GRS Surgery – Male to Female
The journey to the point of considering gender affirmation surgery has not been an easy one. Perhaps you have had non-invasive or invasive cosmetic feminizing procedures. Understanding and fulfilling the pre-surgical WPATH requirements accepted by surgeons globally before surgery can be performed is another step in the process. Once the pre-surgical requirements have been met to ensure that the person is moving forward when ready and willing to have the desired procedures, a consultation with a surgeon will determine the appropriate next steps to meet the goals set by each individual.
Gender Reassignment Surgery (GRS) is also known as Sex Reassignment Surgery (SRS), genital reconstruction surgery, sex affirmation surgery, sex realignment surgery, or sex change surgery. All of these terms refer to the group of procedures by which the appearance and function of an individual’s sexual organs are transformed to resemble that of the opposite sex.
Gender Reassignment Surgery should be considered as irreversible. While few people have tried to revert back, the surgeries are costly and often less than satisfactory. On the positive side, research shows that individuals who undergo GRS are happy with the decision. Understanding the psychological and physical implications of GRS and working with some of the best surgeons in the world can lead to a positive and successful transformation to a happier life.
Genital Surgery for the Male to Female Client
In general, there are a series of surgical procedures performed in the MTF transformation: orchiectomy or removal of the testicles; penectomy or removal of the penis; and creation of the female genitalia including the vagina (vaginoplasty), labia (labiaplasty) and clitoris (clitoroplasty). It is most common to have these procedures done at the same time; however, each procedure can be done separately or not at all according to the patient’s wishes and the surgeon’s recommendations.
Let’s look at each procedure in more detail.
Orchiectomy or removal of the testicles
An orchiectomy (also spelled orchidectomy) when performed by itself can be done under local or general anesthesia in a clinic or hospital setting. An incision is made down the scrotum or skin sac enclosing the testicles, muscles and skin are opened, and the testicles removed. The incision is then sutured closed. The procedure can be completed in less than one hour.
When performed as part of a more comprehensive reassignment process, the skin from the scrotum is used to create the labia – the opening to the vagina – making the surgery easier because the skin is readily available. The surgeon can continue the transition surgery in a smooth fashion. If the testicles are removed as a single procedure and the decision is made later on to have a vaginoplasty with labiaplasty and clitoroplasty, skin grafts will be needed to create the female genitals.
It is important to remember that without testicles, the male hormone testosterone will no longer be produced by the body. Your doctor will advise you about the impact on hormone replacement and other health factors.
Penectomy or removal of the penis plus urethroplasty
A penectomy or surgical removal of the penis can be performed as a single procedure or as part of the gender reassignment process if the individual wants to move to the next stage of creating female genitals. If the individual wants to continue with the creation of a vagina, part of the skin from the penis will be used to form a vagina and labia. Also during the penectomy, the urethra will be redirected to allow for urination in a steady stream while sitting. The redirection and shortening of the urethra is referred to urethroplasty.
Creating female genitals
Your surgeon will have several goals in mind in creating a vagina, labia, and clitoris as part of the reaffirmation surgery. The vagina should be aesthetically pleasing and feel good to the touch; retain its shape and be of a size and shape large and long enough for sexual penetration; be hairless, flexible and moist to the touch; and, of course, provide sexual pleasure and satisfaction.
Do keep in mind that if you want to change your sex from male to female on official documents, the laws in most countries require that you undergo vaginoplasty to obtain new government documents such as passports or birth certificates.
Vaginoplasty or creating a vagina
The most common technique used in vaginoplasty is called penile inversion where the skin of the penis is turned inside out to create the walls of the vagina. The size and length of the penis will impact the choice of the penile skin inversion technique.
- –A long penis will allow the skin to be inverted, erectile skin and tissue removed, and then the remaining skin is inverted into the pelvic tissue.
- –A medium sized penis is one which will not provide enough skin by itself to create a vagina. A scrotal skin graft is needed to supplement the skin from the penis to create the vagina.
- –A small sized penis is one that requires a sigmoid colon graft to combine with the skin from the penis to create a vagina. A section of the colon is removed and used to construct the vaginal opening
A clitoris is fabricated from the head of the penis that is the most sensitive part of the sex organ.
The penis’ erectile tissue which allowed the penis to become erect is removed to prevent the vaginal opening and the clitoris from becoming too swollen and causing discomfort during sexual arousal.
During the vaginoplasty procedure, the urethra – the tube that directs urine from the bladder to excretion – is shortened and repositioned. The repositioning reflects the difference in anatomy between men and women. Men have a longer urethra than women so it is reduced in size as part of the vaginoplasty procedure.
The overall success of the vaginoplasty, labiaplasty and clitoroplasty depends on the surgeon’s skill as well as the amount of penile and other skin available to create female genitals that are aesthetically attractive, minimally scarred, and sensitive to sexual arousal. A consultation with one of our available surgeons gives you the opportunity to learn more about the specific procedures that will meet your goals.
Preparing for your Gender Reassignment Surgery
As with all surgeries, there are certain steps that you must take to prepare yourself mentally and physically for the procedure or procedures that you and your surgeon determine are the right choices for you.
If you are a smoker, in general, prospective patients are required to stop smoking at least two and sometimes as much as six weeks before the surgery. Smoking reduces the amount of oxygen in your blood and that can hinder healing. Your surgeon will give you specific instructions about stopping smoking before and after your surgery. If you have always wanted to quit smoking, this requirement may be the reason you needed to give up smoking.
Arriving at your destination a few days before surgery gives you a chance to adjust to the time difference, if any, and go through the bowel cleansing process in the peace and quiet of your hotel. The bowel prep empties your intestines, reducing potential problems during surgery, and ensuring that you do not have bowel movements for a few days after surgery. Think of it as an unpleasant experience that offers the benefit of losing a few pounds.
You will probably be admitted to the hospital the day before your scheduled surgery for routine medical testing to make sure you are healthy enough for the surgery. Routine tests can include blood tests, X-ray, and an overall examination. Your genital area will be shaved. Eating and drinking will be prohibited immediately prior to your surgery according to your doctor’s orders and the scheduled time for the surgery.
Immediately after surgery
Your recovery time will depend on which procedure or procedures you and your surgeon have chosen as well as your overall health. In general, you will leave the surgical theatre and be taken to a recovery room to allow the anesthesia to wear off while you are being monitored.
You will remain in hospital until you are sufficiently recovered to be discharged and this period of time will depend on which surgery or surgeries you have chosen to have. In general, if you have undergone the surgeries for your sexual transition, you will remain in for about seven to fourteen days. During this team, your doctor will prescribe bed rest, antibiotics to resist the onset of infection, and other medications for pain relief and to prevent blood clots. Your surgeon will be able to have you an accurate estimate of recovery time as well as the specific medications to be administered.
If you have had vaginoplasty
Your new vagina will need special care and attention to ensure proper healing and functioning for the long term so you will have to do your part to engage in this process.
After a vaginoplasty, a prosthesis similar in shape to a penis will be placed in your vagina for about five days to allow the skin of your new vagina to adhere to the vaginal wall. In order to help you urinate while you are healing, a catheter will be used to drain your bladder, allowing your shortened and reposition urethra to mend. Your surgeon will monitor your progress while in hospital and will make a clinical decision as to when the prosthesis and catheter can be removed – generally five to seven days after surgery.
Prior to discharge from the hospital, your surgeon will give you detailed instructions for your continuing recovery. It is extremely important to follow these instructions carefully and completely.
Following discharge from hospital
After you are discharged from hospital and if you have had a vaginoplastly, you will be given instructions about continuing to dilate or open up your vagina. While different surgeons have slightly different variations about how this process is to be done, it is important to be diligent about following these and other instructions from your surgeon.
For about eight weeks following your vaginoplasty, you will be given dialators to wear inside the vagina to ensure that it does not become shorter or narrower that your desired goal. Your surgeon or healthcare provider will show you how to remove it carefully and with the minimum of discomfort, clean it thoroughly and properly to avoid infection, and to reinsert it. Gradually you will be able to reduce the time you need to keep the prosthesis in place until your new vagina has healed to the point where it no longer needs to be opened up.
You will return to the surgeon after discharge for an examination to check for proper healing, signs of infection, bladder function, and bowel movements as well as any other health concerns in the healing process.
Pain and discomfort will continue for several weeks, depending on the number of surgeries you have had and the ability of your body to heal itself. Make sure to ask your doctor or healthcare provider any questions or concerns that you may have before or after your surgery.
You can expect to feel better within six to eight weeks, sometimes longer, and resume your normal light activities. Your doctor will give you instructions about the types of activities you can introduce into your routine post-surgery including those activities that need to be avoided for longer periods of time.
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