Message:   Surgery and Depth

From: zappaz1     Sent: December 18, 1999     Message 1 of 1

As to questions about "vaginal depth and surgery", the following
is a general rambling about this subject... not intended to be
applicable to individual cases. It might help you to understand
a little about the subject:

Hysterectomy often shortens the vaginal depth... especially
where there had previously been extra vaginal depth behind
the cervix in the form of a pouch called the Posterior Fornix
of the Vagina. This pouch is often removed with the hysterectomy.
Depending on the care with which the repair is done, there can
be weakness at the region where the uterus was removed. Vaginal
hysterectomies often shorten the vagina more than abdominal
ones. There are now techniques to remove the uterus without much
shortening or weakness compared to other methods of surgery.
It would be hard to remove the uterus using the common standard
procedures without "some" shortening of the vagina. It is very
important to think twice before doing fisting after a hysterectomy,
but after evaluation by "competent doctors"... it is often possible
to do so. Most doctors that do vaginal hysterectomies will mention
the probable shortening in their pre-operative complication list,
allowing the patient to opt for that or some other type of surgery.

Often A and P repairs of the vagina and other vaginal surgery
will prevent returning to fisting after those surgeries. Where
there have been vaginal hernia (enterocele) repairs.. fisting
should not be done. If doctors would discuss this with those
who wish to start or return to fisting that would help, as
only he could individualize cases and give sound advice in this
regard. Those that have had radiation treatments to the pelvic
region should never do fisting again. I know of a lady who tried
and ruptured the upper vagina into the abdominal cavity due to
the weakness at the upper vagina from the radiation. She lived
but the emergency surgery was something else.

It is indeed sad that most doctors are reluctant to advise about
fisting, but there are also cases where it is contraindicated
(and only a doctor's advice would clear up those questions).

If there has been no previous surgery and the vaginal tissue is
healthy and normally elastic, with very careful practice and
follow up exercises, fisting can usually be done without any
problems. There are also cases where medical advice is needed.
Possibly in the future more doctors will be willing to evaluate
people who want to do this. In my opinion over half of the women
could do it (with proper precautions) without any problems.

Vaginal depth can sometimes be very short in some individuals,
but commonly it is enough for fisting of the entire hand. There
are those that have increased their own vaginal depth to some
extent. It is not wise to overdo this but some have extended
their depth to 12 or more inches. In increasing vaginal depth,
the region that is extended is behind the cervix. This is called
the Posterior Fornix of the Vagina. It lies next to a low sac
of the peritoneal cavity (that holds the abdominal organs) called
the Pouch of Douglas (or posterior cul-de-sac). Sometimes that
pouch can be weakened by trying to increase the depth of the
vagina. When this happens, the Pouch extends lower pushing the
vagina ahead of it in a manner that turns the vagina wrong side
out. This in extreme cases can let part of the vagina protrude
several inches outside the opening or "introitus". Most protrusion
of the vagina is not from this Pouch of Douglas coming down with
abdominal contents in it but is usually due to the rectum bulging
forward or the bladder dropping down some. Less commonly it is from
vaginal prolapse where the top apex of the vagina drops down. Kegel
exercises are important to help prevent all those conditions. When
the Pouch of Douglas is the cause of the protrusion, it is often
spoken of as a "vaginal hernia" but its real name is an "enterocele".
Vaginal hernias like other hernias of the peritoneum usually contain
parts of the abdominal cavity like bowel. If the protrusion is of
this type and comes all the way down, surgery to repair it is usually
needed. Such surgery will usually prevent further fisting being
safely done. I mention this to point out it is best not to try to
greatly deepen the top of the vagina. Some have a naturally deep pouch
for the Posterior Fornix of the Vagina that extends even several inches
upward, and usually they have "no hernia problems" to require such
surgery. Certain rare endocrine problems in women can be associated
with a very deep Posterior Vaginal Fornix with the vagina extending
up into the abdominal cavity behind the uterus... sometimes so deep
and large that it lies behind the uterus in big folds.

If you have had any kind of vaginal surgery and are not doing
vaginal fisting now, consider a medical consult before you start.

If you are doing fisting and "badly need" a hysterectomy but the
doctor mumbles something to you that it will "not shorten" your
vagina using the older methods of hysterectomy.. get a "second
opinion" :-)

There are NEW procedures that remove the uterus through a
laparoscope inside the uterus that usually do not distort the
size or shape of the vagina. A very old method of removing the
uterus without taking out the cervix is coming back now called
supra cervical or subtotal hysterectomy. This can even be done
by laparoscopic method (LSH). The advantage of this is there is
no cut away area at the top of the vagina to heal and the support
of the vagina is better... but the main advantage is that it
does not shorten the vagina or destroy the nerves that let you
enjoy the feeling of stimulation in the upper vagina like other
types of hysterectomies. Some say that because it leaves the
cervix "that" leaves a possible source of cancer. Such logic is
considered rubbish by most doctors that do the procedure and they
quote studies where it shows orgasms are better if you leave the
cervix and the chance of cancer is low enough you do not need to
worry about it. In my opinion if you do fisting and "must have" a
hysterectomy for bleeding, pain, or non-cancerous disease, the way
to go is with the supra cervical hysterectomy. That way it leaves
the support structures for the top of the vagina, it leaves the blood
vessels to the region, it leaves the nerves, and it usually will not
keep you from continuing your fisting. "Your doctor" may not do
these new procedures, but there are always others that do
(thank God for competition).