Sex Change Surgery

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Sex Change Surgery

Dr. Nirved Jain - Sex Change Surgery Specialist

Sex Reassignment Surgery

Transgender are people who have distress or unhappiness because of the mismatch between their bodies and the gender assigned at birth. These are the people born with perfect male or female anatomies but mentally they feel that they are into the “wrong body”.

Sex reassignment surgery is a set of surgical procedures by which a transgender person’s physical appearance and function of their sexual characteristics are changed to that of their identified gender. It is part of treatment for gender dysphoria in transgender people. More than seventy-five percent of transgender is males.

Feminization surgeries are a set of surgeries that change the anatomy of a male to female. These surgeries include vaginoplasty, augmentation mammoplasty, orchidectomy, facial feminization surgery, tracheal shave, and voice feminization.

Masculinization Surgeries are a set of surgeries that changes the anatomy of a female to male. The surgery includes chest masculinization, phalloplasty, scrotoplasty, and hysterectomy.

In addition to SRS surgeries sometimes patients may need hormone replacement therapy lifelong.

What are the pre-requisites for SRS?

  1. All transgender need to have a thorough evaluation by a psychiatrist and a psychotherapist to confirm that they are suffering from gender dysphoria and they are otherwise mentally stable.  Also, a written statement saying that SRS is mandatory to cure them of gender dysphoria.  
  2. Prior to surgical SRS medical sex conversion for a period of one year by adequate and appropriate hormone replacement therapy is done.
  3. A transgender has attained adulthood that is eighteen years of age in India.
  4. Also, he or she should not be suffering from any mental disorder and should be medically fit to undergo the necessary surgery.
  5. Legal formalities are necessary for sex conversion to be completed with the help of a public notary.

What are the pre-operative preparations necessary for SRS?

All transgender contemplating for SRS needs to:

  • Refrain from smoking and other drugs including alcohol for a period of a minimum of three weeks.
  • A liquid diet with laxatives for three consecutive days prior to surgery.  
  • HIV and Tridot screening along with the routine medical tests.

How much time does sex change surgery take?

The surgical duration of operation for a male to female is 2 to 3 hours and for a female to male 8 to 10 hours. The duration of hospitalization varies from five to twelve days depending on the complexity of the surgical procedure.

How is sex change surgery performed?

All sex change operations are performed under epidural or general anaesthesia. For a male to female sex change, the penis skin is inverted after removing the erectile tissues to create the labia. The urethra is shortened to fit the female anatomy.  Orchidectomy is then performed and the scrotal skin flaps are used to create the vagina. Alternatively, the penis skin along with sigmoid colon graft may be used to create the vagina. Other procedures like breast implants, facial feminization, buttock augmentation, laser hair removal, sometimes hair transplant or other ancillary cosmetic procedures may be carried out at a later date as a part of the transition process.

Female to male sex change surgery involves two main types of procedures phalloplasty and metoidioplasty. Hysterectomy is performed in addition to the above-mentioned options. Phalloplasty is done by using a composite free flap from the arm or abdomen. The labia majora is joined to make the scrotal sac and the urethra is connected to the penis. Metoidioplasty involves consumption of male hormones to increase the size of the clitoris and thus construct a penis.

What is the most common type of SRS surgery?

Male to female conversion is the most common type of gender reassignment surgery because this is less complex than the conversion of a female to male and the results of male to female conversion are far better than female to male. Also it has been noticed that during medical sex conversion (Hormone replacement therapy) done prior to the surgical conversion of a female to male the patients are mostly unable to adjust to the changes brought about like hoarseness in voice, hair growth, diminishing breast size, enlarged clitoris, etc. and mostly request to go back to their original form by withdrawing HRT (Hormone replacement therapy). This trend is not seen in male to female conversion.

What is the best team of doctors recommended for SRS surgery?

  1. Anaesthetist 
  2. Urologist
  3. Plastic surgeon.

Apart from a skilled anaesthesia doctor, a urologist is an absolute must in SRS surgery to avoid future complications related to the urinary system which turn out to be very serious in nature if the urethra is not handled with care. It can lead to simple problems like meatal stenosis to a stricture in the penile urethra which if unattended can lead to dilatation of the upper tracts and ultimately renal failure. A plastic surgeon gives an aesthetic result to the genitals externally. Hence, a team is the best option to have uncomplicated and cosmetically superior results.

What are the risks in SRS surgery?

Potential risks in SRS surgery are:

  1. Dissatisfaction with the results cosmetically.
  2. Difficulty in urination.
  3. Rectovaginal or urethrovaginal fistula leading to the passage of motion or urine through the neovagina. 
  4. Inadequate vaginal dimensions.
  5. Infection
  6. Bleeding
  7. Flap necrosis.

All these are potentially avoidable complications with a proper team of doctors having adequate skill, knowledge, and experience.

What other procedures are needed apart from SRS surgery to become a complete female?

The transition from one gender to the other is a multiple step procedure. After gender reassignment surgery a gap of six months is given for the body to transform automatically in the absence of male hormones. Changes are noticeable after four to six months when the fat starts depositing in the face, chest, buttocks, abdomen, and hairs start to fall from face, chest, and limbs to a varying degree. After this gap, even the muscles become less in volume giving a more feminine appearance. At this time according to the desires of the transgender other ancillary procedures are performed to give a more feminine appearance. The various procedures are done are:

  1. Augmentation Mammoplasty.
  2. Face feminization Surgery
  3. Hair removal by laser.
  4. Hair transplant in a few patients.
  5. Botox & Injectable fillers
  6. Lip Augmentation/Reduction
  7. Liposuction.
  8. Fat grafts (Lipo Fill)

The whole idea of adding ancillary procedures to SRS is to make the transition from one gender to the other as smooth as possible so that there are no tell-tale signs of the previous gender and the social stigma attached to being a transgender is totally wiped out. This gives them a new found confidence, mental stability and they become a part of social inclusion rather than seclusion. This is the biggest reward of gender reassignment surgery when a transgender is completely cured of gender dysphoria.

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