282018Feb

Transgender Confirmation Surgery

Transgender confirmation surgery, also referred to as sex reassignment surgery (SRS), is a procedure or procedures that provide genital reconstruction, so a person’s sexual characteristics best resemble the gender he or she identifies with.

Transgender confirmation surgical procedures have advanced in the past decade, allowing for more individuals to effectively resolve physical differences between the gender they identify with and the sexual characteristics they were born having.

Even as transgender confirmation procedures become more well-known, the basics of common surgeries like a vaginoplasty and metoidioplasty remain unfamiliar to the general population. At UGCSF, we strive to educate patients about those surgical options designed to improve their quality of life, including transgender patients seeking procedures to aid in their transition. We’ve outlined two specific procedures, the vaginoplasty and the metoidioplasty, below. We also discuss hysterectomy as part of transgender confirmation surgery. We encourage patients seeking transgender confirmation surgery options to contact our practice to learn more.

Vaginoplasty

What is a vaginoplasty?

The term vaginoplasty refers to two different actions that a surgeon can take:

  • The vaginal muscles can be tightened (to address congenital defects, pelvic prolapse, injury).
  • The vagina can be constructed or reconstructed.

Prior to the procedure, you and your surgeon will discuss your specific goals, risks and benefits of the procedure, and identify any limitations to develop a personalized plan.

Who can perform a vaginoplasty?

A trained, board-certified surgeon experienced in performing transgender confirmation surgery is the ideal candidate for performing a vaginoplasty. Patients are advised to research their options before moving forward with a consultation for the procedure. If you have any questions, or wish to learn more about Dr. Heidi Wittenberg’s experience, please contact UGCSF today.

How do I prepare for a vaginoplasty?

In the year leading to a vaginoplasty, patients will need to complete 12 full months of continual real-life experience as the gender they identify with. Hormonal therapy is also required during this period, along with two “letters of readiness” from mental health professionals the patient will meet with. These requirements follow the World Professional Association for Transgender Health (WPATH) guidelines.

Additionally, permanent hair removal is necessary prior to surgery and can take 6-12 months to complete for this area. You will need stop estrogen two weeks before surgery and to stop any blood thinning medications or supplements the week prior. A medical clearance will also be required prior to surgery.

Before surgery you will meet with your surgeon for a consultation to discuss your goals, risks and benefits of the procedure, and ask questions. You will also have a preoperative exam in the week prior to surgery.

What is recovery like?

A vaginoplasty is an invasive surgical procedure, so pre-operative preparation and postoperative care is very important. Typically, you would be admitted to the hospital the day of surgery and then stay for 3 nights after before returning home. You would be prescribed pain medication and antibiotics to prevent infection. During this time, your doctor will ask that you stop taking hormone medication until your first postoperative visit in the office. Bleeding is common post-procedure, and you may bruise in the area around your abdomen and upper thighs. We recommend you plan on staying 4-5 weeks in the area to ensure optimal postoperative care.

You will have weekly visits for the 3 weeks following surgery to ensure there is no infection and that you are healing well.  If you do not live in the area, it is recommended you have a local provider to follow up with you after surgery to help with surveillance. Visits every 3 months for the first year postoperatively are recommended.

Swelling and discharge are also common in the first 6-8 weeks after a vaginoplasty, with scars often taking up to a year to fade. You will need to use a urinary catheter for the first 5-7 days after surgery as your urethra will need time to heal before you can pass urine on your own. Your surgeon can provide detailed information on the steps involved in a recovering from a vaginoplasty.

Metoidioplasty

What Is a Metoidioplasty?

A metoidioplasty is a transgender confirmation surgery that can construct male sexual genitalia in transgender patients. Prior to the procedure, you and your surgeon will discuss your specific goals, risks and benefits of the procedure, and identify any limitations to develop a personalized plan.

Who can perform a metoidioplasty?

A trained, board-certified surgeon experienced in performing transgender confirmation surgery is the ideal candidate for performing a metoidioplasty. Patients are advised to research their options before moving forward with a consultation for the procedure. If you have any questions, or wish to learn more about Dr. Heidi Wittenberg’s experience, please contact UGCSF today.

How do I prepare for a metoidioplasty?

In the year leading to a metoidioplasty, patients will need to complete 12 full months of continual real-life experience as the gender they identify with. Hormonal therapy is also required during this period, along with two “letters of readiness” from mental health professionals the patient will meet with. These requirements follow the World Professional Association for Transgender Health (WPATH) guidelines.

Prior to surgery, you will need to stop any blood thinning medications or supplements the week prior. A medical clearance will also be required prior to surgery.

Before surgery you will meet with your surgeon for a consultation to discuss your goals, risks and benefits of the procedure, and ask questions. You will also have a preoperative exam.

What is recovery like?

A metoidioplasty is an invasive surgical procedure, so pre-operative preparation and postoperative care is very important. The procedure may be performed in an outpatient surgical facility or in a hospital. Patients can typically return home the same day. You would be prescribed pain medication and antibiotics to prevent infection. Post operatively, bruising and swelling are common. We recommend you plan on staying 3 weeks in the area to ensure optimal postoperative care.

You will meet with your surgeon at one and two weeks following surgery for a postoperative exam to ensure that there is no infection and you are healing well. During surgery, you will have a catheter placed in the bladder directly through the abdominal wall. The catheter is required to allow the urethra to heal and will be removed at one of your postoperative visits.

If you do not live in the area, it is recommended you have a local provider to follow up with you after surgery to help with surveillance. Your surgeon can provide detailed information on the steps involved in a recovering from a metoidioplasty.

Hysterectomy

Hysterectomy and Transgender Confirmation Surgery

Some patients may choose to undergo a hysterectomy as part of their surgical transition. This procedure may be performed as a single procedure prior to a metoidioplasty or simultaneously, in combination with metoidioplasty.

What is a hysterectomy?

Hysterectomy refers to the surgical removal of the uterus and cervix. It may also include removal of the tubes and ovaries, called a bilateral salpingo-oophorectomy. The procedure can be performed laparoscopically through several small incisions using a camera in the abdomen, or through one larger incision.

How do I prepare for a hysterectomy?

For hysterectomy as part of a gender transition, it is required that the patient be on hormonal therapy for at least one year prior to surgery. Additionally, the patient will need two “letters of readiness” from mental health providers the patient will meet with. These requirements follow the World Professional Association for Transgender Health (WPATH) guidelines.

As this procedure impacts future fertility, it is important for the patient to decide before surgery if they want to undergo egg preservation or keep the ovaries intact.

Prior to surgery, you will need to stop any blood thinning medications or supplements the week prior. A medical clearance will also be required prior to surgery. You will meet with your surgeon for a consultation to discuss your goals, risks and benefits of the procedure, and ask questions. You will also have a preoperative exam.

What is recovery like?

The procedure may be performed in an outpatient surgical facility or in a hospital. Patients can typically return home the same day. You would be prescribed pain medication and antibiotics to prevent infection. Post operatively, bloating and constipation are common.  If you have hysterectomy alone, or in combination with metoidioplasty, we recommend you plan on staying three weeks in the area to ensure optimal care. One week is for preoperative visit and two weeks for postoperative care.

You will meet with your surgeon at two weeks following surgery for a postoperative exam to ensure that there is no infection and you are healing well. Your surgeon can provide detailed information on the steps involved in a recovering from a hysterectomy.