Male-to-Female Transsexualism: Technique, Results and 3-Year Follow-Up in 50 Patients

Abstract

Aim: To evaluate the functional and cosmetic results of male-to-female gender-transforming surgery. Patients and Methods: Between May 2001 and April 2008 we performed 50 male-to-female gender-transforming surgeries. All patients had been cross-dressing, living as women, and receiving estrogen and progesterone for at least 12 months, which was sufficient for breast development and atrophy of the testes and prostate to occur. This hormonal therapy was suspended 1 month before the operation. Results: The mean operative time was 190 min and the mean depth of the vagina was 10 cm. On follow-up, the most common complication (10%) was shrinkage of the neovagina, which could be corrected by a second surgical intervention. Of the 50 patients, 45 (90%) were satisfied with the esthetic results; 42 patients (84%) reported having regular sexual intercourse, 2 of whom had pain during intercourse. Of the 50 patients, 35 (70%) reported achieving clitoral orgasm. Conclusion: Male-to-female gender-transforming surgery can assure satisfactory cosmetic and functional results, with a reduced intra- and postoperative morbidity. Nevertheless the experience of the surgeon and the center remains central to obtaining optimal results.

Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques

“…In 43 patients of a total of 582 (7%, range 1–12%), stricture of the vagina other than the introitus was reported. Vaginal shrinkage was seen in 2–10% of treated patients [21,32].…”

“…Dyspareunia was present in 2–6% [27,31,32] and neovaginal bleeding in 3% [27]. Orgasm was possible in 70% [32], 84% [21], and 82.4% [24]. Lawrence [28] asked their 323 patients about the possibility to have an orgasm with masturbation.…”

“…Three studies [22,27,32] determined patient satisfaction with neovaginal depth, by using a patient questionnaire with “yes or no” answer options. They found that, respectively, 100% [22], 76% [27] and 80% [32] of transgenders were satisfied with the depth of the new vagina (mean percentage 83%). Wagner et al.…”

“…Wagner et al. [32] report that two out of eight dissatisfied patients, who underwent a new operation for neovaginal deepening, were still not satisfied with the results obtained.…”

Urogenital/pelvic pain in men

“…Wagner et al [15] published on 50 male-to-female trans-sexual operations over a 7-year period. The incidence of chronic pain with this type of surgery is not clear and probably under reported.…”