Sexual reassignment surgery: Male to female

Abstract

Vaginoplasty is the main surgical problem in male-to female sex reassignment surgery. There are many operative techniques reported, but none is ideal. Thus, there is a continued search for new and better solutions. For changing anatomical sex from male to female, the testicles are removed and the skin of foreskin and penis is usually inverted, as a flap preserving blood and nerve supply to form a sensate vagina. A fully innervated clitoris can be formed from a part of the glans of the penis. If the patient has been previously circumcised, the penile skin available for the neovagina may be insufficient in which case, a scrotal graft can be used after removing its hair follicles. The remaining scrotal tissue forms the labia majora. In extreme cases of skin shortage, or case of a failed vaginoplasty, a vaginal lining can be created from hairless skin grafts; alternatively, a section of the colon may be used (colovaginoplasty). These linings may not provide the same sensate quality as the penile inversion method, but the vaginal opening is identical, and the degree of sensation is approximately the same as that of most women, so there should be no decrease in pleasure. In last couple of decades, Belgrade has established itself as one of the few centers for sex reassignment surgery. In this chapter, accompanied by several instructive photographs, we describe the techniques of vaginoplasty in male-to-female transsexuals. From a reconstructive standpoint, this is indeed a sensible and elegant surgical procedure. It employs techniques which involve urology, and plastic surgery. Many of the patients are able to lead normal sexual lives postoperatively, although the level of satisfaction in this population varies. Psychosocial and psychosexual outcomes allow us to understand the significance of surgical repair, as well as its impact on the lives of both patients and their partners following surgery. Postoperative complications and pitfalls give rise to many physical and psychological problems and should be recognized and corrected in time however patients must realize that these procedures, although may be considered cosmetic, are reconstructive in nature given the multiple tissue planes in which the surgeon works, and therefore should be considered a reconstructive process. © 2014 by Nova Science Publishers, Inc. All rights reserved.