements in medical science have paved the way for transformative procedures like urethroplasty surgery. This surgical intervention, aimed at repairing and reconstructing the urethra, brings forth a myriad of benefits for individuals grappling with urethral issues. One of the primary benefits of urethroplasty surgery is its unparalleled ability to restore normal urinary function. Urethral strictures, marked by the narrowing of the urethra, can impede the natural flow of urine, leading to discomfort and complications.

Urethroplasty addresses this issue by widening or reconstructing the affected area, ensuring a smooth and unobstructed passage for urine. This not only alleviates immediate symptoms but also prevents potential complications such as urinary retention and kidney damage. Urethroplasty acts as a catalyst for an improved quality of life, allowing patients to break free from these limitations. The surgery not only addresses physical symptoms but also positively impacts the psychological and emotional aspects of well-being.

How long is a catheter in for urethroplasty?

The duration a catheter remains in place after a urethroplasty surgery can vary based on the specific details of the procedure, the patient's condition, and the surgeon's recommendations. Typically, the catheter is used to assist in the healing process and ensure proper drainage of urine during the initial stages of recovery. The duration a catheter remains in place can vary, but it is not uncommon for it to stay in for a week or more. Surgeons may opt for a shorter or longer period based on the complexity of the surgery, the extent of the urethral reconstruction, and the patient's individual response to the procedure.

Can I sit after urethroplasty?

In the immediate aftermath of urethroplasty, it's common for patients to experience some discomfort or pain around the surgical site. Surgeons may advise against prolonged sitting or may recommend specific positions that minimize stress on the pelvic area during the initial days following the surgery. As the healing progresses, patients can gradually resume normal activities, including sitting, based on their comfort level. It's essential to listen to the body and avoid pushing oneself too quickly. Gradual reintegration of activities can contribute to a smoother recovery.

What should I avoid after urethroplasty?

Engaging in activities that put significant strain on the pelvic area, such as heavy lifting or intense exercise, should be avoided during the initial stages of recovery, follow the specific guidelines provided by your healthcare team regarding activity restrictions, during the early postoperative period; it's advisable to avoid prolonged periods of sitting to minimize stress on the surgical site.

When sitting is necessary, consider using a cushion or adopting a position that minimizes pressure on the pelvic area. Always consult with your healthcare team for personalized advice based on your specific case. Following their instructions diligently is essential for a smooth and successful recovery after urethroplasty.

Conclusion

In conclusion, urethroplasty surgery stands as a transformative intervention for individuals facing challenges related to urethral issues. This comprehensive and intricate procedure plays a pivotal role in restoring normal urinary function, providing long-term relief from urethral strictures, and significantly enhancing the overall quality of life for patients. Urethroplasty is not just a surgical procedure; it symbolizes a pathway to renewed well-being and a life free from the constraints of urethral issues. If you or someone you know is considering urethroplasty, consulting with a qualified healthcare professional is the first step towards embarking on a journey to a healthier and more fulfilling future.

[aaditya01]

"Hyderabad's Urology Expert: Leading Care"

Hyderabad has witnessed significant expansion of urological services offered by seasoned doctors in the past decade. Multispecialty hospitals across the city now have dedicated urology departments manned by experts trained overseas as well as in premier Indian institutes. Availing minimally invasive solutions, advanced surgical interventions or simple medication advice for urinary problems is possible by consulting an accomplished urologist in Hyderabad itself.

Infrastructure and Technology

Equipped with cutting-edge infrastructure for accurate diagnosis and effective treatment of all urinary health conditions, the urology departments in Hyderabad deliver high success rates. Latest generation cystoscopes, resectoscopes, ultrasonograms, laboratory, modular OTs etc facilitate both basic and complex care. Robotic surgery with da Vinci systems also offered by select centres.

Outpatient consultations diagnose conditions that may merely need medications, dietary advice or non-invasive approaches initially. Admissions provide round-the-clock monitoring for cases needing interventional treatments via expertise of on-call specialists. Prompt emergency services available for acute retention, infections etc.

Key Treatment Areas

The extensive spectrum of care provided by Hyderabad’s urologists spans:

Genitourinary cancers like prostate, bladder or kidney cancer

Infertility workup and advanced surgical sperm retrieval techniques

Neuro-urological conditions causing incontinence or retention

Reconstructive urological procedures including trauma-induced damage reconstructive surgery

Paediatric urological conditions like hypospadias, undescended testes etc

Andrology specializing in erectile dysfunction and male infertility

Endourological stone removal, prostate procedures, laparoscopy etc

Renal transplantation services offered by nephro-urology teams

These result in complete solutions for problems like difficulty in urination, urine leakage, blood in urine, painful urination, blockages, sexual health troubles etc. through medication or surgery.

Ethical Practice Standards

Urologists in Hyderabad strictly adhere to ethical evidence-based protocols aligned with national and international care guidelines regulated by bodies like Urological Society of India. Patient safety and data privacy are upheld through rigorous quality mandates and control systems.

Continual Upgrades of Knowledge and Skills

The specialists keep upgrading their clinical knowhow and technical finesse via research, publications, conferences and skill enhancement courses at premier institutes. Latest advances get incorporated into optimized patient management plans. Compassionate support staff trained in managing urinary conditions aid prompt recovery.

Thus Hyderabad offers access to accomplished urologists implementing cutting edge solutions through a patient-centric approach currently. Patients from both AP and wider South India find reliable urological care available here through reputed hospitals without needing to travel further.

[thekotaroo]

Profiles of Pride: June 5th!  🏳️‍🌈Michael Dillon🏳️‍🌈

Laurence Michael Dillon (May 1st, 1915 - May 15th, 1962) was a British physician and the first trans man to undergo phalloplasty.

Dillon had long been more comfortable in men’s clothing and knew that he was not a woman. In 1939, he sought treatment from Dr. George Foss, who had been experimenting with testosterone to treat excessive menstrual bleeding; at the time, the hormone’s masculinizing effects were poorly understood. Foss provided Dillon with testosterone pills but insisted Dillon consult a psychiatrist first, who gossiped about Dillon’s desire to become a man, and soon the story was all over town. Dillon fled to Bristol and took a job at a garage. The hormones soon made it possible for him to pass as male, and eventually the garage manager insisted that other employees refer to Dillon as “he” in order to avoid confusing customers. Dillon was promoted to tow truck driver and doubled as a fire watcher during the Blitz.

Dillon suffered from hypoglycemia, and twice injured his head in falls when he passed out from low blood sugar. While he was in the Royal Infirmary recovering from the second of these attacks, he happened to come to the attention of one of the world’s few practitioners of plastic surgery. The surgeon performed a double mastectomy, provided Dillon with a doctor’s note that enabled him to change his birth certificate, and put him in contact with the pioneering plastic surgeon Harold Gillies.

Gillies had previously reconstructed penises for injured soldiers and performed surgery on intersex people with ambiguous genitalia. He was willing to perform a phalloplasty, but not immediately; the constant influx of wounded soldiers from World War II already kept him in the operating room around the clock. In the meantime Dillon enrolled in medical school at Trinity College, Dublin under his new legal name, Laurence Michael Dillon. A former tutor of Dillon’s persuaded the Oxford registrar to alter records to show that he had graduated from all-male Brasenose rather than the women’s college St Anne’s, so that his academic transcript would not raise questions. Again he became a distinguished rower — this time for the men’s team.

Gillies performed at least 13 surgeries on Dillon between 1946 and 1949. He officially diagnosed Dillon with acute hypospadias in order to conceal the fact that he was performing sex-reassignment surgery. Dillon, still a medical student at Trinity, blamed war injuries when infections caused a temporary limp. In what little free time he had he enjoyed dancing, but he avoided forming close relationships with women, for fear of exposure and in the belief that “One must not lead a girl on if one could not give her children.” He deliberately cultivated a misogynist reputation to prevent any such problematic attachments.

Dillon qualified as a physician in 1951 and initially worked in a Dublin hospital. He then spent the six years at sea as a naval doctor for P&O and the China Navigation Company.

Dillon had not revealed his own history in Self, but it came to light in 1958 as an indirect result of his aristocratic background. Debrett’s Peerage, a genealogical guide, listed him as heir to his brother’s baronetcy, while its competitor Burke’s Peerage mentioned only a sister, Laura Maude. When the discrepancy was noticed, he told the press he was a male born with a severe form of hypospadias and had undergone a series of operations to correct the condition. The editor of Debrett’s told Time magazine that Dillon was unquestionably next in line for the baronetcy: “I have always been of the opinion that a person has all rights and privileges of the sex that is, at a given moment, recognized.”

The unwanted press attention led Dillon to flee to India, where he spent time with Sangharakshita (Dennis Lingwood) in Kalimpong, and with the Buddhist community in Sarnath. While at Sarnath, Dillon decided to pursue ordination and became Sramanera Jivaka (after the Buddha’s physician). Because Sangharakshita refused to allow Jivaka full ordination, and other frustrations with Sangharakshita’s management of Triyana Vardhana Vihara, Jivaka turned to the Tibetan branch of Buddhism. He went to the Rizong Monastery in Ladakh. He was reordained a novice monk of the Gelukpa order, taking the name Lobzang Jivaka, and spent his time studying Buddhism and writing. Despite the language barrier he felt at home there, but was forced to leave when his visa expired. His health failed, and he died in a hospital at Dalhousie, India, on 15 May 1962, age 47.

After Dillon’s death, his brother said he wanted to burn Dillon’s unpublished autobiography, but the manuscript was saved by Dillon’s literary agent and published as Out of the Ordinary in 2017.

[bestpediatricurologist]

Pediatric Laparoscopy Surgery In Delhi

Pediatric Laparoscopy Surgery

Surgeries are scary, and when it is for your child it is the scariest! You would be terrified to make your mind to take your child to a surgery, preparing for the hospital stay and going through the child recovery process. The happy news is that, there are minimally invasive approaches to treat children with surgical conditions.

Pediatric Laparoscopic surgeries are performed by makings small incisions in your child’s skin, through which the surgeon inserts small tubes with a tiny telescope to see inside and then special instruments to operate on the child.

Pediatric laparoscopic surgery in Delhi

It would be your wisest decision choosing to do a pediatric laparoscopy surgery for your child in Delhi. The best pediatric laparoscopy surgeon in Delhi has the specialised expertise to diagnose, treat and administer your child’s surgical conditions. He has the experience in handling the children patiently and in treating the child after a thorough examination and precise diagnosis. He also uses state-of-the-art facilities and specialised equipment. Your child is treated in a very comfortable and fearless environment by the best pediatric laparoscopy surgeon in Delhi.

Conditions treated by the best pediatric laparoscopy surgeon in Delhi

Advanced medical technology allows many of the surgical conditions to be performed through minimally invasive laparoscopic techniques. Below are few conditions treated laparoscopically –

Treatment of a blocked kidney

Ureteral re-implant to treat vesicoureteral reflux or a blocked ureter

Treatment of an ectopic ureter or a ureterocele

Treatment of an infected belly button

Removal of a bladder diverticulum (pocket in the bladder)

Removal of a nonfunctioning kidney

Treatment of an undescended testicle

Treatment of a swollen vessels in the scrotum

The procedure

The pediatric laparoscopic surgical procedure is performed under general anaesthesia. 3 – 5 small incisions are made in the abdomen, depending on the condition to be treated – close to the belly button, either side of the belly and below or above the belly button. Hollow tubes (cannulas) are inserted into the incisions to operate on the child. Initially, carbon dioxide is filled inside the abdomen to make enough space for the surgeon to operate. A tiny telescope (laparoscope) is inserted through one of the tubes, which shows your child’s inside organs on a television screen in the theater. The surgeon inserts special instruments through other tubes at the other sites to perform the surgery. Give your child in the hands of the best pediatric laparoscopy surgeon in Delhi, and you would have no fear and no worries.

The benefits of pediatric laparoscopic surgery for your child

Pediatric laparoscopic surgeries performed by the best pediatric laparoscopy surgeon in Delhi is completely safe for your child. This technique has many advantages over the traditional open surgery.

There is no big cuts or big scars as the procedure is done through small incisions

This is a painless procedure as there is no big cuts

The healing of small incisions is faster than bigger cuts

No complications of incision healings

Quicker recovery and your child returns to his normalcy much faster

Less costly

Aftercare at the hospital

The aftercare given by the best pediatric laparoscopy surgeon in Delhi is commendable. It is accompanied with a family-centered care that ensures the parents are always connected with their babies during the whole stay at the hospital. Your child will be kept in the Post Anesthesia Care Unit for about 1 – 2hours. Once the child becomes conscious, he will be kept under observation in another room. During this time, he will be given some medications through an intravenous line. At the stage where the nursing staff gives oral painkiller medications, your child is also ready to sip liquid foods. The nursing staff will encourage your child to bend up and will take him to walk around the room, soon after the procedure.  This is to help with easy breathing and stimulate blood circulation.

How do you take care of your child after pediatric laparoscopy surgery?

The wound dressing can be removed in 3 – 4 days after surgery, following consultation of the pediatric surgeon. Small strips under the big dressing should be left in their places for about 1 – 2 weeks, and until the surgeon says they can be removed off. Your child can be let to have showers and make sure the incision area is made to dry well. Give your child ample rest for the first week and make sure no heavy lifting, no sports, no bike riding or swimming until he is completely recovered. Be cautious on any unusual symptoms of rare complications and be never late to call the doctor.

Corrective surgeries with no complications for your child is an absolute possibility by consulting the best pediatric laparoscopy surgeon in Delhi. You need not have any hesitance in taking your child for a pediatric laparoscopic surgery in Delhi.

For More Info.(http://www.pedsurgerydelhi.com/)

Tag =  pediatric laparoscopic surgeon in delhi, best pediatric urologist in india, best pediatric laparoscopy surgeon in delhi, Treatment for renal duplex system delhi, hypospadias surgery in delhi

[biomedres]

Journals on Medical Microbiology- BJSTR Journal

To Cultivate Neourethra of Autologous for Proximal Hypospadias Repair of No Associated with Severe Chordee  by Liu Guoqing* in Biomedical Journal of Scientific & Technical Research https://biomedres.us/fulltexts/BJSTR.MS.ID.001334.php#

Background: Hypospadias is a common congenital disease and the incidence of live birth is about 1/1250~1/1830 [1]. The most typical is ectopic urethra, the ventral curved downwards of penis, and dorsal skin is “hooded”. According to the urethral open position, 80% of patients have a distal malpositioning of the meatus that requires a single-stage repair and nearly 20% have a more severe proximal meatus malposition, which may require two to three stage repair operations. The more serious the initial problem, the higher the complication rate, and the more operations the patient is likely to require. The common postoperative complications of hypospadias include urethrocutaneous fistula, urethral stricture (dysuria) and ventral penile curvature. In a large number of reports of surgical treatment of hypospadias, the evaluation indicators are all complications that are easy to find in the early stages. The performance and acceptability are based on short-term observations. As for satisfaction, it is not possible to seek the opinions of the patients. The final assessment of the effect of the operation can only be determined based on their parents’ “degree of satisfaction”. In view of the incomplete evaluation index of existing treatment effects, many authors proposed the appearance of the penis, penile curvature and urination function as a new index of hypospadias surgery. Research suggests that the preoperative assessment of the severity of hypospadias and the rational choice of surgical methods are important guarantees for the reduction of postoperative complications of hypospadias, and also for the satisfaction of the appearance of the penis and normal sexual function. 

For more Articles on Journals on Medical Microbiology please click here

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[thepcxp]

FreeToM Prosthetics 4-in-1 Traditional 6.5" Review (NSFW)

What happens when you're born with male anatomy but happen to be born with an intersex condition at the same time? You get a smaller than normal penis (a micropenis, really), along with hypospadias and chordee, which can make it difficult to participate in certain sexual activities and even make peeing standing up challenging, plus you've got a smaller than average bulge. So what do you do to solve this problem - without having to resort to expensive, risky, time-consuming, and painful surgeries? You buy a prosthetic penis! That's what I did in late March of 2015.

Disclaimer

Keep in mind that this coming from an intersex guy's point of view, and not from an FTM (I wasn't born female, but I was misassumed to be female at birth, and I consequently had to go through legal gender re-assignment later in life because of this gender error at birth). I made this review primarily to help out the intersex community since I feel like this is something that could use more discussion in the community. Prosthetics are a great alternative to surgery - which can be very expensive, time consuming, painful, and full of side-effects - and more intersex guys should get this option, instead of being pressured into getting a surgery that may not be productive and satisfactory (I'm not trying to discourage anyone from getting surgery - you can if you want to - I'm simply trying to present an alternative, especially since intersex people are often pressured into getting surgeries that they may not even want in the first place). Even though this is primarily targeted towards the intersex community, anyone, including FTMs, can read this. Keep in mind that this review is based on my own personal experience and that everyone else's is going to be different.

Shipping & Customer Service

I placed my order on March 22, 2015. I originally had to wait 14 days to get it but it turns out that during this time, they were doing some restructuring and so about a week before the 14 business days was up, they announced that we had to wait 39 business days to receive our orders (I found out on the FAQ section). So that means that I had to wait until early to mid May to get my Traditional.

On May 11, I got an email from them saying that my order had shipped with a link to my tracking number. My order was expected to arrive on the 18 of May. That day came and nothing arrived. I decided to wait a week to see if it arrived by then (I thought that maybe USPS had a backlog of orders and were running late). After a week went by and nothing had still arrived, I decided to contact FreeToM via their live chat feature on their site. To my surprise, they seemed to have had a knowledge of my situation, even before I contacted them. At the time, they told me that they were trying to get a hold of USPS but that they were unavailable.

The following week (it was June by then), I decided to email them regarding my lost package (no pun intended) and to tell them that I was going to place a new order. Surprisingly, they offered me to send me a new one, so I decided to accept the offer. The estimated wait time by then was 12 business days (while keeping in mind that quality control, demand, and all that other stuff might backlog my order to 21-24 days). 12 days went by and and I hadn't received an email yet, so I thought that they either had to make my prosthetic all over again or that they had a lot of orders  (it looks to me like it was the former because during that time, I saw a Traditional just like the one I ordered on the clearance section), so I decided to wait another 12 business days.

On July 3rd, I decided to email FreeToM just to check on my order. It turns out that by then, my order was getting ready to ship but that it would not ship until the 6th because of the upcoming 4th of July weekend (so it turns out I was right about my order being backlogged because of the issues I mentioned in the last paragraph). They told me they were going to send me an email with my tracking number but I never got that (and that was alright with me in this case - you'll see why next). I thought that maybe they were being backlogged again but it turns out that it had indeed shipped by that time (the 6th) because I received a nice surprise the following week! :D

So overall, I had a pleasant experience with FreeToM's customer service. They did a great job dealing with my lost package ordeal (something that was completely out of their control and totally not their fault). A few months after I received my prosthetic, they switched from USPS to FedEx since apparently USPS isn't so reliable these days (this year was the first time I've had a negative experience with USPS). Supposedly, they added status reports to their orders - with the statuses being: molding, demolding, cutting, paint plus upgrade (if you ordered your prosthetic with the paint upgrade), quality control, packaging, and shipping. This is something I wish they had implemented earlier this year when I ordered from them. It definitely would've been useful back then.

Packaging

My FreeToM came in a small white box. The labeling on the box is discreet - it just says "FreeToM" and doesn't mention anything about them being a prosthetic penis or prosthetic penis company. It also had my order number and initials on the side. Inside the box was my Traditional in a small, handmade canvas bag, wrapped in plastic. There was also the erection rod in a small, bubble-wrapped bag, a proper care brochure, a brochure regarding the rod, and my order summary.

First Impressions

When I first got it, I noticed that the cup seemed to be a bit shorter than usual. It also had rougher cuts than normal (FreeToM says that rough cuts are a normal part of the process, since they're hand-made and have to cut it away from the excess silicone once it comes out of the mold). Even though I didn't really mind it, I still thought that I would mind it just a little bit. Turns out, I was wrong. I'm actually loving it. I still would like one with a more "normal" and smoother cup, so I'll try to get one of those next time and compare that to this one.

Size

The penis is 6.5" in length and anywhere from 5-6 inches in girth. I measured my Traditional with measuring tape in 4 different areas (the upper, mid-upper, mid-lower, and lower parts). The results I've got were quite interesting, to say the least. I found out that at the upper part of the prosthetic (where the head is) it measured about 5.5". When I got to the upper-mid section, it measured a little over 5.5". Then when I got to the lower-mid section, I found out that it measured anywhere from a little under 6" to 6". Finally, I found out that the lower part of the prosthetic (where it connects to the body) a little over 6" (about 6.2" or 6.3")! So as you can see, it is quite girthy (which is the way I like it!). FreeToM's website says that the girth of the Traditional is at about 5 3/4", but they state in their FAQ section that the size of their prosthetics might be different than what they state in their website (which makes perfect sense considering the fact that they're hand-made).

Look

The FreeToM Traditional may not look as realistic as Reelmagik prosthetics, but it looks way more realistic than the Peecock. Either way, its still very realistic looking. It'll look even more realistic with the paint job (I didn't get the paint job on mine because I couldn't afford it, but I plan on getting it for the "All Natural" 6.5" I plan on getting in the near future). This thing actually looks like a giant version of my real penis with the veins and head, except that mine is uncircumcised. I got it in rosy skin because my real penis (and somewhat the scrotum) looks kinda rosy. The prosthetic actually turned out to be a bit darker than my natal dick, but it was fairly close and I'm still satisfied with it (the head of my natal penis is the part that comes closest to the color of the prosthetic). I'm going to get my next prosthetic in a color that's closer to both my regular and scrotal skin, which is the warm rosy skin.

Feel

As a bio guy (who happens to have an intersex condition), I can tell you that the skin on the FreeToM feels pretty realistic (it is almost an exact replica of a real penis). It has a bit of a sticky type of feel, just like my real anatomy, which means that stuff like linen will get attached to it. This happens with my real genitals as well and is removable on both my natal penis and the prosthetic. Bio penises/scrotums have a tiny bit of a tacky feel and this prosthetic has that too (although a little more) and therefore adds to the realism further (plus silicone in general has a more tacky feel). In order to get a feel for this, grab a post-it note and feel the sticky part of it. This will give you an idea of how it feels - I think this is the closest you can get to that (although both the prosthetic and my natal anatomy feel a bit less sticky than that). Something to keep in mind is that the skin on a bio male's genitals have a more sticky type of feel, whereas regular skin doesn't (I can confirm this with both my own genitals as well as hearing the experiences from other bio guys) - my guess is that this is something that catches Transguys/FTMs off guard. The only thing it doesn't have is movable foreskin (which is something that the Reelmagik has), so that takes away from the realism a bit. Additionally, It can be pulled and stretched like a real penis (I tried this with both my own and the prosthetic, in order to compare them both).

I tried squeezing both my real penis and my prosthetic penis, both flaccid and erect. I found out that the prosthetic is almost an exact replica of my real penis when its flaccid. The only difference is that the prosthetic has a bit of a more semi-erect feel because of the extra silicone required to make it durable enough for both play and everyday use, whereas my real penis feels a bit more squishier and softer.

Packing

When I first put it on, it felt a bit awkward, since this is my first prosthetic and I've never put one on before 'till this point. The stickiness of both my natal junk and the prosthetic felt a bit awkward when they came in contact with each other but I got used to it in minutes. Overall, It only took me a day or so to get used to this prosthetic.

There are times when the lower part of the cup of the prosthetic hits my testicles in an awkward way. This can feel pretty uncomfortable, and I end up having to adjust myself from time to time. I'm going to see if wearing a Rodeoh harness makes things better.

My natal dick actually faces my prosthetic dick, sometimes the upper part of the prosthetic's scrotum, rather than the pleasure slide part. This is something that I actually saw coming - I guessed that my dick would actually face the prosthetic's dick or scrotum and it just so happens that I guessed right.

Wearing a prosthetic like this during the summer when its hot and humid can be quite uncomfortable when you have male genitalia (sorry transguys, I have no idea how it feels like to wear this thing with female genitalia since I don't have that, so I can't give you my experience on that). I'm probably not going to wear it as often during those types of conditions since my downstairs area can feel pretty sticky and uncomfortable with it on.

Its best to wear a prosthetic like this with a harness or fitted underwear. In fact, I recommend using a harness for daily use. This makes wearing the prosthetic more comfortable, and you won't have to readjust yourself so often. I personally don't like harnesses, because they look and feel unnatural. But something like the Rodeoh harness is something I'm going to make an exception for, since they seem to feel a lot more natural and they look pretty comfortable. I'm going to get myself a pair of those and try them out. I also have a pair of boxer briefs that I can use as a harness, since it is small and fitted.

Peeing

Learning how to pee with it didn't take me a long time - it only took me two days to learn it. I got the hang of it right away the first time I used it (which was at the toilet at home). Since the urethra on my real penis is on the penis itself (although its on the underside of it), the urine usually flows right on the prosthetic penis itself or the upper part of the prosthetic's scrotum (which makes the urine spill into the cup). The cup seals the back of my natal scrotum very well - I've haven't had any accidents with it, even when I used it for the very first time. When I pee with just my natal anatomy, the vast majority of the urine flows through the urethra. However, because I have hypospadias, a micropenis, chordee, and a bifid scrotum, a small amount of the urine flows through my rear end, which is why whenever I pee with my own penis, I have to pull my pants (including my underwear) down to my ankles and I have to make sure my rear end faces the shallow end of the toilet in order to catch the pee. If it weren't for this issue, I would be able to pee like most males, which is the second reason I got this prosthetic - for more convenient urination, particularly in public. The FreeToM does a great job at sealing that area and catching the urine that flows to the rear.

Peeing with this is quite easy. Whenever you pee, you just put your hand on the scrotum and press it a bit towards your body and you aim the penis towards the toilet/urinal. As you're peeing, put a couple of your fingers on the scrotum and push it upwards a bit. Then after you're done peeing, make sure to sweep the scrotum from the bottom to the top to get all the urine out. Do this until all the pee is out of the cup. Make sure to point the penis downwards after you pee - as you're getting rid of every last drop on the cup - and shake it a bit to make sure you get all the pee out. Since everyone's anatomy is different, I highly suggest you play around with it (use different positions and all that stuff) to find out what works for you (even I've had to do that). If you're new to STPing, I suggest you do this in the shower first and then progress towards peeing in a toilet with all your clothes on (I personally didn't need to do this, despite the fact that this was my first STP device).

Peeing with the rod on is pretty decent. Although I should note that if you don't put the rod in deep enough, some of the pee accumulates around the rod and you have to squeeze the penis in order to get the urine out, which means you have to spend a little more extra time in the bathroom. The rod is very easy to remove and it is very portable. You can keep it in your pocket and take it out and put in the prosthetic when you're ready to use it for play.

I've heard plenty of people say that peeing with the FreeToM is difficult and that they've had accidents and stuff, but that hasn't been my experience (although I could be biased since I'm not a transsexual man). I'm not sure why this is but its probably because 1) they're not using it properly (especially when we're talking about first timers) and 2) it just doesn't work for their bodies. But at the same time there have been plenty of positive reviews about the FreeToM out there with the same experiences I've had. Overall, I don't think the issue is the product itself but rather the people who are using it. Always remember to take every review (including this one) with a grain of salt.

Playing/Pleasure

Something I like to do when I pleasure myself is dry humping. Normally, I dry hump with just my underwear or with my pants on, but dry humping into the prosthetic is even better. Thrusting into the prosthetic is much more pleasurable than thrusting into cloth (it still feels good, its just that with the prosthetic its even more so). I noticed that my orgasms are more intense when I'm humping into the prosthetic, as opposed to cloth. I originally thought that the pleasure slide didn't work for me but after some playing around I found out that I can access it by simply adjusting the prosthetic to face my real dick (it feels really good too).

I have given myself plenty of handjobs with it and just like with the previous thing it feels really pleasurable. I can access the pleasure slide more easily with this position, but it seems especially true while I'm laying down. The next thing I'm going to try is masturbate with a fleshlight, and use it for actual penis-in-vagina sex.

I definitely recommend using a harness for play. Constantly re-adjusing yourself while playing is a definite mood killer (I haven't used it for sexual intercourse yet but I've simulated it). One thing to note is that the prosthetic makes a suction noise but its not that big of a deal (at least for me).

The rod is very easy to get on and off. When you take it off, grab the shaft and pull the rod out with your fingers. It takes minimal effort to do this. Don't pull on the head when you take it off or you risk damaging the prosthetic, since the layer of silicone is thin there. It is sturdy and portable, which means that you can put it in your pocket and put it on the prosthetic when you're ready for play. From what I've heard from others, the prosthetic should be sturdy enough for play even without the rod, but having the rod in there during play makes things easier.

When using condoms, make sure to only use water-based ones as well as water-based lubricants. Oil/silicone-based lubricants and condoms will ruin the prosthetic. Always use a condom during sex in order to prevent the build-up of bacteria in the urethra, and of course, STDs/STIs. (Also, don't forget that you also have the option of using a female condom, if your sex partner is female.)

The first condom I used with it was a Durex PleasureMax. This was my first time using a condom and so I fumbled a bit when I put it on (it took me a bit to roll it down). Once I got past that, it became easier. Rolling it down the first quarter was the easiest part and fit quite snuggly, however, once I progressed halfway down the shaft it became a bit more challenging to roll (because the shaft is the thickens as it progresses down towards the base) but I managed to put it on (since condoms are stretchable) and overall it isn't very difficult to put on. I would have to say that these condoms are a pretty decent fit and would recommend for use with this prosthetic (and a bonus benefit is that they're ribbed), although a bigger condom would be even better.

Conclusion

Overall, wearing this prosthetic makes me feel like a total and complete badass! Wearing a bigger penis, overall, makes me feel like huge badass! I'm really loving this prosthetic and I look forward to purchasing from FreeToM again in the near future. For me personally, it was worth the money.

I don't recommend this prosthetic if you're new to prosthetics and packing since the big size will probably intimidate you (you don't need to look far to see that this has been the case). If you do decide to get this despite this being your first prosthetic, remember that you're doing this at your own risk. But if you're looking for something big this is a great option.

I'm planing on trying out more prosthetics from FreeToM in the future, in order to also try to help out an extremely underserved population (the intersex male population, that is). In addition, I'm going to try out some of the more higher-end prosthetics from Reekmagik, Emisil, Synthetics, and a couple of others, and Transthetics "The Rod" (which should be interesting), so there'll be plenty more prosthetic penis reviews from an intersex guy's point of view in the future! I'm actually planing on having a little collection of prosthetic penises :D .

[hypospadiasclinics]

Hidden Complications of Hypospadias Surgery: Urethral Stricture

An 8-year-old boy with a history of 3 prior operations for hypospadias elsewhere was brought to be with recurrent urinary tract infections. His Ultrasound (USG) examination revealed that he had swelling in both kidneys (hydronephrosis) with a thick urinary bladder which did not empty when he passed urine (over 50% of urine remained in the bladder)!  The parents of the child said that the child’s urination was ok; however, when someone tried to place a urinary tube (catheter) for doing an MCUG test, the tube simply did not go through his neourethra (the urinary tube which was reconstructed at the time of previous hypospadias operations). He was then referred to me. We put him under sedation and on careful examination, realized that the neourethra was very narrow (called stricture or stenosis). This was responsible for all his symptoms, infections and problems. We discussed the situation with his parents and opened up his narrow urethral tube till we reached his natural, normal, original urinary tube at the base of his penis. We re-created his natural opening, and all his symptoms disappeared. His kidney swelling reduced, his bladder was emptying normally now and he had no further infections. After 6 months, he underwent a 2-stage reoperation using an Oral Mucosal graft (OMG/ mucosa from inside the oral cavity). He is doing well henceforth.

This case underscores several important points:

Hypospadias repair can cause urethral strictures (narrowing of the reconstructed urethra)

The child may not complain of typical symptoms like difficulty in urination or thin stream, especially if the stricture develops gradually over a period of time.

The most important cause of stricture after hypospadias repair is the poor surgical technique of not creating a good-sized neourethra at the time of the operation.

Other causes are that the skin tube used to create the neourethra may not expend

Some of the recent techniques create a ‘narrow’ neourethra which causes problems with urination which develops gradually over a period of time

It is important to follow the children after hypospadias repair for many years because some complications like stricture may develop gradually and may not cause many symptoms during the initial period.

Urethral Stricture after hypospadias repair can be a very serious and sometimes dangerous complication. I have personally seen some children coming to me with kidney damage after hypospadias repair elsewhere, because of urethral stricture.

Now the question arises: How can we avoid urethral stricture after hypospadias repair? The answer to this question is to create a good size (adequate caliber for the child’s age) neourethra (urinary tube) during the surgery. This requires that the surgeon should have expertise in many techniques of hypospadias repair, including some complex techniques that involve the creation of vascularized skin flaps from the penile skin to create a good caliber neourethra. Many surgeons may find these techniques difficult to perform and may resort to easy techniques of repair; such easy techniques, some of which are popular, may involve the creation of small size neourethra, thus resulting in urethral stricture. Apart from this, delicate handling of the tissues, use of magnification and fine sutures may also play a role in better healing of the surgery. Thus, the most important factor in avoiding urethral stricture after hypospadias repair is the skill and expertise of the surgeon. In some cases, other factors like poor wound healing or infection might play a role.

Some surgeons routinely advise regular urethral dilatations after hypospadias repair, with the hope of periodically enlarging the urethra and preventing stricture. However, as I have discussed in my previous blogs also, there is no role of routine urethral dilatations after surgery to prevent urethral strictures. In fact, forcible dilatation of the narrow urethra might cause injury and make the stricture more severe. Thus, although such dilatations may cause temporary relief in a few cases, they are usually ineffective in a child with established urethral stricture. Thus, a good hypospadias surgeon would create an adequate size neourethra during the surgery, rather than rely on urethral dilatations after surgery. The hallmark of a good hypospadias surgeon is high success and low incidence of complications like urethral stricture. Parents have to search well for the expert surgeon before they plan their child’s hypospadias repair.

[epic-games-official]

Any idea if dick transplants are a thing, or are close to being a thing?

Not even close to being a thing for trans men, barely a thing for cis men. It’s been done a few times successfully for cis men, I’m guessing if there comes a point that it becomes commonplace for cis men that around that time we’ll see the first few test cases on trans men. Oftentimes trans surgeries are adaptations of something that already existed for cis people. The type of mastectomy I got was an adaptation on how it’s often done on cis men with gynecomastia, and metoidioplasty is very similar to surgery done to correct hypospadias. Oftentimes surgeons who know trans surgeries received their initial training in something else (like hypospadias) and then realized trans surgeries aren’t that different and did a little extra learning so they could help that group of people (and make more money). Phalloplasty was invented more for cis people, in the Soviet Union by a man interested in reconstructive surgery to help wounded soldiers. Metoidioplasty, on the other hand, was invented by and for trans people, by Dr. Marci Bowers who is a trans woman herself, who felt sympathetic to trans men because her boyfriend was a trans man. I imagine she must have read about corrective surgery for hypospadias, because that’s what meta most closely resembles. Probably if penis transplants for cis men becomes very tried & true, someone will come along and think about how to adapt it for trans men.

If it did become a thing for trans men, you still wouldn’t have functioning testes, vas deferens, among other things. So the benefit would be that cosmetically it looks 100% like a dick, has erotic sensation all the way to the tip, and is capable of becoming erect without an implant.

What seems to be in the near future for trans men is a bionic prosthetic. I know there’s some talk about using lab-grown cells for phalloplasty grafts or urethral lengthening for both phallo & meta, and that one doesn’t seem too far-fetched.

My guesstimates are that the bionic penis will be around within the next 3-10 years, using lab grown cells for urethral grafts could happen maybe within the next 20-30 years, dick transplants will be fairly readily available for cis men within the next 20-50 years, and whenever those are available I would guess it might take another 10-30 years for trans men to get it. Those guesses are just based on how quickly other surgeries I’ve seen took to go from that “we’ve done it a few times successfully in a few locations in the world” stage to “this is routine, safe, and readily available in any developed nation” stage.

[vivanhospital]

                                        Penis Surgery

PENILE ENHANCEMENT This is the most commonly sought after treatment throughout the world in sexual medicine. Large number of people visit sexologist to get a bigger organ . This arises out of a misconception that women desire big penis for satisfaction. Many believe that they have to hit the uterus for complete satisfaction. Others assume that people notice the bulge in their crouch while taking bath in the public. Some are so embarrassed that they hesitate to go in public . How much size is normal- Most of these have a normal penis size but suffer due to their misconception. If Stretched Penile Length is equal or more than 2.5 inches, it is normal. Some times , it becomes imperative to increase the dimensions of penis , if there is severe stress to patient, marital discord is present or there is abnormality in the penis.

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Hypospadias- The urinary opening is present on the underside of penis, instead of being at the tip . The penis may be bent down to make it look very small in both soft and erect state . The patient will complaint of soiling clothes while passing urine . This downward bending is called CHORDAE means it is present since birth . It is treated by surgical correction in 1-3 phases . Results are immediate Hidden Penis or Buried Penis- It is usually found in obese individuals . The penis is buried in the fat of pubic area . I recently saw a gentleman with buried penis who had difficulty in passing urine while warring pent in a public toilet . He didn’t have enough shaft of penis available to pull it out from zip and urinate so there was frequent soiling . As a result , he had to hold urine for long periods. He was treated with removal of extra fat around the base of penis to enable him pull out the penis comfortably for urination. These also make penis longer All others have to be helped by cutting the suspensory ligament of penis and giving regular exercises to shaft for 3-4 months . It may result in gain of up to 1 inch or more but results are highly variable , depends on body composition. Similarly girth can be enhanced by injection of fat taken from your body , The results show soon after surgery but final result may be variable due to reabsorption of fat . PENILE CURVE

It can be present since birth or early childhood when it becomes more prominent with the onset of puberty . Often people are too obsessed with the size, shape or the curve of their organ. Remember, NO ONE has a perfectly straight penis and it doesn’t matter as well. If you can perform the job of passing urine and intercourse ( that means you should be able to enter vagina and complete sex) , you needn’t worry. A curve of up to 15 degrees in shaft and any deviation to right, left, up or down is normal . Apart from these situations may need assessment . If present since birth , it can be corrected by surgery only and results are very good . but some times one may develop bend after many years of normalcy. One of the conditions responsible for bending is  Peyronie’s Disease. There can be many reasons of developing peyronie’s – Diabetes is commonest . There is repeated injury to the minute blood vessels in penis , resulting in bleeds. It will heal by fibrosis and slowly, patches of fibrosis develop. When this contracts, a curve in penis is seen . Usually it is in upward direction . There can be shortening as well because the stretchability of penis is reduced . It can be first sign of ageing or diabetes . There may be pain on erection associated with low Sex hormone, Erection problems also can be found . Initial complain can be painful erection . Generally pain will subside with time in 6-12 months . During this time, curve may remain stable, increase or be reduced , needing no further treatment. If the bend is bad enough to hinder Vaginal penetration, surgery may be needed Types of surgery – 1- Penile straightening – The aim of surgery is to reduce the bend as much as is needed to have a successful penetrative sex . We never try to make it absolute straight because this is neither possible nor necessary. The results are variable according to the location and size of plaque . One procedure will result in slight shortening of penile length after surgery while other will result in no loss of size but choice depends on many factors. 2- Penile Implant- If it is not successful or surgeon feels it impossible to make it straight, only option left is putting in a Penile implant

Surgical Treatment of Premature Ejaculation

Premature Ejaculation is the most common problem in sexually active males . It gives rise to loss of self esteem, marital discord, depression or divorce in some cases. PME is due to many reasons Like hypersensitive penis , reduced levels of serotonin in the spinal centre controlling Ejaculation , anxiety, erection problem . It is difficult to permanently alter the serotonin levels , though relaxation and regular exercise can be helpful . Hypersensitive skin of penis have attracted attention of scientists. There have been attempts to reduce sensitivity permanently. These are still not accepted as a standard mode of treatment by ISSM but extensive trials in Korea have reported good results 1- Frenuloplasty- The lower part of glans is having a tag of skin attached so that it can’t be pulled back fully in erect state . This is a normal finding and one needn’t bother about it except when you have Premature Ejaculation, or pain while pulling the skin back in erect state . It is corrected by a surgical procedure where you will be able to take the whole skin back in erect state . In many individuals with Premature Ejaculation, it results in increase of intravaginal latency by 50-70% after a few weeks of surgery . It may be not sufficient to treat your problem fully but can be an aid in severe cases of Premature Ejaculation . 2- Glans Enhancement- Here an intern material is injected below the front part of glans so that sensations become less and time increases . It is not practiced in India Book Doctor Appointment Online, Consult Online or Call  9166 300 200   +91-141-2356122

[best-pediatric-surgeon-in-india]

Pediatric Laparoscopy Surgery

Surgeries are scary, and when it is for your child it is the scariest! You would be terrified to make your mind to take your child to a surgery, preparing for the hospital stay and going through the child recovery process. The happy news is that, there are minimally invasive approaches to treat children with surgical conditions.

Pediatric Laparoscopic surgeries are performed by makings small incisions in your child’s skin, through which the surgeon inserts small tubes with a tiny telescope to see inside and then special instruments to operate on the child.

Pediatric laparoscopic surgery in Delhi

It would be your wisest decision choosing to do a pediatric laparoscopy surgery for your child in Delhi. The best pediatric laparoscopy surgeon in Delhi has the specialised expertise to diagnose, treat and administer your child’s surgical conditions. He has the experience in handling the children patiently and in treating the child after a thorough examination and precise diagnosis. He also uses state-of-the-art facilities and specialised equipment. Your child is treated in a very comfortable and fearless environment by the best pediatric laparoscopy surgeon in Delhi.

Conditions treated by the best pediatric laparoscopy surgeon in Delhi

Advanced medical technology allows many of the surgical conditions to be performed through minimally invasive laparoscopic techniques. Below are few conditions treated laparoscopically –

Treatment of a blocked kidney

Ureteral re-implant to treat vesicoureteral reflux or a blocked ureter

Treatment of an ectopic ureter or a ureterocele

Treatment of an infected belly button

Removal of a bladder diverticulum (pocket in the bladder)

Removal of a nonfunctioning kidney

Treatment of an undescended testicle

Treatment of a swollen vessels in the scrotum

The procedure

The pediatric laparoscopic surgical procedure is performed under general anaesthesia. 3 – 5 small incisions are made in the abdomen, depending on the condition to be treated – close to the belly button, either side of the belly and below or above the belly button. Hollow tubes (cannulas) are inserted into the incisions to operate on the child. Initially, carbon dioxide is filled inside the abdomen to make enough space for the surgeon to operate. A tiny telescope (laparoscope) is inserted through one of the tubes, which shows your child’s inside organs on a television screen in the theater. The surgeon inserts special instruments through other tubes at the other sites to perform the surgery. Give your child in the hands of the best pediatric laparoscopy surgeon in Delhi, and you would have no fear and no worries.

The benefits of pediatric laparoscopic surgery for your child

Pediatric laparoscopic surgeries performed by the best pediatric laparoscopy surgeon in Delhi is completely safe for your child. This technique has many advantages over the traditional open surgery.

There is no big cuts or big scars as the procedure is done through small incisions

This is a painless procedure as there is no big cuts

The healing of small incisions is faster than bigger cuts

No complications of incision healings

Quicker recovery and your child returns to his normalcy much faster

Less costly

Aftercare at the hospital

The aftercare given by the best pediatric laparoscopy surgeon in Delhi is commendable. It is accompanied with a family-centered care that ensures the parents are always connected with their babies during the whole stay at the hospital. Your child will be kept in the Post Anesthesia Care Unit for about 1 – 2hours. Once the child becomes conscious, he will be kept under observation in another room. During this time, he will be given some medications through an intravenous line. At the stage where the nursing staff gives oral painkiller medications, your child is also ready to sip liquid foods. The nursing staff will encourage your child to bend up and will take him to walk around the room, soon after the procedure.  This is to help with easy breathing and stimulate blood circulation.

How do you take care of your child after pediatric laparoscopy surgery?

The wound dressing can be removed in 3 – 4 days after surgery, following consultation of the pediatric surgeon. Small strips under the big dressing should be left in their places for about 1 – 2 weeks, and until the surgeon says they can be removed off. Your child can be let to have showers and make sure the incision area is made to dry well. Give your child ample rest for the first week and make sure no heavy lifting, no sports, no bike riding or swimming until he is completely recovered. Be cautious on any unusual symptoms of rare complications and be never late to call the doctor.

Corrective surgeries with no complications for your child is an absolute possibility by consulting the best pediatric laparoscopy surgeon in Delhi. You need not have any hesitance in taking your child for a pediatric laparoscopic surgery in Delhi.

Tags = best pediatric urologist in delhi, best pediatric urologist in india, best pediatric surgeon in delhi, hypospadias surgery in delhi

[thekotaroo]

Profiles of Pride: June 26th! 🏳️‍🌈Michael Dillon🏳️‍🌈

Laurence Michael Dillon (May 1st, 1915 - May 15th, 1962) was a British physician and the first trans man to undergo phalloplasty.

Dillon had long been more comfortable in men's clothing and knew that he was not a woman. In 1939, he sought treatment from Dr. George Foss, who had been experimenting with testosterone to treat excessive menstrual bleeding; at the time, the hormone's masculinizing effects were poorly understood. Foss provided Dillon with testosterone pills but insisted Dillon consult a psychiatrist first, who gossiped about Dillon's desire to become a man, and soon the story was all over town. Dillon fled to Bristol and took a job at a garage. The hormones soon made it possible for him to pass as male, and eventually the garage manager insisted that other employees refer to Dillon as "he" in order to avoid confusing customers. Dillon was promoted to tow truck driver and doubled as a fire watcher during the Blitz.

Dillon suffered from hypoglycemia, and twice injured his head in falls when he passed out from low blood sugar. While he was in the Royal Infirmary recovering from the second of these attacks, he happened to come to the attention of one of the world's few practitioners of plastic surgery. The surgeon performed a double mastectomy, provided Dillon with a doctor's note that enabled him to change his birth certificate, and put him in contact with the pioneering plastic surgeon Harold Gillies.

Gillies had previously reconstructed penises for injured soldiers and performed surgery on intersex people with ambiguous genitalia. He was willing to perform a phalloplasty, but not immediately; the constant influx of wounded soldiers from World War II already kept him in the operating room around the clock. In the meantime Dillon enrolled in medical school at Trinity College, Dublin under his new legal name, Laurence Michael Dillon. A former tutor of Dillon's persuaded the Oxford registrar to alter records to show that he had graduated from all-male Brasenose rather than the women's college St Anne's, so that his academic transcript would not raise questions. Again he became a distinguished rower — this time for the men's team.

Gillies performed at least 13 surgeries on Dillon between 1946 and 1949. He officially diagnosed Dillon with acute hypospadias in order to conceal the fact that he was performing sex-reassignment surgery. Dillon, still a medical student at Trinity, blamed war injuries when infections caused a temporary limp. In what little free time he had he enjoyed dancing, but he avoided forming close relationships with women, for fear of exposure and in the belief that "One must not lead a girl on if one could not give her children." He deliberately cultivated a misogynist reputation to prevent any such problematic attachments.

Dillon qualified as a physician in 1951 and initially worked in a Dublin hospital. He then spent the six years at sea as a naval doctor for P&O and the China Navigation Company.

Dillon had not revealed his own history in Self, but it came to light in 1958 as an indirect result of his aristocratic background. Debrett's Peerage, a genealogical guide, listed him as heir to his brother's baronetcy, while its competitor Burke's Peerage mentioned only a sister, Laura Maude. When the discrepancy was noticed, he told the press he was a male born with a severe form of hypospadias and had undergone a series of operations to correct the condition. The editor of Debrett's told Time magazine that Dillon was unquestionably next in line for the baronetcy: "I have always been of the opinion that a person has all rights and privileges of the sex that is, at a given moment, recognized."

The unwanted press attention led Dillon to flee to India, where he spent time with Sangharakshita (Dennis Lingwood) in Kalimpong, and with the Buddhist community in Sarnath. While at Sarnath, Dillon decided to pursue ordination and became Sramanera Jivaka (after the Buddha's physician). Because Sangharakshita refused to allow Jivaka full ordination, and other frustrations with Sangharakshita's management of Triyana Vardhana Vihara, Jivaka turned to the Tibetan branch of Buddhism. He went to the Rizong Monastery in Ladakh. He was reordained a novice monk of the Gelukpa order, taking the name Lobzang Jivaka, and spent his time studying Buddhism and writing. Despite the language barrier he felt at home there, but was forced to leave when his visa expired. His health failed, and he died in a hospital at Dalhousie, India, on 15 May 1962, age 47.

After Dillon's death, his brother said he wanted to burn Dillon's unpublished autobiography, but the manuscript was saved by Dillon's literary agent and published as Out of the Ordinary in 2017.

[bhagyashribhole123]

Global Urethral Stricture Market Drivers, Segmentations, Key Players, Analysis & Forecast 2019 - 2023

Market Insights

The global Urethral Stricture Market research report presents a comprehensive study that states that it is expected to achieve a valuation of USD 1.53 billion by 2023 at a rate of 7.30% CAGR. The rapid proliferation of the market has been recorded by Market Research Future Reports analysts, who did a depth analysis of the market during the assessment period. The report also includes the market’s driving factors, expansion, challenges, trends and regional share across the globe.

Urethral stricture is considered to be a chronic disease which narrows the urethral opening caused due to injuries, scars, genetic disorders, and sexually transmitted diseases. The occurrence of any of such diseases, hence, restricts the flow of urine and causes various urological disorders. It is much more common in men than in women, and there need proper care and treatment.

Thus, the urethral stricture market is intensifying steadily owing to the rise in the treatments of injuries, and chronic problems such as kidney stones, poor dietary habits, obesity, and other medical conditions.

Key Market Players

Market Research Future Reports have listed some of the key players, who are named as Stryker Corporation, Lumentis Ltd, Boston Scientific Corporation, Olympus Corporation Bard Medical, and Cook Medical Incorporated, Cook Medical, Richard Wolf, SRS Medical, and others.

Global Urethral Stricture Market: Drivers & Trends

The global urethral strictural market is driven by factors such as the increasing occurrence of urethral strictures, rising cases of urolithiasis in adults, and the mounting frequency of urinary incontinence. With such diseases entering in people’s life, healthcare facilities are bound to increase their pace for providing complete treatment to patients. Also, growing awareness about the disease and favorable treatments are encouraging the urethral structural market to expand exponentially. The best part of its treatment goes to surgeries like urethral dilations, which are popular in countries such as India and China. These surgeries cost lower than others and are considered to be of high efficiency. Therefore, these factors are mainly contributing to cultivate the market in recent years, whereas it is also expected that the market will expand with more and more opportunities in the coming years.

On the other part, the introduction of new and advanced medications and treatments is highly possible to boost the market growth during the forecast period. Advanced medication includes a rising occurrence of hypospadias, which is one of the major interests for healthcare providers, clinical medicines, and research. Hypospadias is referred to common congenital malformation that requires surgical repair, whereas, its long-term management requires a substantial amount of socioeconomic resources. Such advance research enabled high technological treatments that surged the market position at a higher CAGR globally.

Furthermore, technological advancements such as tissue engineering are the modern trend changing the dynamics of the market. Due to tissue engineering technology, surgeons are no longer limited by the quantity and quality of urethral substitutes existing in a patient.

Browse More Information @ https://www.marketresearchfuture.com/reports/urethral-stricture-market-6001

Regional Outlook

In the reports of MRFR, the global urethral structural market has covered the leading regions for their market share of North America, which includes the U.S., Canada, and Mexico, Europe; which includes France, Italy, Germany, the U.K., Asia Pacific; which includes China, India, Japan, South Korea, and the Middle East & Africa; which consists of the Middle East and Africa.

Reports tell that North American region presently holds the largest market share and will continue to be on the same position in the years to come. The growth of the market here is attributed to the practice of sophisticated treatment in several health facilities in the US and other countries. Here, it has been observed that medical facilities are flouring rapidly due to continuous research and developments happening. By this, medical provisions hold massive potential for the future growth of the market in the US. On the other hand, technology has also supported the constant product development which is another reason for the growth of the market. Recently, with the usage of smartphone-based tools that detect urethral blockage is highly being used for patients for testing and curing while residing at home.

Whereas, the Europe market is also anticipated to proliferate suggestively during the forecast period owing to the high accessibility of advanced treatment facilities and healthcare expenditure in a larger scale is making ways for the market to expand substantially.

The market of global urethral structural in the Asia Pacific is observed to gain upward trajectory, which is attributed to growing expensive equipment and infrastructure, along with increasing research and development initiatives to progress the quality and effectiveness of new and modern instrumentations. Countries such as India and China are contributing massively to the market expansion due to the swift expansion of healthcare infrastructure and surging demand for treatment services.

Furthermore, the Middle East and Africa market are also expected to experience a steady growth rate driven by the mounting availability of new and advanced diagnostic and treatment methods.

[bestpediatricurologist]

Pediatric urodynamics at BLK Centre for Child Health - Dr Prashant Jain

Pediatric urodynamics at BLK Centre for Child HealthWhat is Pediatric Urodynamic study?

Pediatric urodynamic study (UDS) is a group of tests done for the assessment of how well your child’s bladder is functioning.

These tests measure-:

The functions of the bladder, urethra and pelvic floor muscles

The bladder pressures while it stores and empties urine

The urinary flow and the urethral sphincter muscle activity at the same time.

What is the function of the bladder?

The urinary bladder is a reservoir that collects the urine produced by the kidneys and then empties it at the appropriate time. This is a well-coordinated system which governs relaxation and contraction of the bladder and urethral muscles. This system functions to maintain a low pressure inside the bladder and at the same time prevents involuntary leakage of the urine.

The urodynamic study tracks the filling of the bladder and monitors the pressures inside the bladder and simultaneously it also assesses the function of the urinary sphincter muscles with the help of the electromyography (EMG) of these sphincter muscles. Once the bladder is filled it then assesses the voiding pattern.

When is a Pediatric Urodynamic study required?

There are a number of conditions which disrupt this coordination between the bladder and the sphincter muscles like -:

Anatomical abnormalities: This includes conditions with bladder outlet obstruction likePosterior Urethral Valve, urethral strictures etc. Also in children with anatomic conditions that lead to incontinence, such as bladder  exstrophy/epispadias or  anorectal malformations, urodynamic studies are recommended as soon as the diagnosis is made and after initial treatments fail to correct the incontinence. Testing helps us inguiding therapy and improves the efficiency of your child’s treatment plan.

Neurological conditions:This includes conditions like spinal cord anomalies like meningomyelocele, cord teethering etc. In these cases the studies are usually performed during the new-born period, so that therapy can be initiated as soon as possible. Studies are also needed when these children are older, if they haven’t achieved continence.

Non-neurological conditions like – Neurogenic bladder, voiding dysfunction, incontinence etc. Through these tests we not only diagnose the bladder function problems in the children and also helps us determine the best way to treat the urologic condition, whether through medication, behavioral therapy, surgery or a combination of these. Additionally, through this study, we can also determine the response to the therapy initiated.

How is the study done?

During the procedure, your child will lie on an exam table for the test. Your child’s genital area will be exposed and cleansed to prepare for the catheters to be placed. A special tube called a urinary transducer catheter is put into your child’s urinary passage. It has two tubes on the other end and through one tube your child’s bladder will be filled with normal saline by the UDS machine. The other tube monitors the pressure in the bladder, which is displayed on the UDS machine.

Another small tube will be put into your child’s rectum. This measures rectal pressure during the test. The rectum pushes on the bladder and this can affect bladder pressure.

Having these tubes inserted can be uncomfortable, but it should not hurt. Your child will also have stickers called electrodes gently stuck to the buttocks and hip. The electrodes let us assess your child’s pelvic floor muscles when the bladder is being filled.

During the test, your child may have a feeling of fullness or pressure, similar to what they would feel before urinating with a full bladder. There may be some discomfort when the urinary and rectal tubes are put in and taken out. Your child may have the urge to urinate or have a bowel movement. These feelings will be less if your child is more relaxed. So we counsel the child and the parents before the study, additionally it also helps if the child is viewing his favourite show on a tablet or a mobile phone.

There are 3 phases of the study-:

Voiding phase: Urinary flow rate (also known as the Uroflowmetry)- Your child will be asked to urinate in a special toilet that is attached to a computer that records the actual flow of urine. It measures second-by-second flow and the total volume of urine.

Cystometrogram (CMG): The bladder is filled with warm normal saline through the catheter and, during the filling the computer or the UDS machine monitors the pressures. When the bladder is full, your child will need to urinate with the catheter in place so that the computer can continue to record pressures. This lets doctors monitor bladder pressures, during voiding as well.

Patch Electromyogram (EMG): The patches which are applied to your child’s buttocks will monitor the pelvic floor muscles during the bladder filling and voiding. This is simultaneously recorded by the UDS machine.

Needle Electromyogram (EMG): If your pediatric urologist suspects a neurological cause for your child’s condition, a needle EMG will likely be recommended, which gives an accurate idea about the specific urinary sphincter muscles. For this part of the test, a needle electrode is placed into the external urinary sphincter muscle. The EMG machine will record your child’s sphincter muscle reflexes and responses when the bladder is filled and emptied.

How to prepare for the study?

It is important to prepare your child, explaining why the test is important, what it is designed to accomplish and how it might improve your child’s health. Understanding the purpose of the test and all of its aspects is likely to make the testing easier for your child.

The test will not be done if the child has a urinary tract infection and is showing symptoms, so it should be treated before the test and also the test is performed under the cover of antibiotics.

Your child can eat and drink as usual before the test.

If possible, please encourage your child to have a bowel movement on the morning of the test. We usually give medications 1 or 2 days before the test to make sure that the child has an empty rectum. If the child is on a bowel management program then it needs to be completed the evening before or early morning on the day of the test. Constipation can affect the accuracy of the test.

You need to give all the medications the child is taking and also to get all the previous investigation reports.

What happens after the test?

When the test is complete, all the tubes and sticky pads will be removed. Your child may have some burning when they urinate after the test. This is normal and should improve the more often your child urinates. It should go away within 24 hours. Make sure your child drinks plenty of fluids. If your child is having any pain, you may give Crocin. A warm bath or shower may also help if they are having discomfort when they urinate.

When are the results of the tests available?

The tests are performed in the urodynamic suite, which have all the equipment installed there, along with the private toilet which is connected to the machine. There is urodynamic technician and a urodynamic nurse who help us in performing the study. The final interpretation is given after the study and further plan of action is explained.

The division of Pediatric Surgery and Pediatric Urology at BLK Centre For Child Health takes care of Pediatric Urodynamic services to diagnose and treat bladder issues in pediatric patients.

For More Info.(http://www.pedsurgerydelhi.com/)

Tag =  hypospadias surgery in delhi, Choledochal Cyst In Children, Thoracoscopic Surgery In Children, best pediatric urologist in india

[kansascityhappenings]

Raising an intersex child: ‘This is your body. … There’s nothing to be ashamed of’

https://embed-prod.vemba.io/vemba-embed.js

When Stephani Lohman got her first look at her newborn in the delivery room, she playfully hit her husband, Eric, on the arm. She made a flustered comment about how ultrasounds could get the sex of the child wrong.

The doctors in the Ontario hospital were silent. Eric knew that the situation was more serious than a mixup.

“I sort of looked around at that moment, and I saw what I would describe as panic on all of the medical staff’s faces,” Eric said.

They had expected their baby, Rosie, to be a girl, but her parents saw what seemed to be a penis. Eric remembered learning when he was getting his doctorate about babies born with genitalia that wasn’t typically male or female. He realized right away that Rosie was like those babies.

“I wanted the baby to be put on my chest right away, because I just had her, and I worked really hard for that moment, and they didn’t,” Stephani said, recalling that day in 2012. “And I was scared.”

The doctors covered Rosie with a blanket and took her across the room for what seemed like a long time, Eric said. When they returned, they offered what they knew: Rosie had atypical genitalia, and more tests were needed to determine whether she was genetically a girl or a boy and if she had a serious medical condition, Eric said the doctors told them.

“It basically went from very celebratory, very exciting, to very scary,” Eric said.

The next few days were filled with extensive tests and examinations until the doctors were finally able to make a diagnosis. Rosie had two X chromosomes, and so was considered to be female, they said, but she had salt-wasting congenital adrenal hyperplasia, a severe form of a condition called CAH for short. People with CAH are missing an enzyme that the adrenal glands need to produce cortisol. Rosie’s body is unable to retain enough sodium.

The adrenal glands also produce the initial ingredients of sex hormones, so when the brain gets signals that cortisol levels are low, it demands that the adrenal glands work harder. That leads to a higher production of sex hormone ingredients, which results in an excess of male hormones. Those hormones are what cause the formation of atypical genitalia in fetuses with two X chromosomes while they’re in utero.

Rosie’s condition is classified as a DSD, or differences or disorders of sex development, by many physicians. Some patients and parents of patients — including Eric and Stephani — dislike this classification. They prefer the term intersex.

Many conditions under the DSD/intersex umbrella could result in a variety of different physical sex characteristics on individuals, such as an enlarged clitoris or a micropenis.

Atypical genitalia does not always occur in patients with CAH, but when it does, doctors sometimes encourage plastic surgery.

Eric remembered learning about these operations as a student, and he was skeptical.

Stephani stayed in the hospital with Rosie, who was still being monitored, and began to research the surgeries. At home, Eric did the same. They familiarized themselves with the list of potential long-term risks, such as chronic pain, an inability to orgasm or eventual rejection of gender assignment. If the doctors proposed surgery, Eric wanted to say no. Stephani didn’t even anticipate that it would come up.

“My idea, because I was very naive about it, was that they would never recommend anything that wasn’t necessary right now,” Stephani said. “Like, they wouldn’t put a tiny baby under the knife for no reason. Can you imagine a world in which they’re just doing cosmetic surgeries on babies? I couldn’t even imagine that existed.”

An ‘easy’ fix

The surgical approach to CAH and other DSD/intersex conditions began in the 1960s, when doctors found ways to perform surgeries that reduced some of parents’ anxieties about their babies. The surgeries were intended to help patients conform more with the mainstream characteristics of one sex or the other. But sometimes, the outcomes of these surgeries didn’t align with patients’ eventual gender identities.

Over the years, some who had these surgeries grew to feel a misalignment between their sex and their gender, or felt that surgery had left them mutilated because their genitals lacked sexual sensation. This led to a wave of activism referred to as the intersex rights movement, with people speaking out and protesting medically unnecessary surgeries on children.

Today, these surgeries are starting to be viewed more as cosmetic procedures instead of emergency treatments, but they are still performed.

There’s legislative pushback from the intersex community too, most recently seen through a California bill, SB 201.

The bill would prohibit doctors from performing surgeries on minors with atypical genitalia unless the procedures are determined to be “medically necessary” or the child can provide informed consent beforehand. It is sponsored by Democratic Sen. Scott Wiener of San Francisco.

The California Medical Association has formally opposed the bill and wrote a letter of opposition to the state Senate Committee on Business, Professions, and Economic Development.

“The bill makes an exception for any procedure or treatment that is deemed medically necessary, which is defined in such a way that cannot properly address the complexity of DSD cases and potentially endangers the physical and emotional health and future of the patient,” the letter stated.

In 2017, Human Rights Watch released a report on infant genital surgeries that are performed on babies with atypical genitalia, declaring it cruel and unnecessary. It provided detailed testimonials from individuals who had the surgeries and felt violated and damaged.

About 1 in 2,000 babies is born with genitalia different enough that doctors might recommend surgery, according to the report.

Tiger Devore, a Las Vegas-based clinical psychologist and advocate for people considered to be sexually different, said the rate of surgeries hasn’t really changed since the 1960s. A 2016 study in the Journal of Pediatric Urology found that of 37 babies with what researchers called “moderate-to-severe genital atypia” who were born after 2011, 35 were subject to genital surgery.

Devore was born in 1958 with hypospadias, a condition in which the urinary opening is on the underside of the penis instead of the tip. He had over 25 surgeries, many of them when he was a child. He describes them as painful and unnecessary.

“There are people who have grown up having these surgeries very early on in life. They’re making it very clear to the medical society that these surgeries don’t work, we don’t like the outcomes, this shouldn’t have been done to us as children,” Devore said. “It’s our genitalia, and we want to grow up with our own genitalia. Not the genitalia that our doctors thought was right, not the genitalia our parents thought was right. It’s our body.”

Surgeries are typically performed to treat the anxiety of the parents, which is not fair to the infant, he said.

The notion is that kids will have a better life because their genitals will look normal, but often that’s not the case, he said.

“If you do plastic surgery on the genitalia, you do not magically get normal male or female genitalia. We get intersex genitalia that has had plastic surgery done to it,” he said.

The parents’ decision to consent rests heavily on their education on the subject, he said.

“If they take a moment to do a little research, it can make a huge difference for the future of the child,” he said.

Feeling the pressure

Three days after Rosie was born, Eric and Stephani were invited to a meeting with specialists to discuss steps. They recall walking into a room with more than a dozen medical staff: pediatric gynecologists, geneticists, pediatric urologists, endocrinologists and a social worker.

“It was probably the most intimidating room I’ve ever been in,” Eric said.

Rosie’s parents said a pediatric urologist presented them with two options only: They could reduce the size of Rosie’s clitoris and create a vaginal canal, or solely do the vaginal canal surgery.

He recommended that Rosie have both procedures done simultaneously at about 6 months old, and preferably not much later than that. The argument was that the younger Rosie was, the faster she would heal, and she wouldn’t have to experience looking physically different from other children.

After thorough research, Rosie’s parents knew that they didn’t want either procedure.

To their dismay, not having any surgery was never presented to them as a possibility, Eric said. And when he brought it up, the doctor said that was a choice he wouldn’t recommend, due to the risk that Rosie might eventually experience psychological trauma from not looking like other girls.

The rest of the staff stayed silent, Stephani said.

“It would have been nice to think that we had one ally in there, but we didn’t,” Stephani said.

The doctor’s sentiment was that if Rosie looked normal, she would feel better about herself. Eric and Stephani felt there was nothing wrong with appearing different, and if there was going to be a surgery, Rosie deserved a choice in the matter. They remained adamant about not consenting to the surgeries.

Meanwhile, the couple was advised by the social worker to be careful when explaining Rosie’s condition to other people, including her older brother and sister.

David Sandberg, a psychologist at University of Michigan who provides clinical services to children with DSD/intersex conditions and their families, said his first step when dealing with families who have a newborn with one of these conditions is to help them figure out the best way to share the information with people they trust.

“The story doesn’t have to be all the details. But there should be nothing that would be considered a lie in retrospect,” said Sandberg, who was not involved in Rosie’s care. “It could be a partial story. It could be less technical. But it has to be based in truth. Because once you go down the road of telling a non-truth, then it’s very difficult to extricate yourself from that.”

The Lohmans continued to feel pressured by their pediatric urologist to consider surgery, even as Rosie approached her first birthday. After putting their foot down and saying they wouldn’t consent, the same pediatric urologist waved them away, Eric said, as if to say they would be back within a few years. (The pediatric urologist declined to comment for this story.)

It’s been years since that appointment, and they still haven’t returned.

According to the American Academy of Pediatrics, its guidelines about atypical genitalia are being reviewed.

“The American Academy of Pediatrics agrees it’s important that a child’s medical team and parents engage in open, transparent conversations so that parents fully understand their child’s condition and the risks and benefits of any proposed treatment, as well as alternatives, such as delaying surgery,” the organization said in a statement.

Dr. Veronica Gomez-Lobo, director of pediatric and adolescent gynecology at Children’s National Medical Center in Washington, said she agrees with the American Academy of Pediatrics’ statement and the further goals it states of “helping children to have a happy and healthy life.”

Gomez-Lobo has worked with many families at the PROUD Clinic, which provides specialized diagnostic, evaluation and treatment services for children with complex diseases, including those that result in atypical genitalia. When an infant is born with one of these conditions, the first priority at the clinic is allowing parents to form a relationship with their child, she said.

“We don’t even need to see these children until they’ve bonded with the parents, and so we don’t even see them for an evaluation until about a month after they’re born,” she said.

For patients with CAH, clinic workers first make sure that all of the medical needs are being addressed and treated, Gomez-Lobo said. After that is taken care of, they inform parents of the benefits and risks of genital surgeries, and they now mention the Human Rights Watch report, she said.

“We don’t know whether making a clitoris smaller has any benefit,” she said. “Whether that’s going to make the child grow up with a better self-image or something like that, nobody has evaluated that. But there is some literature that supports that maybe doing clitoral surgery may reduce the sensation, and it depends on how it’s done and a lot of different reasons.”

Out in the open

After Rosie’s diagnosis, the Lohmans spent a lot of time at home and were open about Rosie’s condition only to family.

“Pretty soon, I started to feel like that was wrong,” Stephani said.

When they began to feel nervous about hiring babysitters who would have to change Rosie’s diapers, they decided to share the secret.

“I was like, ‘this is ridiculous. This is just making it shameful. Sometimes, I don’t feel like we’re doing her a favor,’ ” Stephani said. “We had the thought that we are contributing to this culture of shame. We’re perpetuating what exactly it is we’re trying to avoid.”

Rosie was 18 months old when they stopped hiding her condition and were frank about it with friends and others outside the family, Stephani said. At age 4, Rosie was featured in the documentary “Gender Revolution: A Journey with Katie Couric,” now available on Netflix.

The family now lives in Milwaukee. Eric is on the board of directors of interACT, an organization dedicated to raising the visibility of intersex children and fighting for laws protecting intersex youth against surgeries.

Recently, they brought Rosie to a protest at Lurie Children’s Hospital in Chicago, where they called on the facility to end the practice of medically unnecessary infant genital surgeries. In July, Eric and Stephani released a book about their experience raising an intersex child, “Raising Rosie.”

And in August, Eric flew to California to testify before the state’s Committee on Health in favor of a resolution that condemned unnecessary surgery on children with intersex conditions. Weeks later, the resolution passed, making California the first state to denounce such surgeries. The resolution was introduced by Wiener, who sponsored the bill that would prohibit some of these surgeries.

Outing Rosie as intersex to the public has been the most troubling decision for the Lohmans, Eric said. Eric and Stephani have written a letter for Rosie to read when she is old enough, explaining how they came to the decision to speak out about her condition. They hope she’ll understand. Until then, they are focused on making her as comfortable with her body as possible. As she gets older, they plan to prepare her for how to deal with addressing her condition in front of her peers and choosing when to be private.

“If the time comes and we’re like, ‘OK, now she’s gonna have a sleepover,’ we’ll say, ‘well, we want you to know that this is your body, and you should feel comfortable talking about it, and you don’t have to show anybody your body, but there’s nothing to be ashamed of,’ ” Eric said.

The risks of surgery on a child with differences of sexual development are well-known, the University of Michigan’s Sandberg said, but the risks of avoiding surgery  — which is still rare  — are not clear. When he faces a family who wants to operate on their newborn with atypical genitalia or a family who is adamantly against it, he makes sure to warn them of the risks that could result from either decision. Because there’s very little published evidence on how the children who don’t have surgery do growing up, all he can do is speculate.

“Being different in some way doesn’t necessarily hurt you, but it is not an advantage,” Sandberg said. “And so one has to know something about the factors that make a child more vulnerable for being rejected or neglected by peers. And those would be things that in a gradual, developmentally appropriate way that I would tell some families. But I would sort of telegraph that early on. If I have any value at all to the family, it’s engaging them in a discussion that continues over time, as the child gets older. And then, over time, engaging the child in these conversations.”

On the other hand, Devore, the Las Vegas clinical psychologist, said he thinks there should be only one approach toward helping parents who have a child with one of these conditions.

“We feel strongly that people who are ob-gyns and other people who deliver babies need to be taught to say, ‘you have given birth to a healthy intersex child. Not just a male child. Not just a female child. Or a child that has problems. You have given birth to a healthy intersex child,’ ” he said. ” ‘Someday, that child may choose to have surgery or not. But the hospital will provide genetic counseling, neurologic counseling and psychological counseling so that your family can face this challenge in a healthy way and so that your child can be given the guidance to understand their difference.’ ”

Devore expects younger generations, as well as younger physicians, to be more open-minded about intersex conditions and variability of expression. The changing environment can be seen on college campuses, in the media and on Facebook, he said.

Intersex is a viable identity that shouldn’t be seen as unhealthy, he said. But it is just as important for individuals born with atypical genitalia to have the right to not be defined by that, either.

“If people have a sense of themselves as male or have a sense of themselves as female, no matter what their genitals look like, they get to identify that way,” he said. “And that’s the most basic point that we could have emphasized. It is the right of the individual to determine how they choose to identify. It is not the right of the parent. It is not the right of the physician or surgeon.”

Nothing out of the ordinary

Rosie is now 6 years old and has never had genital surgery. She has big green eyes and blonde hair that she prefers be kept short. Dresses are among her favorite things to wear. Her parents describe her as “intrepid” and “brave.”

“She wants a mohawk,” Eric said. “We try to tell her that having a mohawk is unpractical in Wisconsin because you have to wear a winter hat. But she wants short hair, so that’s what she has.”

“Rosie’s awesome. She’s a firecracker,” Stephani said.

They have told Rosie that her body is different from other people’s but that many people have differences in their bodies. “And that’s OK,” Eric said.

If Rosie ever expressed a desire to have a clitoral reduction, Eric said, they would begin the process by having her speak to a therapist, an intersex person who had surgery and an intersex person who has not had surgery.

“If that happens in a year, then we’ll start it in a year, and if it happens when she’s 16, then we’ll do it then,” he said.

They would urge her to wait until she’s a teen, at least, and until she has experienced sexual pleasure, because of the procedure’s potential effect on sexual sensations.

Rosie’s been taking medication for CAH since she was a baby. She now takes three pills a day to keep her cortisol and electrolyte levels balanced. Pills swallowed at 7:30 a.m., 3:30 p.m. and 10:30 p.m. prevent her from going into adrenal crisis.

With this medical routine, Rosie’s health is stabilized. She’s beginning to learn how to take care of her condition independently and carries around a rescue kit in case she goes into adrenal crisis. But her parents are still concerned about what the future holds. Sicknesses and hospitalizations are inevitable with her condition, Eric said, and he’s nervous about the quality of her health care when she’s older — as well as the possibility of schools and jobs being unforgiving about her having to take time off.

Even though Rosie has been raised as a girl, it’s important to her parents to refer to her as intersex and to encourage gender fluidity. In other words, they don’t confine her gender expression to that of a boy or a girl.

Since Rosie identifies as a girl, her parents check off “female” under the sex category when filling out forms. She’s in first grade this year and has developed a group of core friends. She uses the girls’ bathroom and has yet to be confronted by other students about her body. But they are confident that with her type of personality, she’ll either not care or laugh about it, if anyone were to point out her differences.

Her teachers are aware of her condition and have been compassionate, he said. Parents in their community have also been accepting.

“As of right now, she’s very stable, and we have a very supportive network,” Eric said. “It’s almost as if nobody cares about the intersex part of her.”

from FOX 4 Kansas City WDAF-TV | News, Weather, Sports https://fox4kc.com/2019/04/15/raising-an-intersex-child-this-is-your-body-theres-nothing-to-be-ashamed-of/

from Kansas City Happenings https://kansascityhappenings.wordpress.com/2019/04/15/raising-an-intersex-child-this-is-your-body-theres-nothing-to-be-ashamed-of/