Sex Reassignment Surgery is performed to transition individuals with gender dysphoria to their desired gender. The primary surgical option, Genital Reassignment Surgery, involves reshaping the penis and scrotum to form the appearance of, and, as far as possible, the function of a vulva.
It is important to note that Sex Reassignment Surgery (also known as: Gender Confirmation Surgery, Sex Confirmation Surgery, Gender Reassignment Surgery, Gender Realignment Surgery, Sex Realignment Surgery) is the umbrella term for a number of procedures that transform the anatomical sex of an individual.
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Before pursuing Genital Reassignment Surgery, it is recommended that you reflect on whether the procedure is right for you, and the right time to pursue it.
The World Professional Association for Transgender Health (WPATH) (WPATH) suggests the following prerequisites:
Your physical and mental wellbeing prior to surgery are vital to preparing for the changes that you will go through in the lead up to and recovery from surgery.
Physical readiness means you have considered the following and consulted a health professional throughout the process:
Mental wellbeing means you have the following:
If you are sure that this is the option for you, but not right now, you don’t have to abandon Genital Reassignment Surgery altogether.
You can still work towards the procedure by considering what might help you get to the point where you are ready – counselling, medical treatment, peer support, etc. – and slowly but surely making life changes to move closer to readiness.
In fact, there are even clinics who specialise in Genital Reassignment Surgery who can also help you locate and access these resources.
The most important thing is ensuring you are pursuing surgery on the terms that are best for you and your journey.
Each person’s reasons for Genital Reassignment Change are highly personal with varied ideal outcomes for each person.
Overall, it is important to understand the surgeon’s goals (based on best practice) and assess if and how they align with your own.
The surgeon will aim to:
If any of these goals are particularly important, or if you have other outcomes in mind it is best to thoroughly discuss this with your surgeon to ensure that by surgery day, you feel comfortable about your own realistic post-operative goals.
Generally you will be admitted to hospital the day before your surgery, so that your doctors can assess your your overall health.
Due to the length of surgery time and the area operated on, you will also likely have a “bowel prep” to clean out your intestines. This helps to prevent problems during surgery and also reduces discomfort going to the bathroom after surgery.
You will be unable to eat or drink after midnight the night before you have surgery and will be shaved in preparation.
Genital Reassignment Surgery has three key parts:
After the testicles are removed, the penile skin, glans, blood vessels, nerves and urethra are separated from the penile shaft, and the erectile tissue of the penis is removed as close to the body as possible.
The most common technique for creating a vagina is the penile inversion. The penis skin is turned inside out so that the outer skin becomes the inner lining of the vagina.
Penile skin or scrotal tissue is then also used to form the labia. In some cases, extra skin is required to make the vagina longer or wider; this is usually taken from the lower abdomen or the scrotal sac. A segment of your large intestine may be used to create the vagina if the penile inversion fails or is not possible.
As part of the penile inversion, a small section of the head of the penis – the part that is most sensitive – is used to create a new clitoris.
The blood supply and nerves of the glans or head of the penis are kept intact and it is transformed into a functional clitoris, and the urethra is shortened and positioned like it would be in a female.
Finally, incisions are then made to expose the new urethra and the clitoris in their correct positions.
After surgery, patients will generally stay in hospital for 3 to 7 days to minimise risk of infection and ensure your doctor can check your general health and healing process.
For example, you will be asked questions about your bowel and bladder function, and the surgical incisions will be checked for infection and scarring.
Most importantly - the body will treat the new vagina as a wound, so after the surgery, in order to maintain the width and depth of the new vagina, it must be kept dilated using medical graduated dilators.
Your surgeon and nurse will be able to monitor this process to ensure you feel confident managing this process on your own outside of their care.
Additionally, if you had a graft as a part of the procedure, you will have an incision on your abdomen, just above the pubic bone. Hospital staff will check this incision and change your dressings on a regular basis.
The stitches from your surgery will dissolve or be removed 7-10 days after surgery and you will be able to leave the hospital once your surgeon is confident that you are healing well.
After you go home, it is important to have appointments scheduled with your trusted GP and mental health professionals to ensure you are supported in this stage of your recovery.
You can go back to your usual routine when you feel well enough to do so, which is typically 4–6 weeks but can also be longer in some cases.
Most importantly, for the first 8 weeks you will continue to wear a prosthesis inside your vagina most of the time, ensuring it doesn’t heal too narrow or shallow.
The amount of time the prosthesis is left out will gradually be increased as per your surgeon’s advice, but as a reference, you can consider the following timeline:
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