Important/vital SRS information about avoiding diversion neovaginitis post-colovaginoplasty

In the article linked below, please find some very useful (if not crucial) information about how a neovagina created by colovaginoplasty should be cared for long-term if it is to be kept in good health:

Using SCFAs to prevent diversion neovaginitis in neovaginas created by colovaginoplasty. Little known info in trans female 'circles', even by SRS surgeons

Please also note the second page which contains relevant study and paper citations, if you need more references.

u/HiddenStill, maybe you could consider please including the article link in your wiki, given how little known about, such important info is for trans females.

The summary/TL;DR from the linked article:

Summary: For a transsexual female who has a neovagina (partially) constructed using tissue from colon tissue (e.g. sigmoid), it is prudent (from ‘day one’) they irrigate their neovagina (at appropriate intervals) with a short chain fatty acid (SCFA) – namely sodium butyrate solution (recommended 0.6 moles/liter concentration , though see note below on concentration). This is the same procedure and regimen which any individual with a section of bypassed colon is instructed to undertake (unless the bypass is for a very limited time only), so as to ensure the bypassed colon section is provided the necessary nutrients for it to remain in good health (and thus diversion colitus/diversion neovaginitis avoided). Otherwise, without regular SCFA instillation, the bypassed colon section (whether part of a neovagina or otherwise) will become (to a certain extent) diseased over time as its tissues ‘degrade’ as a result of not receiving the necessary nutrients (i.e. normally, luminal nutrients flowing over the colon segment’s mucosa). Colon tissue is not able to obtain all that it requires for health (and avoidance of disease) via the blood and lymph system only (reference) and thus additionally requires the presence of SCFAs on the mucosa, so they can be absorbed and function as a very specific and vital type of cellular ‘fuel’ and protective ‘agent’. If short chain fatty acids (SCFAs) are not available to the mucosa, certain cell types won’t have what they require for survival and reactive oxygen species such as H2O2 will build up in the neovagina tissue and cause cellular injury, inflammation, tissue and mucosa changes (reference). Without adequate SCFA instillation, potentially, over time, significant tissue degradation and loss of integrity may therefore occur – with all the consequential risks to health such poses (e.g. potentially in serious cases, even sepsis, severe hemorrhaging, etc). Some trans females have even had excision of their neovagina suggested as a treatment. (reference) At the present time, SRS surgeons are seemingly not advising their (procedure relevant) transsexual female patients about the requirement/benefit of such ongoing SCFA instillation – along with ensuring such transsexual females have an indefinite/ongoing prescription for sodium butyrate solution (suitable for neovagina instillation). Though there are relatively few studies and papers covering diversion neovaginitis, there are many covering the far more common diversion colitus which is essentially an identical condition (see links below and on this page here for selected papers and studies). Diversion colitus is a fully documented condition which happens at a rate of near 100% in any section of colon tissue that is bypassed (luminal nutrient wise). (reference) The difference between individuals with a section of bypassed colon tissue which is not receiving adequate SCFA instillation, is how significant the symptoms are (and/or become) from the changes which occur in the colon tissue and mucosa. If SCFA instillation is begun before a neovagina’s tissues reach a critical state of disease, it is expected that a full recovery of tissue and mucosa health will take place, with the neovagina tissues and mucosa almost fully regenerating/healing over a 6 month to one year time-frame. For an extremely insightful clinical report (which is only a 5 minute read), see linked paper (1) at the bottom of this page here (though more studies along with citations can be found on this page here). At the minimum, by douching with a SCFA at regular intervals, a trans female who has had colovaginoplasty, will likely benefit from improved tissue condition and a significant decrease in mucus and improvement in odor to that of being almost identical a cis female’s vagina (given cis female vaginal fluid contains SCFAs). (reference)

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Neovagina tissue before daily SCFA installation

The same neovagina tissue after daily SCFA instillations for approx 6 months