Sex reassignment surgery (male-to-female)

Sex reassignment surgery (SRS), also known as gender reassignment surgery (GRS), gender affirmation surgery, or gender-confirming surgery, refers to a series of surgical procedures that alter the physical appearance and function of a transgender person's existing sexual characteristics to resemble those typically associated with their identified gender. These procedures are part of the treatment for gender dysphoria in transgender individuals. The term may also be used to describe surgical interventions for intersex people, although some prefer the term "intersex surgeries" to differentiate them from transgender-specific procedures.

Types of surgery

Sex reassignment surgeries can be categorized into two main groups: top surgery and bottom surgery. Top surgery involves procedures on the chest, while bottom surgery includes procedures on the genitals and reproductive organs.

Top surgery

• Breast augmentation: For transgender women, breast augmentation surgery may be performed to increase the size and shape of the breasts to create a more feminine appearance.
• Mastectomy: For transgender men, a mastectomy, or chest reconstruction surgery, is performed to remove breast tissue and create a more masculine chest contour.

Bottom surgery

• Vaginoplasty: For transgender women, this procedure involves the creation of a vagina and vulva, usually using penile and scrotal tissue. The surgery may also include labiaplasty to create labia and clitoroplasty to create a clitoris.
• Phalloplasty: For transgender men, this procedure involves the construction of a penis using tissue from other parts of the body, such as the forearm or thigh. A penile implant may be inserted to achieve erections.
• Metoidioplasty: An alternative to phalloplasty for transgender men, metoidioplasty involves the release and lengthening of the clitoris, which has been enlarged through hormone therapy, to create a small phallus.
• Hysterectomy and oophorectomy: For transgender men, these surgeries involve the removal of the uterus (hysterectomy) and ovaries (oophorectomy), which can help reduce gender dysphoria and prevent certain health issues.
• Orchiectomy: For transgender women, this surgery involves the removal of the testicles, which can help reduce the production of testosterone and may be performed prior to or as part of vaginoplasty.

Other surgeries

In addition to top and bottom surgeries, some transgender individuals may undergo other surgical procedures to further masculinize or feminize their appearance. These surgeries may include:

• Facial feminization surgery: A series of procedures that can be performed to create a more feminine facial appearance for transgender women, including forehead contouring, rhinoplasty, and chin or jaw reshaping.
• Tracheal shave: A procedure to reduce the prominence of the Adam's apple, often performed on transgender women.
• Voice surgery: Some transgender individuals may choose to undergo voice surgery to raise or lower the pitch of their voice to better align with their gender identity.

Considerations and requirements

Sex reassignment surgery is often considered the final step in a transgender person's transition, following psychological counseling, hormone therapy, and living in their identified gender for a specified period, often called the "real-life experience." Many medical professionals and organizations, such as the World Professional Association for Transgender Health (WPATH), have established guidelines and criteria for determining eligibility for SRS. These criteria may include:

• A diagnosis of gender dysphoria
• Persistent and well-documented desire
• Persistent and well-documented desire to undergo sex reassignment surgery
• The capacity to make a fully informed decision and give consent for treatment
• Age of majority in the country where the surgery is being performed (usually 18 years or older)
• Completion of a specified period of hormone therapy, unless medically contraindicated
• Living in the identified gender role for a specified period, often called the "real-life experience"
• Favorable recommendation letters from qualified mental health professionals, typically including at least one gender therapist

These requirements may vary by surgeon or country and are meant to ensure that the individual is fully prepared for the physical, emotional, and social changes that accompany sex reassignment surgery.

Risks and complications

As with any surgical procedure, sex reassignment surgery carries risks and potential complications. These may include:

• Infection
• Bleeding
• Scarring
• Poor wound healing
• Adverse reactions to anesthesia
• Unsatisfactory aesthetic results
• Loss of sensation or function
• Complications related to urinary function or sexual function
• Need for additional surgeries or revisions

It is essential for individuals considering sex reassignment surgery to discuss the potential risks and benefits with their surgeon and to carefully weigh the decision before proceeding.

Post-operative care and recovery

Following sex reassignment surgery, patients will require a period of recovery and may need to stay in the hospital for a few days to several weeks, depending on the type and extent of the surgery. Post-operative care may include:

• Pain management
• Wound care and dressing changes
• Monitoring for complications
• Instructions on hygiene and care of the surgical site
• Dilator use for patients who have undergone vaginoplasty to maintain vaginal depth and elasticity

It is crucial for patients to follow their surgeon's post-operative instructions and attend all follow-up appointments to ensure proper healing and address any potential complications. In addition, many transgender individuals continue to work with mental health professionals and support groups throughout their recovery and beyond to help them adjust to their new bodies and navigate the social aspects of their transition.

Summary

Sex reassignment surgery for male-to-female involves reshaping the male genitals into a form with the appearance of, and as far as possible, the function of female genitalia. Before any surgery, patients usually undergo feminizing hormone therapy, though this is not a requirement. There are associated surgeries patients may elect to undergo, including vaginoplasty, facial hair removal, facial feminization surgery, breast augmentation and various other procedures. There is debate among trans people and activists regarding what terms are preferable to use, some arguing gender confirmation surgery or gender affirmation surgery are preferable terms, while other trans people maintain use of the term sex reassignment surgery.

See also

• Transgender
• Gender dysphoria
• Hormone therapy (transgender)

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