title: A report from a single institute's 14-year experience in treatment of male-to-female transsexuals.
abstract: BACKGROUND
  Gender identity disorder or transsexualism is a complex clinical condition, and prevailing social context strongly impacts the form of its manifestations. Sex reassignment surgery (SRS) is the crucial step of a long and complex therapeutic process starting with preliminary psychiatric evaluation and culminating in definitive gender identity conversion.
  
  
  OBJECTIVE
  The aim of our study is to arrive at a clinical and psychosocial profile of male-to-female transsexuals in Italy through analysis of their personal and clinical experience and evaluation of their postsurgical satisfaction levels SRS.
  
  
  METHODS
  From January 1992 to September 2006, 163 male patients who had undergone gender-transforming surgery at our institution were requested to complete a patient satisfaction questionnaire.
  
  
  METHODS
  The questionnaire consisted of 38 questions covering nine main topics: general data, employment status, family status, personal relationships, social and cultural aspects, presurgical preparation, surgical procedure, and postsurgical sex life and overall satisfaction.
  
  
  RESULTS
  Average age was 31 years old. Seventy-two percent had a high educational level, and 63% were steadily employed. Half of the patients had contemplated suicide at some time in their lives before surgery and 4% had actually attempted suicide. Family and colleague emotional support levels were satisfactory. All patients had been adequately informed of surgical procedure beforehand. Eighty-nine percent engaged in postsurgical sexual activities. Seventy-five percent had a more satisfactory sex life after SRS, with main complications being pain during intercourse and lack of lubrication. Seventy-eight percent were satisfied with their neovagina's esthetic appearance, whereas only 56% were satisfied with depth. Almost all of the patients were satisfied with their new sexual status and expressed no regrets.
  
  
  CONCLUSIONS
  Our patients' high level of satisfaction was due to a combination of a well-conducted preoperative preparation program, competent surgical skills, and consistent postoperative follow-up.
authors.affiliation: University Federico II, Department of Urology, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Imbimbo
authors.forename: Paolo
authors.initials: P
authors.lastname: Verze
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palmieri
authors.forename: Nicola
authors.initials: N
authors.lastname: Longo
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Fusco
authors.forename: Davide
authors.initials: D
authors.lastname: Arcaniolo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005783:Gender Identity; D005837:Genitalia, Male / Q000601:surgery*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010413:Penis / Q000601:surgery*; D010549:Personal Satisfaction; D011594:Psychometrics; D019529:Sexuality; D011795:Surveys and Questionnaires; D013997:Time Factors; D014189:Transsexualism / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures; D055815:Young Adult