Sex Affirmation Surgery

No matter what your gender identity is, if you believe that you need gender reassignment, you CAN!  Today, you can empower and be confident in yourself.  Whether it is a male-to-female or female-to-male reassignment, you can fulfill your calling and be happy everyday of your life.  

 

Transwoman

Male-to-woman surgery is to transform male’s penis to a woman’s genitalia from its look and function of both outer labia and inner labia, urethra, clitoris to vagina.  Today, there are lots of interesting techniques that can achieve this transformation:

1) Penile Skin Inversion with/without Scrotal Skin Graft 

The skin from the scrotum is used to reconstruct the vagina.  If there is not enough skin, scrotal skin graft will be performed.  The external appearance is similar to that of the female genitals. There are nerves to create sensation for clitoris, inner labia, around the urethra.  This method is a standard surgery for the first gender reassignment surgery.  There is no need to use skin graft from abdomen if there is enough penile skin.

Advantages:

• Uncomplicated procedure
• Low complications 
• Does not disturb nearby organs.  No need for skin graft from abdomen.
• Use original genital tissue to reconstruct the new one.

Precautions:

• This method requires you to dilate your neo-vagina regularly to prevent stenosis. 
• Must use lubricating gel every time you have sexual intercourse.

2) Rectosigmoid Vaginoplasty

This is a surgical technique that involves using about 7-8 inches of sigmoid and upper rectum section of the large intestine to recreate a neo-vagina. This technique is useful for patients who do not have enough penile skin such as those who already had the first surgery but had vaginal stenosis, or those who needed to have a deeper vagina canal.  This method will help fulfill their needs effectively.

Advantages:

• The new lining has similar tissue to the real vagina.
• Reduce chances of stenosis with low complications.
• No need for lubricating gel for intercourse as the tissues naturally produce mucus.
• You need to dilate the outer vagina only, which is easier than Penile Skin Inversion.

Precautions:

• Additional abdomen surgery is required.
• Longer recovery time depending on patient’s condition.
• Patients with gastrointestinal diseases may not be able to use this method.
• Patients may have abdominal fibrosis which can lead to intestinal obstruction.
• If there is an intestinal leak, it can cause serious complications.   

3) Peritoneum Vaginoplasty

The procedure uses abdominal (peritoneal) lining for the creation of the neo-vagina by sliding peritoneal flap pull-down into the vaginal cavity.  This technique is suitable for the first timers who do not have enough penile skin and those who already had Penile Skin Inversion but experienced shrinkage.  This method can help lengthen up to 6-inch long and the lining is smoother and has natural lubrication.  

Advantages:

• The length of the neo-vagina is as deep as Penile Skin Inversion technique or a bit deeper.
• May produce some sexually responsive secretion.
• Able to have regular intercourse but may need some lubricating gel.
• No intestinal leakage that can cause severe complications.
• Patients need to dilate their vagina the same as Penile Skin Inversion method.

Precautions: 

• There may be abdominal fibrosis.
• If patients do not have sufficient dilatation, there may be some shrinkage or stenosis. 
• Longer recovery time, depending on the patients’ condition.  
• The procedure should be performed by an experienced specialist only.  

---

Transman

Female-to-male gender reassignment surgery is more complicated and involves many procedures.  Therefore, patients need to understand all the details before getting the surgery which requires an experienced specialist.  This procedure includes:  

1) Mastectomy

Removing the breast is the first step of the procedure, after which your breasts will be flat.  Then, there is a procedure to reduce the size and adjust the position of the nipple and the areolas while maintaining their nervous system as much as possible and minimizing scars.  There are a few methods for your selection from O-shape or circular technique to nipples reposition, depending on the size and sagging of the breast, as well as elasticity of the skin which must be diagnosed and evaluated by the specialist.  Patients can return to their normal routine after 2 weeks of surgery and the wound will be totally healed within 3-6 months.

2) Hysterectomy and Oophorectomy

This surgery involves removal of the uterus and ovaries to permanently stop production of female hormones and menstruation.  The patients are required to consult a psychiatrist before the surgery.  There are several methods to remove uterus and ovaries – both laparoscopic and open surgery and vaginal access procedure.  The most popular method is laparoscopic surgery for small incision, less pain, fast recovery, and less complications after the procedure.  Once the uterus and ovaries are removed, patients need to have follow-ups as scheduled as each method requires different recovery periods.

3) Removal of the Vagina – Vaginectomy

This surgery permanently stops the function of the vagina after the hysterectomy and oophorectomy are complete.  The body will no longer produce female hormones, no ovulation, no menstruation, and no chance of conception in the future, all of which meet with patient’s goal to become the transman.   The surgery not only closes the vaginal canal, but also extends urethra to create male urethra which will be as per patients’ desire.  The patients need to follow the doctor’s advice strictly for 3-6 months to get satisfactory results without any complications.

4) Metoidioplasty

This procedure is to create a penis by enlarging tissues around clitoris to form a penis and extending the urethra to the tip of the neophallus or new penis.  This involves closing the vaginal canal and cutting ligaments around it to create the urethra and inserting testicular implants, so you can stand while urinating like a man.  However, for female-to-male metoidioplasty, the penis will be too small to have sexual intercourse.  The patients must take male hormones for 1-2 years to grow the clitoris to at least 4 centimeters to complete the procedure.     

5) Phalloplasty

Phalloplasty procedure not only lengthens the urethra so you are able to stand to urinate, but also has natural look and feel that you can have sexual intercourse as all the nerves are connected and the incision is very small.  There are a few techniques, but the most popular one is ALT-Phalloplasty which uses the outer thigh skin to create penis with urethra at the tip for urination.  The advantage of this technique is that you get the right penis size which can fit prosthetic erectile device perfectly.  Radial Forearm Free – Flap Phalloplasty is easier to connect the blood vessels and nerves. The urethra does not contract very much, and it is less complicated to perform. However, the penis will be small and thin. A prosthetic erectile device may cause inflammation and fistula. Overall, phalloplasty is a multistage and complicated process which takes quite some time to recover. 

---

Preparation for Sex Affirmation Surgery

• Psychological evaluation by at least 2 psychiatrists and obtain medical certificates for confirmation.
• Spend at least a year living full-time in an identified gender role.  Have desire to reassign gender for a long time.
• Must be over 20 years old.  In the case of patients over 18 years or have not reached the age of 20, they need to have a parental consent letter.   Patients under 18 cannot have the sex affirmation surgery.
• Be healthy with no health problems, no severe congenital disease or cannot go under anesthesia.  

Today, sex affirmation surgery is getting more popular, and the procedures are continually being advanced and improved.   The most important thing is the choose experienced specialist, international standard hospital with modern technology and equipment, as well as nurses, medical staff and multi-disciplinary doctors to give you the best care that you deserve and be who you want to be.