With the growing acceptance of gender dysphoria, more patients are seeking gender reassignment surgery nowadays. To update clinicians’ knowledge, a research team from Ghent University Hospital in Belgium discussed many of these surgical approaches in a recent literature review.
People with gender dysphoria identify with the gender that is the opposite of their birth gender. Many describe their situation as being born in the “wrong” gender. While some patients adapt by living as their desired gender or undergoing hormonal therapy, others decide to have surgery to further their transition.
Male-to-female gender confirmation surgery concentrates on the following areas, the authors wrote:
• Facial feminization. Surgical approaches to develop more female features include adjustments to the chin, jaw, nose, forehead, and skull. Such techniques result in an oval, heart-shaped that is more common in women. Hair can sometimes be an issue; hair transplantation is possible, but some patients will need to wear a hairpiece.
• Voice and Adam’s apple. The voice may be deepened by shortening vocal cords or increasing tension. Thyroid cartilage can be reduced to make the Adam’s apple less prominent.
• Breasts. Patients who undergo hormonal therapy may develop breasts to some extent. These can be augmented with implants similar to those used for women who aim to increase their breast size. In some cases, fat grafting is used to make the implant less obvious.
• Removal of testes. Fertility may be a concern for some patients, who may decide to bank their sperm before any hormone treatment.
• Vagina. Surgery creating of vagina involves removing the penis, developing and lining a vaginal cavity, constructing labia, a clitoris, and a urethral exit point. After this surgery, patients will need to use vaginal dilators for at least a year to keep the vagina open. They will also need to use a lubricant during intercourse.
For female-to-male surgery, the authors noted the following:
• Facial masculinization. Surgery generally focuses on the forehead, chin, and jaw area. However, such procedures are not very common and have not been widely researched. Some transmen use facial hair to “camouflage” undesired female features.
• Male chest. Surgical techniques involve removal of the breasts (along with excess skin) and repositioning the nipples.
• Penis creation. The most commonly used approach for penis creation uses tissue from the forearm. However, this method results in a rather obvious scar on the arm; an alternative is using tissue from the leg because the scar is easier to conceal.
Another technique extends the clitoris to create a small penis, but patients will not be able to have intercourse and might not be able to urinate while standing up. An external prosthesis is also an option, although it cannot be used for urination and has no sensation.
The authors also discussed penis transplants, a procedure that was first done successfully in 2015. However, no studies of patients in transgender populations have yet been conducted.
Sexual Medicine Reviews
Colebunders, Britt, MD, et al.
“An Update on the Surgical Treatment for Transgender Patients”
(Article in press. Published online: September 10, 2016)