HIV risk in post-SRS women

I cast a (somewhat) wide net trying to find out about the risk of HIV transmission through post-SRS vaginal sex. I will post responses as they come in. I posted to the “Ask the Experts” forums on and, and I sent emails to a few surgeons.

If anyone has read any articles, please let me know where I can find them.

The first response I got was from Dr. Marci Bowers, and this is it:

This is a fascinating subject and something I believe I have heard of previously tho not sure where without a serious wracking of my brain.

As a gynecologist and someone with experience in this area, I can tell you my impression is that it is likely that HIV risk would be higher than in natal born women and for several reasons.

  • One, the epithelial lining, although squamous epithelium (excpet in the rarely done colon segment procedures) lines the post-GRS vagina, it is thinner, much thinner than in natal females. There is also less to very little cornification yielding further risk. There is no transudation across the vaginal epithelium altho I do not know how that might affect risk in either direction.
  • Secondly, some postops bleed, probably as a result of the thinner epithelium, with penetration, adding obvious risk but also due to other factors such as granulation tissue and vaginal strictures or scarring.
  • Finally, I know that some postops still enjoy or opt for rectal penetration, despite the presence of a functional vagina, for whatever reasons.

Are you considering study in this area or what are your thoughts?

Marci Bowers, MD/ / San Francisco Office: 66 Bovet Road, Ste. 101, San Mateo, CA 94402 Phone: (877) 439-2244 • FAX: (877) 439-9922/ Seattle Office: 1229 Madison #840 Seattle, WA 98101 Phone: (206) 328-3200 • FAX: (206) 328-4636/ Admin office: P.O. Box 1044, Trinidad, CO 81082 (719) 846-6300

This entry was posted in community and tagged , . Bookmark the permalink.

1 Response to HIV risk in post-SRS women

  1. I got the following response from Aegis:


    Thank you for posting your question to the Ask the Doc forum at AEGiS.

    *Please forgive the time that has elapsed since your question was posted.*

    Your response from Dr. Barrow follows:

    I just don’t think the numbers are there to give any certainty to this question.

    There are different techniques for making a neo-vagina. If made from a segment of colon, there would be a different risk than if made entirely from an inverted penis, which has a squamous epithelium, which would be presumably more resistant.

    If the neo-vagina has problems with bleeding, that would have an effect on the risk.

    I don’t think this question can be answered with any degree of certainty.

    John Barrow, M.D.

    However, for more information, please access the following discussion, “Case 4: Transgender Women and HIV” from the Northwest AIDS Education and Training Center and the University of Washington.
    Here is the link to the entire study module: ,
    and, here is the direct link to the discussion portion that includes information about HIV transmission:

    Best Regards,
    Ask the Doc On-line Coordinator,


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s