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Gender Reassignment Surgery for MtFs
Though there are many surgeries a trans woman may opt to have, the three primary ones that make up gender reassignment surgery (also "genital reaalignment surgery" or "sex reassignment surgery") are orchiectomy, vaginoplasty, and labiaplasty.
In this surgery, the testicles and the full spermatic cord are removed. After the procedure, the patient will be rendered permanently sterile and will require hormone replacement therapy for life.
Benefits of the surgery include reduced production of male hormones, which in turn improves the results of HRT. Some people interested in surgery may choose to only have the orchiectomy done, due to concerns over the other surgeries, limited money, or other reasons.
This is the most intensive surgery of the three, requiring the longest recovery time as well as permanent aftercare. The surgery creates a neovagina which is typically capable of sexual intercourse, though it does not always have erotic sensation. The two most common techniques are explained in detail below.
The penis is opened using a flap technique and the erectile tissue is removed, while the skin, blood supply and nerves remain. Some of this tissue is inserted into a cavity created in the pelvis to form the walls of the neovagina, while part of the glans of the penis is used to create a clitoris. The urethra is shortened so that it ends at an appropriate place for female genitals. Because genital nerves are part of the vagina and clitoris, erotic sensation is typically preserved.
The neovagina does not self-lubricate, though some women do report the skin feeling more like mucus membranes as time goes on. Personal lubricant is recommended for all women who use this procedure when having sexual intercourse. This method requires manual dilation using a stent to maintain vaginal depth.
In this technique, the neovagina is created with a section of the sigmoid colon. It may also require a skin graft, usually using tissue from the thigh or abdomen. The neovagina is self-lubricating due to the presence of mucus membrane from the colon, but the lubrication is permanent rather than strictly associated with sexual arousal. Penile tissue may still be used for a labiaplasty and creating a clitoris.
There are many potential complications from this surgery, including diversion colitis. Additionally, it does not create a neovagina with erotic sensation. This method also requires manual dilation using a stent.
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