- Acquiring an iatrogenic vesicovaginal fistula (VVF) via abdominal hysterectomy is a risk of less than 2%.
- Acquiring an iatrogenic vesicovaginal fistula via laparoscopically assisted hysterectomy is a risk of about 1%.
- Healing of a simple VVF through catheterization of 4-6 weeks has a chance of less than 5%.
- The chances of spontaneous healing of a VVF with no treatment? Virtually nil.
They said it wouldn’t happen. They didn’t want me to get my hopes up. Despite being stacked up against some very steep odds, I have apparently overcome them:
I have been symptom-free from my VVF for five days now! Yes, my VVF has spontaneously healed!!
I spoke with my gynecologist this morning and he thinks I am “out of the woods.” I will have another cystoscopy with the first urologist I consulted in about two weeks to take a closer look at how the former fistula is doing, if it’s visible at all.
In terms of the hysterectomy itself, I am no longer bleeding, so last night I was able to go to bed commando—no pad for bleeding or incontinence—the first time in almost 5 weeks. I don’t think I need to further impress just how freeing this was!!
How did my VVF spontaneously heal?
It’s hard to say. Certainly the small size of the fistula was on my side. I maintained a very healthy diet, high protein, lots of B and C vitamins, a pint of cranberry juice a day to ward off infection, avoided bladder irritants like coffee and alcohol, got lots of rest, limited fluid intake especially at night, and took Spanish Fly. Yes, Spanish Fly. It’s a homeopathic remedy for the urinary system, and was prescribed by my GP (who is both a medical and homeopathic doctor.) Was it the missing link that helped stimulate my body to heal itself?
The impact the VVF will have on future SRS
I have concerns about the integrity of the damaged/now healing tissue, but my gynecologist reassured me that I have no need to worry about this. He did however highlight the fact that I am now at higher risk of bladder injury if I go ahead and pursue a metoidioplasty. More specifically, the colpocleisis* would need to be done very carefully as the bladder may be more adhered to the vaginal wall than normal. Because I will not require corrective surgery for the VVF though, tissues required for metoidioplasty (with urethral lengthening) will be left untouched, making me no less a candidate as I had previously feared.
* In this procedure, also referred to as a vaginectomy, the mucosa of the vagina is ablated and the muscular walls of the vagina are fused together.
The message I am taking from my VVF experience
It is believed that my VVF was caused by an accidental slip of the hand—the hand of a very experienced and skilled surgeon who had never seen a VVF before in his 20 years of practice. Could that hand have been guided by the Universe? I am taking this experience as a message to slow down my medical transition. It has been a raw reminder that nothing is more important than good health. Quite frankly, this complication scared the hell out of me.
I have been going through transition for about a year and a half, have been on testosterone for just 12 months, and have had three surgeries in less than 11 months. My pursuit of a metoidioplasty has now ground to a halt. I have no immediate need to get back into an operating room. I want to give myself a few years to enjoy what my transition has given me so far, without being so caught up in the medical aspects of it, and without being blinded by the mad scramble to save money for another big surgical event (indeed, the biggest!) I would prefer to take my GF on that beach vacation that has eluded us for our entire 12 years together, put some money into my property, and travel to see my family and friends so they can get to know me again. I will reserve any decision about metoidioplasty or further SRS for as long as I can keep dysphoria at bay. As much as I admire and identify with the metoidioplasty results I have seen in photos, and respect the journeys those guys have gone through, it may turn out that my need for a meta lessens, perhaps even evaporating completely. Time will tell, and I’m content to just enjoy that time for now.
Taking action to fight against VVF
In researching VVFs—symptoms, treatment and effects on the lives of the people afflicted with them—I learned that they are prevalent in developing countries. Young girls and women who have been subjected to genital mutilation, young child bearing and prolonged labor due to lack of medical care are at high risk of obstetric fistulas, both the urinary and rectal varieties. They become social outcasts, rejected by the families they married into and by their original families, and are at high risk of related medical conditions. Some of these women have lived with fistulas for more than 20 years.
I am currently aware of three organizations that work to promote awareness of this global health issue and raise money to fund surgeries of compassion. It costs about $500 to pay for a VVF repair surgery, and to provide the woman with a new dress and travel fare. I am working on ideas to help promote these organizations. If I can mobilize an online effort to contribute to the restoration of dignity for just one girl or woman afflicted by VVF, it will be a great success. Anything more will be exponentially wonderful. More about this soon.
I will close this post by simply offering my gratitude to whatever forces have been at play in what I would call a miraculous healing experience.