An overview of female-to-male gender-confirming surgery

Abstract

Gender dysphoria is estimated to occur in approximately 25 million people worldwide, and can have severe psychosocial sequelae. Medical and surgical gender transition can substantially improve quality-of-life outcomes for individuals with gender dysphoria. Individuals seeking to undergo female-to-male (FtM) transition have various surgical options available for gender confirmation, including facial and chest masculinization, body contouring, and genital surgery. The World Professional Association for Transgender Health guidelines should be met before the patient undergoes surgery, to ensure that gender-confirming surgery is appropriate and indicated. Chest masculinization and metoidioplasty or phalloplasty are the most common procedures pursued, and both generally result in high levels of patient satisfaction. Phalloplasty, with a resultant aesthetic and sensate phallus along with implantable prosthetic, can take upwards of a year to accomplish, and is associated with a considerable risk of complications. Urethral complications are most frequent, and can be addressed with revision procedures. A number of scaffolds, implants, and prostheses are now in development to improve outcomes in FtM patients.

Genital Sensibility in the Neophallus: Getting a Sense of the Current Literature and Techniques

“…14 It is not only of importance to achieve sexual pleasure but also remains desirable for protective sensation in the setting of penile implant placement. [2][3][4]16 Most surgeons wait at least 12 months after phalloplasty for development of tactile sensation prior to implant placement, but there appears to be no rigorous data on methods to assess genital sensibility after phalloplasty in the current literature. This study set out to characterize the data available on genital sensibility after phalloplasty while taking into account which nerves were coapted.…”

“…Also, in certain cases, providers may choose to not denervate the clitoris in transmales with the goal of leaving a fully functional clitoris under the phallus for erogenous sensibility. 2,4,11 Yet, comparisons across groups in regard to erogenous sensation are nonexistent.…”

“…The following inclusion criteria had to be met: (1) the nerves included in the neophallus had to be described, (2) the nerves used as the donor nerves had to be described, (3) the neophallus could be transferred on a vascular pedicle, as a flap, or transferred by microsurgical technique, (4) the nerve coaptation had to be described, (5) the average followup period of time from surgery to sensibility evaluation of at least 6 months, (6) the measurement of sensibility had to be described, and (7) the definition of erogenous had to be given. Exclusion criteria included: (1) age 18 years, (2) articles that did not report primary evidence, and (3) those that did not meet full inclusion criteria, especially with the robust description of microneuroreconstruction. Both transmales and cismales were included.…”

“…Formation or reconstruction of the phallus after congenital or acquired absence of the penis or during gender-affirmation surgery can have profound psychosocial impacts for patients. [1][2][3][4][5][6] These reconstructions are generally accompanied by vastly improved quality-of-life outcomes. 4,7,8 With the advent of microsurgery, the ability to reconstruct the phallus has evolved to include pedicled perforator and free flaps.…”

U.S. Oral and Maxillofacial Residents’ Experience with Transgender People and Perceptions of Gender‐Affirmation Education: A National Survey

“…6 Given that the role of gender-affirmation surgery for gender dysphoria is well documented, the team should also include surgical specialists with experience in gender-affirmation surgery. [7][8][9][10][11][12][13][14] Furthermore, teams that provide care for individuals who are considering gender-affirmation surgery may find ethical and practical guidance in the World Professional Association for Transgender Health Standards of Care. 6,15 Currently, there are few health care centers that specialize in the gender-affirmation process, and many of those that do are in major metropolitan areas at large academic institutions.…”