#urethral variation

[dhddmods]

So while doing more research on intersex variations, we found that - although there's very limited discussion of it - it seems that persistent cloacas don't always require surgery. Its just that nobody examines or tests the strength of the pelvic floor muscles, or the internal appearance of the cloaca, before shoving kids into surgery.

You can be a healthy adult with an unaltered persistent cloaca. It is possible.

Persistent cloaca in adult with satisfactory renal function

A case of persistent and uncorrected cloaca in a twenty-five-year-old woman is presented. In spite of the anomaly not being corrected, no de

And also, surgery for persistent cloaca are far more cosmetic then it should be. There's way too much focus on making three separate canals, when - if surgery is necessary - the focus should be on making a functional separated anus, not making a "normal urethra & vagina." There's no need to make them as perisex-looking as possible!

As far as we've seen in our research, the only intersex variation that 100% always needs surgery is urethral agenesis, because they have no way to urinate. And even then, the focus of doctors is to make it as perisex-appearing as possible.

For example, a person with a penis & urethral agenesis should usually be given a perineal urethrostomy, not a urethroplasty that reconstructs the penis, because that damages an infants penile tissue unnecessarily, and can cause sexual dysfunction, scarring, desensitization, or chronic pain later in life (since they are young, and their genitals are not developed enough for such complex procedures yet.) Theres only a few cases where opening the urethra through the penis itself would be more ethical - specifically, in the scenario where the urethra is still mostly formed but there's just a small part that is undeveloped, and all it would take to open it is to push a tool into the existing urethra and break through the undeveloped part. And even that avoids cutting open the penis itself, which saves the erectile tissue from getting scarred.

Doctors need to stop giving surgery to intersex children unless its absolutely necessary. And when it is necessary, they should thoroughly investigate the best course of action, and shouldn't prioritize appearance over functionality!

[dhddmods]

I feel like this is kind of a foolish question but you seem knowledgeable on this stuff, so, a conversation with my friends lead to my checking where my urethra is out of curiousity, and I realised I had a really hard time finding it. I had to be poking around and lifting and moving skin a lot, and I'm underweight. I eventually found it and it seems... partially inside the vaginal canal? It definitely seems like it's not in the same spot that medical diagrams place it. So I was trying to figure out what's up with that, and I'm perisex but was getting frustrated by lack of finding things so I looked at the intersex wiki and your intersex guide, and found, oh, hypospadias can happen with vulvas. But I don't really know I guess like... I'm finding so little information on vulval hypospadias. I'm having such a hard time figuring out if my urethra is in a spot that's considered to be typical mullerian development or not, and I know this is going to bug me so I can't just drop it. So I guess I'm asking if you know anywhere to look, or ask about this sort of thing. I know I've got some sort of urinary troubles, I feel the need to use the washroom all the time even though I don't have a UTI and I struggle with retention, but I've got so much else going on that it just hasn't been worth going to the doctor for me because I can put up with it. Take your time answering, I saw your posts about having a lot of stress right now, I hope it eases on you and quickly.

Hi! So if you are struggling to find your urethra, that is a definite sign of hypospadias. The urethra is pretty obvious on typical vulvas, being at a sort of middle-point between the clitoris and vaginal entry.

Unfortunately hypospadias is SEVERELY underdiagnosed, as is a lot of vulvar variations, because of medical misogyny and doctors only really caring if an AFAB person has a small enough phallus and a visible vaginal canal. They don't care much about the other parts.

It could also be persistent urogenital sinus (PUGS), rather than vulvar hypospadias, though the two do overlap quite a bit, and the type of hypospadias where the urethra opens directly into the vaginal wall may be diagnosed as either one.

We'll share some sketches (not the finished product, it still needs lineart and coloring, this is just a messy sketched reference point with slightly unrealistic proportions) of vulvar hypospadias, which we made for our in-progress intersex character creation guide.

(Again, this is sketches, not the finished product. Its a messy reference point. The actual lineart and coloring will give it more realism in the finished product.)

Its under the cut, obvious content warning for genitals.

This is typical urethral placement:

This is vulvar hypospadias:

[dhddmods]

Oh, wow. Mine looks really similar to the second one in the second image in your reply. But it also… doesn't? Your diagram and every other diagram I've seen have this sort of… you can just kind of pull everything back and get this overall pointed oval sort of shape. But mine doesn't. If I try to kind of spread it out, I can't actually see either hole well unless I mess with the angle, and even then I have to do even more struggling with angle to see two holes rather than one. Instead of the pointy-ish spot on the opposite-of-clit side, it's round, circular, like there's some sort of sheet of flesh under the majora but a little above or just by the minora, obscuring the majority of any entrances, everything but the top of what I think is my urethra? This is kind of a ramble and it feels embarrassing and inappropriate to be talking about, but I'm kind of just now realising not only how little I know about my own anatomy but also how my anatomy doesn't really match up to diagrams as much as I guess I expected it to. But I've also been on testosterone for over a year and a half now, so that could be it. Anyway, thank you for the reply. I don't really know what to think about what this means for me, if anything, but it's good to know.

So what we're reading from this, you struggle to see your vaginal entry due to flesh coverage?

This could be due to having vaginal atresia, specifically what we're thinking is hymenal variations or vaginal septums (which you can refer back to our intersex guide again to read more on that.)

We may be misunderstanding what you are saying here, but we'll give you our hymenal variation sketches just in case. Vaginal septums are slightly different, especially when they are internal, but they're along the same lines as this.

(Once again, not the finished product, it still needs lineart and coloring, this is just a messy sketched reference point with slightly unrealistic proportions.)

Its under the cut, obvious content warning for genitals.

Microperforate hymen:

Septate hymen & cribriform hymen:

Sleeve hymen:

[dhddmods]

This may be weird but I couldn’t find my urethra for a long time, but I did eventually find it.

Its next to the vary top of my vaginal opening behind my labia minora, like to the side of it.

Would this be vulval hypospadias or just a really weird placement?

Sounds like it, from what you're describing. The urethra is usually more towards the center between the clitoris and the vaginal entry, so if it's right above/next to the vaginal canal, then that is vulvar hypospadias.