Full feminising vaginoplasty includes bilateral orchidectomy and penectomy, with the creation of a vagina, sensate neoclitoris and labia majora.
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This is usually performed in a single procedure, although some surgeons prefer to undertake labiaplasty and clitoroplasty after healing of the vaginoplasty. Different surgical techniques are available for vaginoplasty and these can be classified into five categories: The advantage of this process is that, as the flaps have their own blood circulation, there is less tendency for the neovagina to shrink or necrose, compared with free skin grafts.
B Harvesting the dorsal neurovascular bundle to form the neoclitoris. Several methods exist to form a sensate neoclitoris. This is aesthetically acceptable, and serves as a focus for erotic stimulation. Injury to the arteries or nerves within the neurovascular bundle can occur, resulting in impaired blood supply or a reduced sensation clitoris.
Secondary procedures are available at a later date if necessary to further improve the cosmetic results.
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On pack removal, the patient is allowed to mobilise. The urethral catheter is removed and the patient is taught how to adequately clean and dilate the neovagina. Vaginal dilatation consists of inserting a special dilator for 15 min three times daily, gradually increasing the size of the dilator used. When the patient is comfortable with this she is discharged, usually on the seventh or eighth postoperative day.
The vast majority of patients report important benefits from feminising genitoplasty at a low risk of complications. The authors concluded that in this 30 year period, only 1—1. There are a variety of measures MTF transsexual people can employ to maximise their female appearance and comfort in the female role. It is clear that gender identity disorder is a complex disorder.
The UK standards of care will establish agreed criteria for the diagnosis, management and care of people with GID. These are not expected to differ too significantly from the HBIGDA but will, for the first time, establish the principles of shared and agreed care in this complex field within the UK.
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Good clinical management of GID demands a multidisciplinary approach. The diagnosis may take several months to establish. There are hormonal, psychological, behavioural and surgical components to the management process. Hormonal and surgical treatments carry very real risks. The positive outcome reports, however, clearly demonstrate that successful surgical outcome and user satisfaction is achievable in carefully selected patients. Gender realignment surgery is therefore here to stay. National Center for Biotechnology Information , U. Journal List Postgrad Med J v. Author information Article notes Copyright and License information Disclaimer.
Received Apr 3; Accepted May This article has been cited by other articles in PMC.
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Abstract Gender identity disorder GID , or transsexualism as it is more commonly known, is a highly complex clinical entity. Open in a separate window. Aetiology The worldwide incidence of GID ranges from 1: Real life experience Once accepted into the gender identity service, patients are asked to participate in the Real Life Experience which requires the transsexual individual to function full time in their desired gender role for a minimum period of 12 months.
Hair removal Almost all patients will need advice on the facial and pubic hair removal process, whether this consists of ablation, shaving, laser or electrolysis. Endocrinological management It is important to note that none of the feminising hormones used by specialists has a product licence for use in MTF patients. Postoperative follow up The vast majority of patients report important benefits from feminising genitoplasty at a low risk of complications.
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The endocrinology of transsexualism: Male to female transsexualism: Br J Urol ; Plast Reconstr Surg ; Good practice guidelines for the assessment and treatment of gender dysphoria. Intercollegiate Working Party, A sex difference in the human brain and its relation to transsexuality. Other surgical treatment options There are a variety of measures MTF transsexual people can employ to maximise their female appearance and comfort in the female role.
Conclusion It is clear that gender identity disorder is a complex disorder. GID is more common in females than males. The Hogarth Press Die intersexualle constitution [The intersexual state]. Jahrb sex zwischenstufen 23 3— Plast Reconstr Surg e—45e. American Psychiatric Association Diagnostic and statistical manual of mental disorders , 4th ed.
American Psychiatric Association, ABC of sexual health: BMJ — Psychoneuroendocrinology 15 3— Eur J Endocrinol — Hartmann U, Becker H. Nature 68— J Clin Endocrinol Metab 85 — Treatment of hair loss. N Engl J Med — Towards optimal hormonal treatment of male to female gender identity disorder.
J Sexual Repro Med 1 45— Endocrine treatment of transsexual people: J Clin Endocrinol Metab 88 — Clin Endocrinol Oxf 47 — Clin Endocrinol Oxf 28 — J Clin Endocrinol Metab 66 — Plast Reconstr Surg — Br J Urol 88 — A method of preserving the glans penis as a clitoris in sex conversion operations in male transsexuals.
Scand J Urol Nephrol — Each book in this bundle would cost 2.
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Current management of male‐to‐female gender identity disorder in the UK
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