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Douching: In regards to my surprise that Chettawut, unlike other surgeons, doesn't have you douche that douching is bad for your internal flora: Yup it sure is. Except with a neo-vagina there really isn't any real culture up there. The skin in a neo-vagina is also mainly external skin, penile shaft, scrotal, and in my case belly rather than the usual mucosal skin of the inside of the vagina. (It eventually adapts, the cells actually change shape, and you end up with what is a far more natural internal structure, usually with some limited self lubrication). And you also have wounds that need to be kept clean. Obviously, from Dr. Chettawut's technique it isn't necessary, but it's not quite like the havoc that twice daily douching would do to a natal woman.