Sex change surgery, more appropriately known as gender reassignment surgery (GRS), sex reassignment surgery (SRS) is the final stage in the physical transitioning of a transgendered male-to-female. GRS is a surgical procedure that entails removing the external genitalia, followed by reconstruction of female genital organs.
The procedure carries high rates of success when performed by well trained and experienced surgeons, particularly for male-to-female procedures. Gender reassignment surgery has been performed for over 50 years and the techniques have been refined steadily in the past 10 years providing patients with excellent results. Normal erogenous sensitivity should be achieved, which enables patients to experience normal sexual intercourse and genital orgasm following GRS.
Q: What is Gender Reassignment Surgery, SRS?
The goals in Male to Female Gender Reassignment Surgery are 1. A normal functioning vagina, and 2. Cosmetically normal, female external genitalia. At the time of GRS, the testes are removed (orchidectomy) and the penis is excised (penectomy). A Neovagina is reconstructed utilising all of the penile skin and a paddle shaped flap (tennis racquet) from the posterior scrotal skin. This ensures that the new vagina has adequate depth and calibre to allow normal sexual intercourse. The new urethral opening (meatus) is fashioned and labiaplasty is performed using the anterior scrotal skin. Clitoroplasty can be either cosmetic or functioning using a sensate glans flap. Male to Female GRS once performed is totally irreversible.
Q: What are the benefits of Gender Reassignment Surgery?
GRS or SRS will enable normal sexual intercourse and frequently orgasm which can restore self-confidence and boost self-esteem. Male to Female GRS will enable patients to live a normal life as a woman but does not allow pregnancy or childbearing.
Q: Am I a suitable patient for Male to Female GRS, SRS?
You must have had a persistent and constant desire to live as a female for at least 2 years and under gone Psychiatric assessment for at least 2 years. You must demonstrate your ability to live as a female for at least 1 year before considering Male to Female GRS. It is very important that you have good support from family, friends or partner prior to and following your Male to Female GRS, SRS. Patients who are significantly overweight or obese are not good candidates for Male to Female GRS. You should be realistic as to what can be achieved by GRS and understand the risks and side effects of this surgery.
Q: Does Male to Female Gender Reassignment Surgery GRS, require a general anaesthetic or hospitalisation?
GRS, SRS surgery is performed under general anaesthetic and requires a hospital stay of 8 nights. You will be admitted to hospital the day preceding your GRS for blood investigations and bowel preparation.
Q: Must I stop smoking before my Male to Female GRS, SRS?
You will be required to agree to give up smoking for a minimum of 3 weeks before and 6 weeks following your GRS. Male to Female GRS, SRS is a complex Plastic Surgical procedure and smoking increases your risk of wound infection by 40% and Deep Vein Thrombosis as well as chest infection. Smoking delays wound healing and compromises your results.
Q: Should I stop Hormone treatment before my Male to Female GRS?
You must stop your hormone treatment 4 weeks prior to your GRS.
Q: How long is the Male to Female Gender Reassignment Surgery?
GRS, SRS Surgery normally takes approximately 4 to 4 ½ hours to perform depending on the complexity of the surgery.
Q: Will I need a blood transfusion during Male to Female Gender Reassignment Surgery?
Male to Female GRS, SRS is a long and complex operation and fortunately significant blood loss is uncommon. Blood will be available for you in the event of significant blood loss, should this occur during or after your surgery.
Q: What about the scars following Male to Female Gender reassignment Surgery?
Regrettably, it will be necessary to have some scar in order achieve a functioning vagina and normal female genitalia. However, the aim of surgery is a natural appearance with scars which are barely visible once complete healing is achieved. The scars are situated in the natural junction between the inner labia and the vaginal lining and the inner and outer labia to make these as inconspicuous as possible.
Q: Will a bladder catheter be required in GRS, SRS Surgery?
Yes, following your GRS, a bladder / urinary catheter is necessary, which will be removed before your discharge.
Q: Can Male to Female GRS be performed at the same time as other procedures?
Male to Female GRS is a complex Plastic Surgical procedure and it is not recommended that you combine other Plastic Surgery procedures at the same time. However, some procedures may be appropriate for you, such as Liposuction, Thyroid shave or Rhinotip surgery. What is appropriate and safe for you to combine will depend on your Medical Health, your goals and the individual procedures.
Q: What reassurance do I have with Male to Female GRS, SRS?
At LBPS, we understand that your decision to have GRS can be a daunting and anxious time for you. Mr Inglefield and the Team at London Bridge Plastic Surgery have many years experience and expertise in Male to Female GRS. Our aim is to fully understand your concerns and desires, before agreeing on a treatment plan which is in your best interest. If for any reason you are unsuitable for GRS, you will be advised against this form of surgery. We will provide you with all the information you need and support before, during and after your surgery.
Q: How long is the recovery time?
Moderate pain is expected for 3 – 5 days following your surgery and you will be prescribed suitable painkillers during this time. You will be on strict bed rest for 5 days initially until the vaginal pack is removed. You will then be able to mobilise gradually until your discharge from hospital. You should avoid strenuous exercise / activity for 6 weeks following your GRS. Abstain from any intercourse for 3 months.
Q: What about the results of GRS, SRS?
The results are first and foremost natural. The goals of Male to Female GRS are to create a functioning vagina, which allows you to enjoy normal vaginal intercourse and as aesthetically normal female genitalia as possible with scars which are inconspicuous enabling you to feel confident and comfortable.
Q: What are the risks of Male to Female GRS?
Common to all surgical procedures there are always risks associated with GRS surgery. However, complications are uncommon. Bruising is uncommon and may take 2 weeks to resolve, while major bleeding or haematoma is rare (less than 0.5%). Infection is rare (less than 0.5%) and will require a course of appropriate antibiotics. Irregularity or asymmetry of the labia is uncommon and may result from excessive swelling or disruption of stitches. This may require revision surgery to improve the result. Hypertropic or keloid scarring is also rare but will require specific treatments to reduce the scarring. Sensitivity is expected for 4 – 6 weeks before normal sensation returns. Bowel injury is rare which may result in a fistula (leak) into the vagina. Hence the importance of scrupulous bowel preparation. Urinary retention – difficulty passing urine, is uncommon and may require re-insertion of the bladder catheter for an additional week until the swelling has subsided. Penile Bulb enlargement may develop many months or even years following your GRS, due to sexual excitation stretching the tissue covering the bulb. This will require further surgery to restore a normal appearance. Late narrowing of the external meatus (urine opening) is rare which can cause spraying of the urine or difficulty passing urine. This stenosis (narrowing) will require a revision operation (meatotomy or meatoplasty) to correct this.
Q: What is the cost of Male to Female Gender Reassignment Surgery?
A: The cost for GRS, SRS Surgery will vary depending on the complexity of the surgery required to achieve an aesthetically pleasing and natural result. An accurate quotation can only be provided following your consultation.