Gender reassignment surgery in male-to-female transsexualism: A retrospective 3-month follow-up study with anatomical remarks.
BACKGROUND
Greater acceptance of sexual minorities has enabled people with transsexualism access to adequate treatment and social integration. Gender reassignment surgery is a complex phase in the care of transsexual patients. In response to a greater volume of patients, surgical techniques have evolved and the outcome in patients with male-to-female transsexualism is now a very accurate imitation of female genitalia, enabling sexual intercourse with orgasm.


OBJECTIVE
To evaluate the results of surgical reassignment of genitalia in male-to-female transsexuals.


METHODS
A retrospective 3-month follow-up study of patients' opinions following gender reassignment surgery in 129 patients having a primary procedure (eight of whom had later sigmoideocolpoplasty) and five patients undergoing reoperation following an initial unsuccessful procedure at other units. All patients were male transsexuals. The surgical techniques are described in detail.


METHODS
Sexual functions and complications 3 months after surgery.


RESULTS
All patients were satisfied with the first phase operation. Thirteen patients (9.7%) underwent successful sigmoideocolpoplasty. Main complications were as follows: rectal lesions developing during preparation of the vaginal canal (1.5%); bleeding from the stump of the shortened urethra in the first 48 hours postoperatively requiring secondary suturing (4.5%); temporary urinary retention requiring repeated insertion of urinary catheters for up to 6 days (5.2%); and healing of the suture between the perineum and the posterior aspect of the vaginal introitus healing by secondary intention (5.2%). The neoclitoris had erogenous sensitivity in 93.9% of patients and 65.3% reached orgasm in the first 3 months.


CONCLUSIONS
Surgical conversion of the genitalia is a safe and important phase of the treatment of male-to-female transsexuals.
Jarolím
Ladislav
L
Department of Urology, Second Faculty of Medicine and University Hospital Motol Charles University, Prague, Czech Republic;. Electronic address: ladislav.jarolim@lfmotol.cuni.cz.
Šedý
Jiří
J
Institute of Experimental Medicine and Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic.
Schmidt
Marek
M
Department of Urology, Second Faculty of Medicine and University Hospital Motol Charles University, Prague, Czech Republic.
Naňka
Ondřej
O
Institute of Anatomy, First Faculty of Medicine, Prague, Charles University, Czech Republic.
Foltán
René
R
First Faculty of Medicine, Charles University, Prague, Czech Republic.
Kawaciuk
Ivan
I
Department of Urology, Second Faculty of Medicine and University Hospital Motol Charles University, Prague, Czech Republic.
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002987:Clitoris / Q000033:anatomy & histology / Q000294:innervation; D005260:Female; D005500:Follow-Up Studies; D005837:Genitalia, Male / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014189:Transsexualism / Q000601:surgery*; D014621:Vagina / Q000033:anatomy & histology; D055815:Young Adult