Sometimes when newborns are found with intersex deformities, they must be early assigned to one sex or the other. These deformities represent intermediate stages between the primordial female genitals and the change into male genitals caused by male hormone stimulation. In some cases both men and women occasionally believe they are physically a different sex than they are mentally and emotionally. This is called gender dysphoria or gender identity disorder.
In both cases, technical considerations favor successful conversion from one sex to the other in order to better define the external sex organs. Sexual Reassignment Surgery (SRS) alters the physical appearance of a person from one gender to another. The phalloplasty operation which is the gender change operation from female to male is the most demanding and difficult operation in the field of Transexuality.
However, female to male surgery has difficulty of creating a functioning penis from the much smaller clitoral tissue available in the female genitals. Penis construction is not attempted less than a year after the preliminary surgery to remove the female organs. However, most patients were pleased with the change of sex. Besides the genital organs, the breasts need to be surgically altered for a more male appearance. This can be successfully accomplished.
The capacity to experience an orgasm, or at least "a reasonable degree of erogenous sensitivity," can also be expected by almost all persons after gender reassignment surgery.
About the Procedure
Sexual Reassignment Surgery requires multiple surgeries, which are performed in one or more stages, depending on the surgeon’s and patient's choice. The surgeries include:
• Mastectomy to remove breasts
• Hysterectomy to remove uterus and fallopian tubes
• Ovarectomy to remove ovaries
• Kolpectomy to extirpate the vagina
• Preparation of a free forearm-flap (including vessels and nerves) with microsurgical technique.
• Creation of a phalloplastic with a neo-urethra
• Prolongation of the female urethra with the labia minores.
• Microsurgical anastomosis of arteries (end-to-side to femoral artery), veins (end-to-end to perisaphenic veins) and nerves (end to end to inguinal nerves) and anastomosis of the neo-urethra to the prolonged urethra, so that the phallus is situated in the midline similar to the normal male anatomy.
• Covering the forearm-flap-area of the arm with a full-thickness-skin-graft from the inguinal region or with skin from the mastectomy procedure.
• Preservation of the clitoris on the base of the phallus to maintain the ability to have an orgasm post-operatively. The ability to have an orgasm will be as good as pre-operatively.
The clitoral organ is deep ithelisized only and will be located at the base of the penoid and covered with skin of the future scrotum. So, during sexual intercourse, the clitoris will be stimulated.
• Preparing the labia majora to allow for a scrotal prosthesis at a later time.
Erectile Prosthesis/Scrotal Prosthesis: This is a second operative procedure required to put testicle implants (scrotal prosthesis) and a penile implant (erectile prosthesis).
It is performed after 8-12 months when sensitivity is present in the phallus.
The surgeon will use a hydraulic implant with a pump that is placed in the neo-scrotum. Furthermore, a reservoir is placed underneath the lower abdominal wall and two silicon rods are introduced into the penoid in order to have a functional erection. Silicon testicles are also placed in the neo-scrotum.
However, before deciding to undergo the process, you should consider the outcome very well as a variety of regulations must be met to ensure no regrets.
Length
The procedure takes about 7 to 9 hours to complete the whole process.
Who is an ideal candidate?
In order to undergo the sexual reassignment surgery, a patient must meet the following criteria:
• The patient must demonstrate a desire for sexual reassignment for at least 2 years.
• A clinical behavioral scientist trained to deal specifically with trans-sexualism must make the diagnosis of gender dysphoria.
• The patient must live and work exclusively in his or her chosen gender for not less than 12 months.
• The patient must be under psychological or psychiatric care for not less than 6 months before the surgery.
• The patient must have hormonal sex reassignment and treatment for not less than 6 months before the surgery.
• Throughout the evaluation process, peer review should be evaluated and the patient discussed by the appropriate clinicians.
• The patients should have two recommendations for the S.R.S, from two separate clinical psychologists.
Recovery
Usually, the sexual reassignment surgeries require multiple operations and recovery time in between procedures. The procedures are almost always performed in 2 to 3 stages with 7 to 14 days of healing time between stages. However, the time required for complete transformation depends on a person’s body, how it heals and which surgeries a patient undergoes.
Planning your surgery
As gender reassignment surgery is irreversible, you should really consider all the related matters before deciding to undergo the surgery. You should consult a surgeon regarding following questions:
• What will my body look like afterward?
• Is the surgeon board-certified in urology, gynecology, or plastic and reconstructive surgery?
• How many gender reassignment procedures has the surgeon performed?
• How many of the type similar to the one being contemplated (i.e., male to female or female to male) has the surgeon performed?
• What is the surgeon's complication rate?
• What are the risks and complications after the surgery?
• What will be the outcome?
Preparing your surgery
While preparing for your surgery, you will be instructed to follow the below guidance:
1. Should stop taking hormone pill for 2 weeks before operation.
2. The patient should eat a soft diet for 2-3 days prior to surgery to prevent the problem of defecation after operation.
3. The patient should not drink and eat food for 6 hours before the operation.
4. Patients must complete a health check up within three months prior to SRS.
5. Patients must also be confirmed by a private physician to be free from serious medical diseases and must pass the following blood tests:
- CBC, HIV Electrolytes, FBS, Creatinine Urinalysis
- Alkaline Phosphatase, Chest X-ray
- SGOT LDH EKG
6. Oral tablets should be halted two weeks prior to surgery and injectables should be halted four weeks prior to surgery.
7. Oral anti androgens can be halted three days before surgery (four weeks if injectables).
8. Aspirin and smoking should be halted two weeks before surgery.
Anesthesia
Female to male sex reassignment is done under general anesthesia to keep the patient unconscious while performing the surgery.
Risks / Complications / Side effects
All surgery carries the risks of
• Infection
• Bleeding
• A second surgery for repairs.
• Pain
• Dissatisfaction with results
Less than 5% of patients might experience:
• Stenosis at the anastomosis urethra-neourethra. This can be easily solved by an urologist widening with special devices (re-operations are necessary in less than 2% of all occurring cases and generally will be done as an outpatient procedure)
- Fistulas at the same anastomosis. They will close spontaneously within 2-3 months. If the closure does not appear to be complete, a minimal invasive procedure with local anesthesia can be done to provide a definitive closure.
However, a relatively common complication of female to male surgery is dysfunction of the penis. Implanting a penile prosthesis is technically difficult and does not have uniformly acceptable results. Psychiatric care may be required for many years after sex-reassignment surgery.
After your surgery
After the surgery, you will experience soreness, swelling, bruising and reduced activity. Apart from those, there are the emotional, psychological, and sociological issues to be adapted to SRS. Many patients seek psychological therapy after surgery.
Usually, those who select female to male gender reassignment surgery undergo a hysterectomy to remove the uterus and ophorectomy to remove their ovaries. Developing the habits and mannerisms characteristic of your new gender will take many months or years.
However, the results that will be achieved are:
• The best aesthetic result
• The best achievable functional result
• Shortest time of inconvenience (in one stage procedure)
• Usually return to work after approximately 6 weeks
At home, family support should be provided, which is important for readjustment as a member of the opposite gender. If surgical candidates are socially or emotionally unstable before the operation, over the age of 30, or have an unsuitable body build for the new gender, they tend not to fare well after gender reassignment surgery. However, it is still not found that the surgery diminishes their ability to work.
Post operative care
The post operative care that should be taken includes:
• 1-2 days intensive care.
• You will have to get up for the first time on the 6th day.
• The phallic catheter will be removed on the 12th day so that you are able to urinate while standing.
• You may go back home during 14th-16th day.
However, additional post operative care will be provided.
Price range
USD 3,000-13,000