Sex reassignment surgery (SRS), also known as gender confirmation surgery or gender-affirming surgery, is a series of surgical procedures that help align an individual’s physical characteristics with their gender identity. The specific procedures performed can vary depending on the desired gender and individual preferences.

Here are the common procedures involved in male-to-female (MTF) and female-to-male (FTM) SRS:
Male-to-Female (MTF) Sex Reassignment Surgery:
⦁ Vaginoplasty: Vaginoplasty is a surgical procedure to create a neovagina. There are various techniques, including penile inversion, sigmoid colon, or other tissue graft methods. The procedure involves removing the penis and using the penile skin or other tissues to create the vaginal canal and external genitalia.
⦁ Clitoroplasty: Clitoroplasty involves creating a clitoris from the glans of the penis or other tissue sources. The goal is to provide erogenous sensation and enhance sexual satisfaction.
⦁ Labiaplasty: Labiaplasty is performed to create the labia majora and labia minora, which are the outer and inner folds of the vulva. This helps to create a more natural and aesthetically pleasing appearance.
⦁ Orchiectomy: An orchiectomy involves the removal of the testes. This procedure helps to reduce testosterone production and is often performed as a precursor to vaginoplasty.
Female-to-Male (FTM) Sex Reassignment Surgery:
⦁ Metoidioplasty: Metoidioplasty is a procedure that involves releasing and enhancing the clitoris, which has been naturally enlarged through hormone therapy, to create a phallic structure. The procedure also involves scrotoplasty to create a scrotum using tissue grafts.
⦁ Phalloplasty: Phalloplasty is a more complex procedure that involves constructing a neophallus using tissue grafts, often from the forearm or thigh. The neophallus can be further enhanced through additional procedures such as urethroplasty (creation of a urethral opening) and placement of erectile prostheses.

It’s important to note that the specific procedures performed can vary depending on individual goals, preferences, and healthcare provider recommendations. SRS is a complex and highly individualized process that should be approached with careful consideration, proper preparation, and guidance from experienced healthcare professionals specializing in transgender care.

Individuals considering SRS should consult with qualified healthcare professionals who can provide personalized guidance, discuss the specific procedures involved, potential risks and complications, expected outcomes, and post-operative care. These professionals will evaluate individual needs, goals, and medical considerations to develop a tailored treatment plan that aligns with the individual’s gender identity and overall well-being.

1. Male-to-Female (MTF) Surgery

Vaginoplasty

Vaginoplasty is a surgical procedure performed on transgender women or individuals assigned male at birth who desire to have female genitalia. It is a gender-affirming surgical intervention that creates a neovagina, resembling anatomical structures found in cisgender women. Vaginoplasty typically involves several steps:

1. Pre-operative Evaluation: Before undergoing vaginoplasty, patients undergo a comprehensive evaluation by healthcare professionals, including a psychological assessment, medical history review, and discussions about surgical goals, expectations, and potential risks.
2. Hormone Therapy: Many patients undergo hormone therapy, typically estrogen therapy, for a certain period before surgery. Hormone therapy helps induce secondary sex characteristics, such as breast development and softening of the skin, which can aid in achieving more natural and functional results from surgery.
3. Surgical Technique:

1. • Orchiectomy: In some cases, patients may undergo orchiectomy (removal of the testes) as part of the vaginoplasty procedure to reduce testosterone production and eliminate male secondary sex characteristics.
   • Penile Skin Inversion Technique: The most common technique for vaginoplasty involves using penile and scrotal tissue to create the neovagina. The penile skin is inverted to form the vaginal lining, while scrotal tissue may be used to create the labia minora and majora.
   • Vaginal Canal Creation: Surgeons use the penile skin inversion technique to construct a vaginal canal between the urethra and rectum. The depth of the vaginal canal varies depending on patient anatomy and surgical technique.
   • Clitoroplasty: A small portion of the glans penis may be preserved and reshaped to create a clitoris, which is positioned at the top of the vaginal opening to enhance sexual sensation and satisfaction.
   • Labiaplasty: The remaining penile and scrotal tissue is used to create the labia minora and majora, which frame the vaginal opening and contribute to the aesthetic appearance of the neovagina.
   • Urethral Lengthening (Optional): Some patients may opt for urethral lengthening to enable standing urination. This involves extending the urethra through the neovagina to the tip of the neoclitoris.

1. Post-operative Care:

1. • Following surgery, patients require a period of hospitalization for monitoring and pain management. They are provided with detailed instructions for post-operative care, including wound care, dilation techniques, and hygiene practices.
   • Dilations: Patients must regularly dilate the neovagina using graduated dilators to prevent narrowing and maintain vaginal depth and width. Dilations typically begin a few weeks after surgery and continue for several months to years, gradually decreasing in frequency over time.
   • Follow-up: Patients undergo regular follow-up appointments with their surgical team to monitor healing, address any complications, and provide ongoing support and guidance.

1. Recovery and Adaptation:

1. • Recovery from vaginoplasty varies from person to person but generally involves a period of several weeks to months. Patients may experience temporary discomfort, swelling, bruising, and restrictions on physical activities during the initial recovery phase.
   • Emotional and psychological adjustment to the new genital anatomy is also an important aspect of recovery. Patients may benefit from counseling, peer support groups, and resources to navigate changes in body image, sexuality, and intimacy.

Vaginoplasty can be a life-changing procedure for transgender women, helping them achieve a body that aligns with their gender identity and enhancing their overall well-being and quality of life. However, it is essential for individuals considering vaginoplasty to thoroughly research the procedure, consult with experienced healthcare providers, and carefully weigh the potential risks and benefits before making informed decisions about surgery.

Orchiectomy

An orchiectomy, also known as orchidectomy, is a surgical procedure involving the removal of one or both testicles. It is commonly performed for various medical reasons, including the treatment of testicular cancer, hormone-sensitive prostate cancer, and certain hormonal disorders. In the context of transgender healthcare, orchiectomy is often performed as part of gender-affirming surgery for individuals transitioning from male to female (MTF). Here are details on orchiectomy:

1. Purpose:

1. • Orchiectomy is performed to eliminate testosterone production, reduce male secondary sex characteristics, and alleviate gender dysphoria in transgender women.
   • By removing the testes, which are the primary source of testosterone in the body, orchiectomy helps feminize the body and facilitates the effectiveness of hormone therapy in achieving feminine physical characteristics.

1. Surgical Technique:

1. • Orchiectomy can be performed through different surgical approaches, including inguinal or scrotal incisions, depending on the surgeon’s preference and patient anatomy.
   • In an inguinal orchiectomy, an incision is made in the lower abdomen near the groin area to access and remove the testicle(s). This approach allows for easier access to the spermatic cord and minimizes scarring in the scrotal area.
   • In a scrotal orchiectomy, an incision is made directly in the scrotum to access and remove the testicle(s). This approach is less invasive but may result in more visible scarring in the scrotal area.

1. Anesthesia:

1. • Orchiectomy is typically performed under general anesthesia to ensure the patient is unconscious and pain-free during the procedure.
   • Local anesthesia may also be used to numb the surgical site and minimize post-operative discomfort.

1. Recovery:

1. • Following orchiectomy, patients may experience temporary pain, swelling, and bruising in the surgical area. Pain medication and cold packs can help alleviate discomfort during the initial recovery period.
   • Patients are advised to avoid strenuous activities, heavy lifting, and sexual intercourse for several weeks to allow for proper healing.
   • Most patients can resume normal activities within a few weeks after surgery, although full recovery may take several weeks to months.

1. Impact on Hormone Therapy:

1. • Orchiectomy significantly reduces testosterone levels in the body, allowing for greater feminization effects from hormone therapy (e.g., estrogen).
   • After orchiectomy, transgender women typically require lower doses of estrogen to maintain feminizing effects, as the need to suppress testosterone production is reduced or eliminated.

1. Psychological and Emotional Effects:

1. • Orchiectomy can have significant psychological and emotional effects on transgender women, including relief from gender dysphoria, increased comfort with their bodies, and improved overall well-being.
   • Some individuals experience a sense of empowerment and validation following orchiectomy, as it represents a concrete step in aligning their bodies with their gender identity.

Clitoroplasty

Clitoroplasty is a surgical procedure performed as part of gender-affirming surgery for transgender women or individuals assigned male at birth who desire to have female genitalia. The primary goal of clitoroplasty is to create a clitoris or enhance an existing clitoris to improve sexual sensation and satisfaction. Here are details on clitoroplasty:

1. Purpose:

1. • Clitoroplasty aims to create a neoclitoris, resembling the anatomical structure of a cisgender woman’s clitoris, or enhance the existing clitoris to improve sexual function and pleasure.
   • The clitoris is a highly sensitive sexual organ associated with arousal and pleasure. Creating or enhancing the clitoris can enhance sexual satisfaction and alleviate gender dysphoria in transgender women.

1. Surgical Techniques:

1. • Clitoroplasty techniques vary depending on the patient’s anatomy, surgical preferences, and desired outcomes.
   • For patients undergoing vaginoplasty (creation of a neovagina), clitoroplasty is often performed concurrently as part of the same surgical procedure.
   • The surgeon may use penile or scrotal tissue to create the neoclitoris, reshaping and repositioning the tissue to resemble the glans clitoris. The size and shape of the neoclitoris can be customized to the patient’s preferences.
   • Alternatively, in cases where the patient has an existing clitoris that is hormonally enlarged through testosterone therapy, clitoroplasty may involve enhancing the size and appearance of the clitoris through surgical techniques such as glansplasty or hoodectomy.

1. Anesthesia:

1. • Clitoroplasty is typically performed under general anesthesia to ensure the patient is unconscious and pain-free during the procedure.
   • Local anesthesia may also be used to numb the surgical site and minimize post-operative discomfort.

1. Recovery:

1. • Following clitoroplasty, patients may experience temporary swelling, bruising, and discomfort in the genital area. Pain medication and cold packs can help alleviate discomfort during the initial recovery period.
   • Patients are advised to avoid strenuous activities, heavy lifting, and sexual intercourse for several weeks to allow for proper healing.
   • Most patients can resume normal activities within a few weeks after surgery, although full recovery may take several weeks to months.

1. Impact on Sexual Function:

1. • Clitoroplasty aims to enhance sexual function and pleasure by improving clitoral sensitivity and arousal.
   • Many transgender women report increased sexual satisfaction and improved intimacy following clitoroplasty, as it allows for more natural and fulfilling sexual experiences.

1. Psychological and Emotional Effects:

1. • Clitoroplasty can have significant psychological and emotional effects on transgender women, including increased confidence, body satisfaction, and overall well-being.
   • Some individuals experience a sense of empowerment and validation following clitoroplasty, as it represents a tangible step in aligning their bodies with their gender identity.

Labiaplasty

Labiaplasty is a surgical procedure that involves altering the size, shape, or appearance of the labia minora (inner vaginal lips) and/or labia majora (outer vaginal lips). While labiaplasty is often associated with cosmetic reasons, it can also be performed as part of gender-affirming surgery for transgender women or individuals assigned male at birth who desire to have female genitalia. Here are details on labiaplasty:

1. Purpose:

1. • Labiaplasty aims to reshape the labia minora and/or labia majora to improve aesthetic appearance, reduce discomfort, and alleviate physical or psychological discomfort associated with enlarged or asymmetrical labial tissue.
   • In the context of gender-affirming surgery, labiaplasty may be performed as part of vaginoplasty to create the external genitalia of transgender women or individuals assigned male at birth who desire female genitalia.

1. Surgical Techniques:

1. • Labiaplasty techniques vary depending on the patient’s anatomy, surgical preferences, and desired outcomes.
   • For patients undergoing vaginoplasty (creation of a neovagina), labiaplasty is often performed concurrently as part of the same surgical procedure.
   • Labiaplasty may involve reducing the size and length of the labia minora to create a more symmetrical and proportionate appearance. This may be achieved through surgical excision of excess tissue or tissue sculpting techniques.
   • Additionally, labiaplasty may involve enhancing the size and appearance of the labia majora to provide aesthetic balance and contour to the external genitalia.

1. Anesthesia:

1. • Labiaplasty is typically performed under general anesthesia to ensure the patient is unconscious and pain-free during the procedure.
   • Local anesthesia may also be used to numb the surgical site and minimize post-operative discomfort.

1. Recovery:

1. • Following labiaplasty, patients may experience temporary swelling, bruising, and discomfort in the genital area. Pain medication and cold packs can help alleviate discomfort during the initial recovery period.
   • Patients are advised to avoid strenuous activities, heavy lifting, and sexual intercourse for several weeks to allow for proper healing.
   • Most patients can resume normal activities within a few weeks after surgery, although full recovery may take several weeks to months.

1. Impact on Sexual Function:

1. • Labiaplasty aims to improve aesthetic appearance and reduce physical discomfort, which may indirectly enhance sexual satisfaction and intimacy for some individuals.
   • While labiaplasty itself does not directly affect sexual function or sensation, some patients report increased confidence and improved body image following surgery, which may positively impact sexual well-being.

1. Psychological and Emotional Effects:

1. • Labiaplasty can have significant psychological and emotional effects on transgender women or individuals assigned male at birth who undergo the procedure as part of gender-affirming surgery.
   • Many patients experience increased confidence, body satisfaction, and overall well-being following labiaplasty, as it represents a tangible step in aligning their bodies with their gender identity.

2. Female-to-Male (FTM) Surgery

Mastectomy (Top Surgery)

Mastectomy, commonly referred to as “top surgery,” is a surgical procedure performed to remove breast tissue and contour the chest for individuals assigned female at birth who identify as transgender men, non-binary, or genderqueer. This procedure is a vital aspect of gender-affirming surgery for transgender individuals seeking to align their physical appearance with their gender identity. Here are details on mastectomy:

1. Purpose: The primary goal of mastectomy is to eliminate the appearance of breasts and create a more masculine chest contour. This helps alleviate gender dysphoria and enhances the individual’s sense of congruence with their gender identity.
2. Surgical Techniques: Mastectomy techniques vary depending on factors such as breast size, skin elasticity, and desired chest appearance. Common techniques include double incision mastectomy, periareolar mastectomy, and keyhole mastectomy. The chosen technique determines the location of incisions, extent of tissue removal, and preservation of nipple-areolar complex.
3. Anesthesia: Mastectomy is typically performed under general anesthesia to ensure the patient’s comfort and safety throughout the procedure.
4. Recovery: Following mastectomy, patients may experience temporary discomfort, swelling, bruising, and restricted arm movement. Pain medication and compression garments may be prescribed to manage symptoms. Strenuous activities and heavy lifting should be avoided during the initial recovery period. Most patients can resume normal activities within a few weeks, although full recovery may take several months.
5. Psychological and Emotional Impact: Mastectomy can have profound psychological and emotional effects on transgender individuals, including increased confidence, relief from gender dysphoria, and improved overall well-being. For many individuals, mastectomy represents a significant milestone in their gender-affirming journey, affirming their identity and enhancing their quality of life.

Hysterectomy and Oophorectomy

Hysterectomy and oophorectomy are surgical procedures commonly performed as part of gender-affirming surgery for transgender men or individuals assigned female at birth who identify as transgender, non-binary, or genderqueer. Here are details on these procedures:

1. Hysterectomy (Removal of the Uterus): Hysterectomy involves the surgical removal of the uterus, eliminating menstruation and reducing the risk of certain gynecological conditions. It is often performed laparoscopically or abdominally, depending on factors such as the size of the uterus and the patient’s medical history. Hysterectomy is typically irreversible and results in infertility.
2. Oophorectomy (Removal of the Ovaries): Oophorectomy involves the surgical removal of one or both ovaries, which are the primary source of estrogen and testosterone in the body. Oophorectomy may be performed concurrently with hysterectomy or as a separate procedure. It reduces hormone production, induces menopause, and may require hormone replacement therapy to maintain hormonal balance and bone health.

Phalloplasty or Metoidioplasty

Phalloplasty and metoidioplasty are surgical procedures performed as part of gender-affirming surgery for transgender men or individuals assigned female at birth who identify as transgender, non-binary, or genderqueer. These procedures aim to create or enhance the appearance of male genitalia, aligning physical characteristics with gender identity. Here are details on phalloplasty and metoidioplasty:

1. Phalloplasty:

1. • Phalloplasty involves creating a neophallus (new penis) using tissue grafts from other parts of the body, such as the forearm, thigh, or abdomen. The procedure typically involves multiple stages and may require microsurgery to connect blood vessels and nerves.
   • Phalloplasty allows for greater customization of the neophallus, including size, shape, and sensation. It can also include the creation of a urethra for urination and potentially sexual function.
   • Phalloplasty is a complex and lengthy procedure with a significant recovery period. Complications can include donor site morbidity, scarring, and potential loss of sensation in the neophallus.

1. Metoidioplasty:

1. • Metoidioplasty involves enhancing the clitoris, which has been hormonally enlarged through testosterone therapy, to create a small phallus. The procedure involves releasing the ligaments that tether the clitoris to the pubic bone, allowing it to extend further outward.
   • Metoidioplasty may also include urethral lengthening to allow for standing urination and improved urinary function. Scrotoplasty may be performed to create a scrotum using labial tissue.
   • Metoidioplasty is less invasive than phalloplasty and typically results in shorter recovery times and fewer complications. However, the size of the neophallus is limited by the size of the original clitoris.

Scrotoplasty

Scrotoplasty is a surgical procedure performed as part of gender-affirming surgery for transgender men or individuals assigned female at birth who identify as transgender, non-binary, or genderqueer. This procedure involves the creation or enhancement of a scrotum, the sac of skin and muscle that contains the testes. Here are details on scrotoplasty:

1. Purpose:

1. • Scrotoplasty aims to create a scrotum to provide a more masculine appearance to the genitalia and enhance the overall congruence with the individual’s gender identity.
   • In some cases, scrotoplasty may be performed concurrently with other gender-affirming procedures, such as metoidioplasty or phalloplasty, to create a more comprehensive male genitalia.

1. Surgical Techniques:

1. • Scrotoplasty techniques may vary depending on factors such as the patient’s anatomy, surgical preferences, and desired outcomes.
   • The surgeon may use tissue from the labia majora (outer vaginal lips) or other donor sites to create the scrotal sac. The tissue is sculpted and positioned to resemble a natural scrotum.
   • Implants may be inserted into the scrotum to provide a more natural appearance and feel. Silicone testicular implants are commonly used to mimic the size and texture of the testes.

1. Anesthesia:

1. • Scrotoplasty is typically performed under general anesthesia to ensure the patient’s comfort and safety throughout the procedure.
   • Local anesthesia may also be used to numb the surgical site and minimize post-operative discomfort.

1. Recovery:

1. • Following scrotoplasty, patients may experience temporary swelling, bruising, and discomfort in the genital area. Pain medication and cold packs can help alleviate discomfort during the initial recovery period.
   • Patients are advised to avoid strenuous activities, heavy lifting, and sexual intercourse for several weeks to allow for proper healing.
   • Most patients can resume normal activities within a few weeks after surgery, although full recovery may take several weeks to months.

1. Impact on Sexual Function:

1. • Scrotoplasty itself does not directly affect sexual function or sensation. However, it can contribute to improved body image and self-confidence, which may positively impact sexual well-being for some individuals.

Urethroplasty

Urethroplasty is a surgical procedure performed to repair or reconstruct the urethra, the tube that carries urine from the bladder to the outside of the body. It may be necessary in cases of urethral strictures (narrowing or blockages), hypospadias (urethra opening on the underside of the penis), or complications from gender-affirming surgery. During urethroplasty, the surgeon makes incisions in the urethra and surrounding tissue to remove scar tissue or create a new urethral opening. The procedure aims to restore proper urinary function and may involve the use of tissue grafts or synthetic materials to support the repair.

Testicular Implants

Testicular implants, also known as testicular prostheses or testicular implants, are synthetic implants used to replace or augment the appearance of the testes. They are commonly used in gender-affirming surgery for transgender men or individuals assigned female at birth who identify as transgender, non-binary, or genderqueer. Here are details on testicular implants:

1. Purpose: Testicular implants are used to create a more masculine appearance to the genitalia and enhance the overall congruence with the individual’s gender identity.
2. Surgical Technique: Testicular implants are typically placed in the scrotum during scrotoplasty or other gender-affirming procedures. The surgeon creates a pocket in the scrotum and inserts the implants, which are then positioned to mimic the size, shape, and texture of natural testes.
3. Materials: Testicular implants are made from silicone or saline-filled silicone shells, providing a realistic feel and appearance.
4. Recovery: Following surgery, patients may experience temporary discomfort, swelling, and bruising in the scrotal area. Pain medication and supportive garments may be prescribed to manage symptoms.
5. Psychological Impact: Testicular implants can have a significant psychological impact, contributing to increased self-confidence, body image, and overall well-being for transgender men.