Genital transformation surgery, often termed “gender-affirming genital surgery” or “gender confirmation surgery,” is a procedure transgender and gender non-conforming individuals might undergo to have their physical anatomy align more closely with their gender identity.
The specifics of the procedure differ depending on the direction of the transition:
- Male-to-Female (MTF) Surgeries:
- Vaginoplasty: This is the most common genital surgery for MTF individuals. It involves the removal of the testicles and the inversion of the penile skin to create a vagina, clitoris, and labia. The prostate gland is left in place. The neovagina allows for penetrative sexual intercourse and is created in a way that offers sexual sensation.
- Labiaplasty: This procedure is often done some months after a vaginoplasty and refines the appearance of the vulva to look more cisgender-like.
- Orchiectomy: This is the removal of the testicles. It is a simpler procedure than a full vaginoplasty and might be chosen by individuals who do not desire a neovagina but wish to reduce testosterone levels and/or achieve a flatter scrotal appearance.
- Female-to-Male (FTM) Surgeries:
- Metoidioplasty: This procedure takes advantage of the clitoral growth caused by testosterone therapy. The clitoris is released from its ligamentous attachments, creating a small phallus. The surgery might also include urethral lengthening to allow the individual to urinate from a standing position and the creation of a scrotum using labial tissue.
- Phalloplasty: This is the construction of a neophallus using skin from another part of the body, often the forearm or thigh. Phalloplasty results in a larger phallus than metoidioplasty but is a more complex procedure and often requires multiple stages. It can include urethral lengthening, nerve anastomosis for tactile and erotic sensation, and the insertion of erectile and testicular implants.
- Hysterectomy: This is the removal of the uterus and might also involve the removal of the ovaries (oophorectomy).
- Vaginectomy: This procedure involves the removal or closure of the vaginal canal.
Other Considerations:
- Sexual Sensation: While surgeons aim to preserve and optimize sexual sensation, the outcomes can vary. It’s essential to discuss potential risks and outcomes with the surgeon.
- Fertility: Many of these surgeries will result in permanent sterilization. Those wishing to have biological children in the future should consider fertility preservation (like sperm or egg banking) before surgery.
- Risks: As with any surgical procedure, there are risks involved, including infection, bleeding, complications from anesthesia, poor wound healing, and unsatisfactory cosmetic results. A detailed discussion with the surgical team will help understand and mitigate these risks.
- Post-Operative Care: Genital surgeries require specific post-operative care, including dilation for vaginoplasty (to keep the neovagina open) and potential additional procedures or revisions.
It’s vital for individuals considering gender-affirming genital surgery to consult with experienced surgeons, understand the potential risks and benefits, and undergo a thorough evaluation and preparation process, often including mental health assessments and support.