Sex reassignment surgery: Basic ideas

Basic ideas regarding male to female genital reassignment surgery, feminising genitoplasty or sex reassignment surgery

Despite what people think, or at least an important part of the population, it is a surgical intervention that must be considered with the utmost respect as it deals with an irreversible surgery, which leaves you sterile and is not risk-free if performed by the hands of amateurs. No-one undergoes this surgery for fun, as those patients who have been undergoing hormone treatment for years know, playing a female role in society and hiding their genitals so they cannot be seen through their pants or bikini. They were born in the wrong body and feel ashamed of their genitals, as they do not identify with them. With this said, we are going to briefly explain what the intervention consists of and what the most common risks are. The surgery starts with the opening of the perinea and the removal of the testicles, followed by separating the skin of the penis from the corpus cavernosum. We are going to keep this to line the vaginal cavity. At this stage, we can separate the urethra from the corpus cavernosum and extract the new clitoris by preserving a block of glans, with its blood vessels and sensitive nerves which will preserve sexuality as much as possible. Having reached this point, we can remove and connect all the erectile tissue of the corpus cavernosum and the spongy bulb. This step is important as if it is not done so correctly, it means that when the patient is aroused, the stumps of the erectile tissues that have not been correctly removed take up space. Now we can begin the reconstruction of the feminine genital complex by introducing the skin of the penis into the pelvis cavity, which we have preserved beforehand, between the bladder and the rectum, and placing the clitoris and the urethra in the place that is anatomically the most similar possible to the female vulva.

The most frequent acute complications are bleeding or infection, meaning we should control blood loss and give good antibiotic coverage. The most concerning, but the least frequent, is a perforation of the rectum when the space where the vagina will be placed is being prepared. Long-term complications have reached us mainly from other centres. The ones most frequently observed include the incorrect positon of the clitoris and the urethra, a large and very exposed clitoris, cutaneous excess surrounding the introduction of the partial expulsion of the penile skin of the vagina, urinating forward from a poorly-placed urethra and splashing yourself when sitting on the toilet. If, after reading this, you still believe that you want to undergo this complex intervention, we can only advise you to put yourself in the hands of an expert team and one with years of experience, who not only know how to handle the intervention but also know the potential complications that can arise during and after the intervention.