Gender reassignment surgery, which used to be known as sex reassignment surgery, helps the transition of those with gender dysphoria to change the appearance of their birth genitalia to their identified gender. Here we look at what is required to be accepted for surgery, the types of surgery and the effects they can have.
Surgery is not an easy process, but for many transgender people, the dissonance between their assigned gender and their experienced gender can lead to major upset and impairment on both personal and social levels, which is now recognised in the medical community as gender dysphoria.
The ability to change gender role through reassignment surgery allows for the individual’s outside appearance to match what is felt internally. Therefore, the pain and the risks of surgery are outweighed by the results.
Sex reassignment surgery is usually broken down into those that occur above the belt (top surgery) and those below the belt (bottom surgery). Not everyone signs up for all these surgeries, but the following procedures may be considered:
Subcutaneous mastectomy, or breast reduction surgery, is the first surgical procedure to be completed after the mental health and hormone therapy. A subcutaneous mastectomy makes the chest more masculine by removing breast tissue and skin excess, reduction and proper positioning of the nipple-areola complex to create a chest wall with minimal scars.
The motivation for a hysterectomy ranges from preventative health care and the treatment of persistent gynaecological conditions like painful cramping and endometriosis. It is certainly recommended for a transgender man at risk for cervical cancer without access to regular smear tests. Aside from removing the risk of a sexually transmitted disease and accidental pregnancy, a hysterectomy also fully aligns internal anatomy with the external gender identity.
Creating a functional penis is one of the biggest challenges for those who want to transition their body from female to male surgically. There are actually two different surgical procedures. One is metoidioplasty, which transforms the clitoris, which due to testosterone hormone therapy has grown, into a penis. Once the clitoris has grown, the internal suspensory ligament is cut, which causes more of the clitoris to fall outside of the body.
At this point, surgery can also lengthen the urethra and route it through the newly formed penis. It is also possible to perform a scrotoplasty in which the labia are sutured together to form a scrotum containing testicular implants. By taking advantage of the natural erectile tissue in the clitoris, metoidioplasty creates a penis that has its own erectile capabilities. It also retains more original nerve pathways, giving greater potential for orgasm post-surgery than other surgical options. However, the size of the clitoris may not be large enough for those who want to perform penetrative intercourse.
The other option, which creates a bigger penis, is a surgical procedure known as phalloplasty. This involves taking skin grafts, usually from the thigh, and using them to create a penis. The urethra can be lengthened and routed through the penis, and a scrotoplasty can be performed. Phalloplasty creates a larger penis, but this is not capable of erection on its own and has less sensitivity than a metoidioplasty operation. Additional surgery can insert a penile implant similar to those used in cisgender men with incurable erectile dysfunction.
Gender reassignment surgery takes place more than a year after hormone therapy has begun and at least two years after the first mental health evaluation. The amount of time until completion is variable depending on the number of procedures wanted, recovery time, and much more.
Research has shown that quality of life appears to improve after gender-affirming surgery, with the ability to reach orgasm often increasing after surgery. Also, more than 80 per cent report satisfaction with the surgery and frequency of sexual activity usually increases as well. So, despite the limitations to what can be achieved through surgery through gender affirmation surgery, outcomes are good as people physically become who they believe they were born to be.