What is Gender Confirmation Surgery / Gender Reassignment Surgery, SRS?
The goals in Male to Female Gender Confirmation Surgery GCS are 1. A normal functioning vagina, and 2. Cosmetically normal, female external genitalia. At the time of GCS / GRS, the testes are removed (orchidectomy) and the penis is excised (penectomy). The new vagina (Neovagina) is created utilising all of the penile skin and a paddle shaped flap of skin from the posterior surface of the scrotum. This is referred to as the “Peno-scrotal inversion technique” This technique ensures that the neovagina has good depth and calibre(size) to allow normal vaginal intercourse. The new urethral opening, meatus (for urinating) is fashioned and the labia are created using the anterior scrotal skin. Clitoroplasty can either be cosmetic or functioning using a “sensate glans flap” taken from the glans of the penis.
What are the benefits of Gender Confirmation Surgery GCS?
GCS / GRS will enable normal sexual intercourse and frequently orgasm which can restore self-confidence and boost self-esteem. Male to Female GCS will enable patients to live a normal life as a woman but does not allow pregnancy or childbearing.
Am I a suitable patient for Male to Female GCS / GRS?
Prior to undergoing GCS / GRS you must have had a persistent and constant desire to live as a female for at least 2 years and undergone Psychiatric assessment for at least 2 years. You must demonstrate your ability to live as a female for at least 1 year – REAL Life Experience, before considering Male to Female GCS. It is very important that you have good support from family, friends or partner prior to and following your Male to Female GCS, GRS. Patients who are significantly overweight or obese are not good candidates for Male to Female GCS. You should be realistic as to what can be achieved by GCS and understand the risks and side effects of this surgery.Because GCS / GRS is irreversible it is essential to ensure that this surgery is right for you and is in your best interest. Hence we adhere to the internationally accepted guidelines to safeguard you – www.wpath.org
Standards of Care for Transgender Individuals
- A true transsexual with gender dysphoria.
- Hormone treatment for at least 1 year recommended.
- Real life experience for 1 year.
- Surgery recommend by 2 mental health specialists trained in Gender Identity care.
- Adult age – at least 18 years old.
- Emotionally stable
- Medically healthy with any medical conditions being treated and under control.
- Support of spouse, family, significant other, friends.
Does Male to Female Gender Reassignment Surgery GRS, require a general anaesthetic or hospitalisation?
GCS, GRS surgery is performed under general anaesthetic and requires a hospital stay of 6 to 8 nights. You will be admitted to hospital the day preceding your GRS for blood investigations and bowel preparation.
Must I stop smoking before my Male to Female GCS, GRS?
You will be required to agree to give up smoking for a minimum of 3 weeks before and 6 weeks following your GCS. Male to Female GCS, GRS is a complex Plastic Surgical procedure and smoking increases your risk of wound infection by 40% and Deep Vein Thrombosis as well as chest infection. Smoking delays wound healing and compromises your results.
Should I stop Hormone treatment before my Male to Female GCS?
You must stop your hormone treatment 4 weeks prior to your Gender Confirmation Surgery.
How long is the Male to Female Gender Conformation Surgery?
GCS, GRS Surgery normally takes approximately 4 to 5 hours to perform depending on the complexity of the surgery.
What are the advantages of the Peno-scrotal vaginoplasty?
Patients who have sufficient penile and scrotal tissue can achieve a good functioning neovagina which enabled normal vaginal intercourse. The peno-scrotal inversion technique retains normal erogenous sensation from the penis and scrotum which for many individuals allows normal orgasms once fully healed. Hair removal either by LASER or Electrolysis will be recommended prior to surgery to reduce any hair growth inside the neovagina.
What are the advantages of the Colovaginoplasty?
Colovaginoplasty utilises a segment of the large intestine (bowel) to create the neovagina. This technique is usually required in individuals who do not have sufficient penile and scrotal tissue to create the new vagina and in transgender individuals who have previously had a failed GCS / GRS procedure. This is a more complex surgery but provides the patient with an excellent functioning neovagina. The bowel segment looks and feels very similar to a normal female vagina and has natural lubrication.
Will I need a blood transfusion during Male to Female Gender Conformation Surgery?
Male to Female GCS, GRS is a long and complex operation and fortunately significant blood loss is uncommon. Blood will be available for you in the event of significant blood loss, should this occur during or after your surgery.
What about the scars following Male to Female Gender Confirmation Surgery?
Regrettably, it will be necessary to have some scar in order achieve a functioning vagina and normal female genitalia. However, the aim of surgery is a natural appearance with scars which are barely visible once complete healing is achieved. The scars are situated in the natural junction between the inner labia and the vaginal lining and the inner and outer labia to make these as inconspicuous as possible. Scar care and or treatments will be advised during your post-surgery recovery.
Will a bladder catheter be required in GCS, GRS Surgery?
Yes, following your GCS, a bladder / urinary catheter is necessary, which will be removed before your discharge.
Can Male to Female GCS be performed at the same time as other procedures?
Male to Female GCS is a complex Plastic Surgical procedure and it is not recommended that you combine other Plastic Surgery procedures at the same time. However, some procedures may be appropriate for you, such as Liposuction, Thyroid shave or Rhinotip surgery. What is appropriate and safe for you to combine will depend on your Medical Health, your goals and the individual procedures.
What reassurance do I have with Male to Female GCS, GRS?
We understand that your decision to have GCS can be a daunting and anxious time for you. Mr Inglefield and the Team at London Transgender Clinic have many years of experience and expertise in Male to Female GCS. Our aim is to fully understand your concerns and desires, before agreeing on a treatment plan which is in your best interest. If for any reason you are unsuitable for GCS, you will be advised against this form of surgery. We will provide you with all the information you need and support before, during and after your surgery.
How long is the recovery time?
Moderate pain is expected for 3 – 5 days following your surgery and you will be prescribed suitable painkillers during this time. You will be on strict bed rest for 5 days initially until the vaginal pack is removed. You will then be able to mobilise gradually until your discharge from hospital. You should avoid strenuous exercise / activity for 6 weeks following your GCS. You must abstain from any intercourse for 3 months following your surgery.
What about the results of GCS, GRS, SRS?
The results should first and foremost be natural female genitalia with a good healthy functioning vagina which will allow you to enjoy normal vaginal intercourse without concerns about your desired gender. We aim to ensure that your scars are as inconspicuous as possible enabling you to feel comfortable and confident with your appearance.
What are the risks of Male to Female GCS, GRS?
Common to all surgical procedures there are always risks associated with Gender Confirmation Surgery. However, complications are uncommon. Bruising is common and may take 2 weeks to resolve, while major bleeding or haematoma is rare (less than 0.5%). Infection is rare (less than 0.5%) and may require a course of appropriate antibiotics. Irregularity or asymmetry of the labia is uncommon and may result from excessive swelling or disruption of stitches. This may require revision surgery to improve the result. Hypertropic or keloid scarring is also rare but will require specific treatments to reduce the scarring. Sensitivity is expected for 4 – 6 weeks before normal sensation returns. Bowel injury is rare which may result in a fistula (leak) into the vagina. Hence the importance of scrupulous bowel preparation before your surgery. Urinary retention – difficulty passing urine, is uncommon and may require re-insertion of the bladder catheter for an additional week until the swelling has subsided. Penile Bulb enlargement may develop many months or even years following your GCS, due to sexual excitation stretching the tissue covering the bulb. This will require further surgery to restore a normal appearance. Late narrowing of the external meatus (urine opening) is rare which can cause spraying of the urine or difficulty passing urine. This stenosis (narrowing) will require a revision operation (meatotomy or meatoplasty) to correct this.
What is the cost of Male to Female Gender Confirmation Surgery?
The cost for GCS, GRS will vary depending on the complexity of the surgery required to achieve an aesthetically pleasing and natural result. The costs will include your pre-operative and post-operative care and your follow-up appointments for 1 year. You will be provided with a detailed quotation following your Consultation with your Surgeon.