Male-to-female (MTF) gender confirmation surgery, sometimes referred to as “vaginoplasty” or “sex reassignment surgery”, is a procedure that transforms male genitalia into female genitalia. Here’s a simplified breakdown of the process:
- Penectomy: This involves the removal of the penis. The skin from the penis might be inverted to form the lining of the neovagina.
- Orchiectomy: This is the removal of the testicles.
- Vaginoplasty:
- The main procedure for constructing a neovagina.
- The skin of the penis (and sometimes a portion of the scrotal skin) is typically inverted to create the vaginal lining. The depth of the neovagina can vary, but surgeons aim to create a depth that allows for penetrative sexual activity.
- If there’s insufficient skin to achieve the desired depth or if there are complications, skin grafts from other areas, like the inner thigh or abdomen, or other procedures like the use of sections of the colon, might be used.
- Clitoroplasty:
- A portion of the glans (head) of the penis is often used to create a neoclitoris. This provides the individual with the potential for sexual sensation, as the tissue of the glans retains its sensitivity.
- The nerve endings are connected in such a way that the neoclitoris is sensate.
- Labiaplasty:
- The remaining scrotal tissue and other tissues are sculpted to create the labia majora and labia minora, giving the external appearance of female genitalia.
- Urethral Shortening: The male urethra is longer and extends to the tip of the penis. During surgery, the urethra is shortened and repositioned, allowing for urination from a more anatomically female position.
- Dilation:
- After the surgery, regular dilation of the neovagina is crucial. This involves inserting dilators (graduated cylindrical devices) into the neovagina at regular intervals to ensure that the space doesn’t contract or close up.
- Over time, the frequency of dilation can be reduced, but it’s a long-term commitment to maintain the depth and width of the neovagina.
- Recovery:
- Initial recovery usually requires a hospital stay of several days to a week.
- Full recovery can take several weeks to months, during which strenuous activities and sexual intercourse should be avoided.
- Regular follow-up appointments with the surgeon are essential to monitor healing and address any complications.
- Sensation & Sexual Function:
- While the neovagina and neoclitoris often have sensation and can provide sexual pleasure, it can take time for the full range of sensations to return after surgery. Sensation can vary among individuals.
- It’s also essential to note that, while the surgery provides external and internal female genital structures, the neovagina does not connect to internal reproductive organs (like the uterus), and individuals with a neovagina do not menstruate or have the capacity for gestational childbirth.
The decision to undergo MTF gender confirmation surgery is deeply personal and should be made in consultation with experienced medical and mental health professionals. The procedures can vary based on surgeon techniques, individual needs, and preferences. It’s crucial to understand the potential risks, benefits, and post-operative commitments involved.