Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals.
OBJECTIVE
After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism.


BACKGROUND
Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major role in the research and treatment of gender identity disorder, publishing the Standards of Care for Gender Dysphoric Persons.


METHODS
The authors performed an overview of the terminology related to male-to-female gender identity disorder; the different theories regarding cause, epidemiology, and treatment; the goals expected; and the surgical technique available for sex reassignment surgery in male-to-female transsexualism.


RESULTS
Surgical techniques available for sex reassignment surgery in male-to-female transsexualism, with advantages and disadvantages offered by each technique, are reviewed. Other feminizing nongenital operative interventions are also examined.


CONCLUSIONS
This review describes recent etiopathogenetic theories and actual guidelines on the treatment of the gender identity disorder in male-to-female transsexuals; the penile-scrotal skin flap technique is considered the state of the art for vaginoplasty in male-to-female transsexuals, whereas other techniques (rectosigmoid flap, local flaps, and isolated skin grafts) should be considered only in secondary cases. As techniques in vaginoplasty become more refined, more emphasis is being placed on aesthetic outcomes by both surgeons and patients.
Selvaggi
Gennaro
G
Department of Plastic Surgery, University Hospital of Ghent, Ghent, Belgium. selvaggigennaro@yahoo.it
Ceulemans
Peter
P
De Cuypere
Griet
G
VanLanduyt
Koen
K
Blondeel
Phillip
P
Hamdi
Moustapha
M
Bowman
Cameron
C
Monstrey
Stan
S
D002987:Clitoris / Q000601:surgery; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery; D007830:Larynx / Q000601:surgery; D008297:Male; D016462:Mammaplasty; D010413:Penis / Q000601:surgery; D019651:Plastic Surgery Procedures; D012611:Scrotum / Q000601:surgery; D016038:Skin Transplantation; D014189:Transsexualism / Q000175:diagnosis / Q000601:surgery*; D014521:Urethra / Q000601:surgery; D014621:Vagina / Q000601:surgery*