Feminizing vaginoplasty is one of the methods of operative sex change, in which the male genital organs are removed and the female ones are formed. After this operation, a transsexual can lead a normal sexual life and even enjoy sexual intercourse. Consider how feminizing vaginoplasty is performed, what preliminary preparation is needed and what complications are possible.
Transsexualism and surgical sex change
Transsexualism is a condition in which a person feels uncomfortable in his own body and wants to change his gender to the opposite. Do not confuse transsexualism with homosexuality and transvestism. Attraction to one’s own sex does not mean that a person doubts his own gender or wants to change his gender. Transvestites can also dress in clothes of the opposite sex, while they are not eager to change their bodies with hormone therapy or surgery.
It is worth noting that most transsexuals have suicidal tendencies due to rejection of their own bodies, problems with self-identification, rejection of loved ones and society. In this case, only radical measures can help: hormone therapy, sex reassignment plastic surgery, vaginoplasty and breast plastic surgery.
Not all transgender people decide on the most drastic measures. Many stop at the stages at which they begin to feel comfortable. We list the main stages and options for changing sex as their complexity increases:
- Without surgery, with hormone replacement therapy. In the case of taking hormones, the man’s body changes, changes are especially noticeable if the man starts taking medications in his teens, when the body has not yet fully formed. When hormones are taken, the genitals of men are reduced, complete chemical castration occurs within 6-12 months.
- Surgical castration - removal of the testicles.
- Removal of the penis and testicles, the formation of external genital organs.
- Vaginoplasty.
Feminizing vaginoplasty - what is it? This is an operation due to which the penis and testicles are removed, the formation of external genitalia and the formation of a vagina suitable for full sexual contact.
The first gender reassignment surgery
The first mention of successful sex reassignment surgery appeared in 1926. The German scientist M. Hirschfeld removed the mammary glands of a woman who wanted to be a man, as well as the penis of a man who wanted to become a woman.
At the beginning of the twentieth century, transgender people did not really want to publicize their desire to change their gender, because this was considered one of the signs of schizophrenia. On the other hand, there were a large number of homosexuals who wanted to change their gender, because in many countries homosexuality was illegal.
History is famous for Danish artist Einar Wegener, who decided on a sex change operation. He underwent two operations: on the first man, the testicles and penis were removed, and during the second, the uterus and ovaries were transplanted. Einar wanted to become a mother, and therefore decided on this. However, in those days, doctors were not yet aware of antigenic incompatibility, because alien organs began to be torn away by the body over time, from which Wegener died.
History
Initially, vaginoplasty (plastic vagina) was more the prerogative of women. With its help, external and internal defects of the female genital organs were corrected. In 1950, A. MacLoyd developed a technique that began to be used for vaginoplasty of women, using a split skin flap.
The history of feminizing vaginoplasty begins in 1970, when M. T. Edgerton and D. Bull described vaginal plastic surgery of transgender people from perineal tissue flaps.
In 1978, N. Zh. Pandai and O. Kh. Stutvil described the technique of vaginoplasty in transsexuals using flaps of tissue from the abdominal cavity.
In 1987, the history of feminizing vaginoplasty made a new round thanks to Dr. L.P. Small, who began to use the skin of the penis and scrotum to form the vagina, which is widely practiced today.
In 1993, S. Perovik introduced the technique of penile inversion with sensitive clitoroplasty. According to this method, tissues of the glans penis were used to form the sensitive clitoris, as well as the sensitive layer over the entire area of the neovagina.
New methodologies are still being developed. This is due to attempts to find the most advanced methods for creating a functional and visually indistinguishable from a natural vagina, while minimizing operational risks and subsequent complications.
Preparation for the operation and necessary documents
In some clinics, the requirements for feminizing vaginoplasty may be slightly different. Typically, preparation for surgery can take about two years. First, the patient must prove that he is in fact a transgender: he considers his current gender to be erroneous and for his more comfortable existence in society, gender reassignment is necessary.
The main indication for feminizing vaginoplasty is the conclusion of a psychiatrist. Often, the patient is prescribed hormone therapy. At least a year he must live in a female form. If afterwards he still insists on the operation, while the doctor does not detect any psychiatric abnormalities, the patient receives a psychiatrist's opinion. The sex change operation is performed only by adults.
Contraindications for surgery
There is a set of contraindications, because of which the patient may be denied an operational sex change:
- minor age;
- homosexuality;
- alcoholism or drug addiction;
- the lack of a psychiatrist opinion on transsexuality;
- the presence of mental illness and problems;
- elderly age.
Training
It should be noted that the average age of patients who decided to have feminizing vaginoplasty is 37 years, the average duration of preparation for surgery is 3.5 years.
Hormone therapy begins at least six months before the operation. It is necessary to prevent post-castration syndrome and simplify social adaptation.
A man who decides to undergo such an operation must understand that its consequences are irreversible. Removing the testicles and penis will make it impossible for a man to have children in the future. Many doctors advise you to save your semen before surgery if there is a desire to have children in the future. In any case, if the patient has even a drop of doubt about the feasibility of performing feminizing vaginoplasty, it is worth abandoning this venture, because it will be impossible to return everything to its place.
Penal Inversion Method
The most popular and simplest method of feminizing vaginoplasty is the method of penile inversion. With it, the vagina is formed using tissues of the penis and scrotum. The operation is considered quite simple, its duration is about 4 hours.
The following advantages of this method can be distinguished:
- the operation is simple, which means that the risk of complications is minimal;
- fast postoperative recovery: about 4-6 days;
- there is no risk of intestinal adhesion or peritonitis;
- relatively low cost of operation.
The disadvantages of this technique include:
- the need for constant stretching of the neovagina;
- during sexual contact, artificial lubrication is necessary;
- painful electrolysis of hair from the scrotum;
- with a small penis size it is impossible to achieve large sizes of the vagina. It is worth noting that hormone therapy often leads to a decrease in the penis and scrotum, which may not be enough tissue during surgery.
The method of penal inversion is the most popular due to its simplicity and cheapness.
Sigmoid method
With the sigmoid method of feminizing vaginoplasty, a part of the sigmoid colon about 18 cm long is cut off in the patient, and the intestine is then sutured. This part of the intestine will be used to form the neovagina.
The main advantages of this technique:
- fluid released by the intestines becomes a natural lubricant during intercourse;
- lack of likelihood of contracting the neovagina after surgery;
- no risk of hair growth in the vagina;
- the vagina has a more natural appearance;
- Constant stretching is not required.
This method also has its drawbacks:
- the operation is quite complicated, in addition, the intestine is involved in it, which can affect its condition;
- long period of postoperative rehabilitation;
- the vagina can smell and leak unpleasantly;
- the possibility of complications;
- very high cost.
The sigmoid method is less popular than the penal inversion method because of its high cost and complexity. However, it may be suitable for patients with a small penis in order to form a vagina of a more suitable size for sexual intercourse.
Complications
Possible complications depend on the complexity of the operation, the age of the patient, his physical condition, qualifications and experience of the surgeon. It is worth remembering that any surgical intervention carries certain risks to the health of the patient.
We list the main possible unpleasant consequences of sex reassignment surgery:
- lack of sensitivity of the neovagina and clitoris;
- rectal fistula formation;
- hair growth inside the neovagina;
- necrosis of penal and scrotal skin;
- bleeding
- peritonitis;
- urination disorder.
Rehabilitation
Inpatient treatment of a patient who changed sex by the method of penile inversion lasts up to 6 days, provided there are no postoperative complications. A swab is inserted into the vaginal area for a period of 12 days. A catheter in the urethra is inserted for a period of about 6 days.
With the sigmoid method of feminizing vaginoplasty, an incision is made in the abdominal cavity, which means that the patient’s rehabilitation period lasts longer. After the operation, processing of the postoperative suture and monitoring of the intestine is necessary.
After the operation, the patient should go on a diet for a while. Exclude from your diet fruit and vegetable juices, milk and other products that contribute to increased gas formation in the intestine.
It is worth abandoning increased sexual and physical activity until complete recovery.
The consequences of the operation
Surgeons claim that genitals formed as a result of feminizing vaginoplasty can only be distinguished from the real ones by another surgeon. During intercourse, the partner will not feel the difference. A transgender girl after feminizing vaginoplasty can have a relationship with a heterosexual man without even talking about her innate gender.
Most transgender people who underwent sex reassignment are completely satisfied with the outcome. Their life before and after feminizing vaginoplasty is fundamentally different. A sex change operation helps them adopt their own body.
However, it is worth noting a certain number of dissatisfied. One part is unhappy with the results of the operation, since it did not fully meet their expectations. For example, this is possible with a small vaginal size as a result of surgery or postoperative complications. There are transgender people who regret their decision to go through the operation. They acknowledge that their decision was not fully considered.
Thus, feminizing vaginoplasty is a fairly popular operation among transsexuals, which results in the removal and modification of the male genital organs and the formation of female ones in their place. The choice of vaginoplasty technique should be made based on the expected results. Since many transsexuals do not have sex after surgery, it is likely that a cheaper and simpler method of penal inversion is more suitable for them. A more natural result is achieved by the sigmoid method.