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.

Orchiectomy

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.

Vaginoplasty

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.

Penile Inversion

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.

Colovaginoplasty

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.

Future Techniques

There is currently research being done on creating neovaginas using two different grafting methods. In one, samples of bucchal cells from the inside of the cheek would be used to culture the tissue necessary for a vagina. This method is already being used for women with some intersex conditions. The other would use stem cells to cultivate the tissue for a neovaginal graft. In both cases, the neovaginas would self-lubricate and potentially maintain their volume sans dilation because of the tissue type.

Labiaplasty

Scrotal tissue is used to form the labia majora and this may be performed at the same time as the vaginoplasty, or in a later surgery. During vaginoplasty, some penile tissue is often used to form the labia minora. Scrotal tissue may also be incorporated into the neovagina using inversion techniques if there is not enough tissue after this. In preparation for the surgery, laser hair reduction or electrolysis may be preferred over having hair follicles removed during surgery.

Post Op Care

Once the dressing in and around the vagina is removed, keeping the healing genitals clean and dilation are the two most important aspects of post operative care. Salt baths are often recommended, but should only be used after talking to your physician. Inexpensive cotton panties and loose cotton pants are the best lower body clothing choices during the first month of recovery, as cotton is a breathable fabric and blood and other bodily fluids are likely to spread to undergarments. Nothing heavier than 10 lbs (4.5 kg) should be lifted during this healing period.

All currently available male-to-female surgical techniques require lifelong dilation to maintain vaginal volume. This is due to the fact that the body treats the neovagina as a wound and will attempt to heal it by contracting around it. This may not be the case with future techniques.

Dilation begins several days after surgery, using a sterile water-based lubricant and a cleansing solution to disinfect the stents. This needs to be continued several times a day for weeks, until this can be cut down to once per week. Sexual intercourse is not an adequate dilation replacement. The insertion of the hard stent is required to keep the body open.

Some women will also use regular applications of estrogen products in the vagina, which may help maintain skin quality. If you decide to do this, ensure that you also calculate it into your total estrogen dosage.

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