Gender re-assignment is undertaken when an individual finds that he/she is comfortable being a person of the opposite sex.Physically such a person may appear to be a male/female but mentally the sex of the person will be opposite to that of the phenotype. As a pre-requisite for surgery, such a person shall have lived his/her life as an individual of the opposite sex for a minimum period of 2 yr, with hormonal supplementations that shall ensure changes in the physical structure before surgery.Hence a person appearing physically as male, intending to convert to female may need to live for a minimum period of two-years as a female, taking oestrogens that shall induce some feminine characters in him until definitive surgical measures are undertaken.
Genital re-construction is the prime task in gender-reassignment surgeries.The operative procedure for conversion of a male into a female is briefly described below:
For some patients who have a small penis it may be necessary to use a colon graft to reconstruct the vagina.
For male to female transexual surgery a period of living as a woman for 2 years whilst taking feminizing hormones is advocated. With the successful transition into the female role, construction of the female external genitalia and a vagina is planned.
the erectile tissue of the penis is removed, the urethra (the channel down which the urine is conducted) is dissected out, the skin of the penis with its own erogenous sensation and blood supply is turned inside out and goes to make the labia minora and the introitus of the vagina. The urethra is brought through the dorsal penile skin into the position of the female external urethral opening. The reduced scrotal skin goes to make the labia majora.
Portions of the glans penis with its own blood supply and nerves are used to reconstruct a sensate clitoris which can still have erogenous sensation and function.
A vagina is constructed via a laparoscopic operation. Portion of the large bowel, the ascending colon, is mobilised on its own blood supply down into the position where the normal female vagina is situated between the bladder and rectum.The advantage of using the large bowel is that the bowel is naturally distensible, does not contract, has its own blood supply so remains healthy. The bowel is self cleansing with a small amount of mucus so it is also lubricated. This vagina has considerable advantages over the previous operations where they used the penile skin and a skin graft to make the new vagina.
With successful construction of the external genitalia, breast construction and facial plastic surgery may be undertaken.Please refer the appropriate pages for information.
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