Genital organs after gender reassignment. Sex reassignment surgery, technique and possible complications

Patients diagnosed with transsexualism (a sense of belonging to opposite sex) or hermaphroditism (the presence of both types of sexual characteristics), sex reassignment surgery is indicated. However, the patient should be fully aware of the prolonged postoperative hospitalization and rehabilitation.

This procedure is preceded by lengthy preparation, consisting of several stages:

  1. It is imperative to register in a psychiatric hospital, undergo a thorough examination and be observed by a psychiatrist for 2 years (psychocorrectional measures, instrumental and somatic examination).
  2. After this period, the patient must undergo a special commission, which includes at least three qualified specialists.
  3. If the patient successfully passes the commission, he is given a certificate of form F 64.0 with a diagnosis of transsexualism.

After confirming the diagnosis, the endocrinologist selects a hormone therapy regimen. Her course is conducted under the supervision of a specialist. This is required because the transformed person needs to take hormonal medications throughout his life. The role of hormones in the human body is extremely high: they not only regulate body temperature, homeostasis, secondary sexual characteristics, but also other functions. Before hormone therapy, it is necessary to undergo a complete examination to exclude anemia, infectious diseases and disturbances in liver function.

During the course, women undergo the first operation - removal of the mammary glands. After a mastectomy, the uterus, cervix, ovaries and fallopian tubes are removed. The last operation is neofalolplasty: a sensitive penis and scrotum are formed from the subcutaneous tissues of the groin area, femoral artery and a set of nerves. The length of the penis depends on the parameters of the artery, and the thickness depends on the patient’s fatty tissue. After healing - after 2-3 weeks - a silicone prosthesis is placed into the formed penis.

In transsexual men, the vagina is formed from the penis and scrotum. To do this, the testicles, most of the seminal ducts and the corpus spongiosum are removed. After this, the clitoris is formed from the upper part of the head of the penis. A nerve leading to the head is left underneath to ensure its sensitivity during intercourse. If there is a lack of material, intestinal tissue is used. The vagina is sutured to the peritoneum. To preserve urinary function, the prostate gland is preserved.

It should be taken into account that there are a number of contraindications to the operation:

  • age under 18 years;
  • alcoholism;
  • elderly age;
  • the presence of severe mental and systemic diseases.

In the postoperative period, the patient should limit physical exercise. Sexual activity is not recommended until the surgical area is completely healed. The patient should also regularly visit the attending physician to monitor the progress of healing.

Today, gender reassignment surgery hardly shocks others, but just 20-30 years ago, many could not even think about such a thing. It has become quite possible to transform from a man to a woman or vice versa, and surgery has achieved fantastic results in this area. Of course, there are difficulties, not only functional, but also psychological. And those who decide to do this must understand that there is a lot of colossal work ahead, first of all, on themselves.

What is the essence of such operations

In general, sex reassignment surgery is a whole complex of medical, pharmacological and psychological procedures aimed at achieving one goal: eliminating the dissonance between physiological and psychological sex. You can’t just lie down on the surgical table and wake up a different person. This is a long process, sometimes taking several years.

At the beginning of the 20th century, people who claimed to have been born in a body that was not theirs were placed in psychiatric clinic, diagnosing them with schizophrenia. Today, a person who lives in the body of a man, but considers himself a woman (or vice versa), is called a transsexual. This is also a diagnosis that a psychiatrist can confirm, but the treatment is completely different: medicine offers surgical correction of sexual characteristics. And, by the way, it is the medical report marked “transsexualism” that is the starting point for further actions leading to gender reassignment.

Important! A transsexual should not be confused with a transvestite. The latter simply dresses in clothes intended for the opposite sex for the purpose of entertainment or self-expression. For a transsexual, everything is much more complicated psychologically: it is difficult for such a person to be who he was born.

The first gender reassignment operations

In the 30s of the 20th century, there was an Institute of Sexual Sciences in Berlin. And it was in the clinic at this institution that the first gender reassignment operations were performed. The year 1926 was marked by the removal of a woman’s mammary glands, and already in 1930 a man’s penis was removed. Unfortunately, nothing is known about the fate of these patients who became “pioneers”.

By the way! The operation to transform a man into a woman is referred to in medicine as MtF (Male to Female), and from woman to man, respectively,FtM.

The most popular first transgender (from the Latin transire - “deviation” and genus - “gender, gender”) is Einar Wegener, Danish

an artist who later became known as Lili Elbe. The film “The Danish Girl” (2015) was based on his life story. As a child, Einar was an ordinary boy. He then married Gerda, who was also an artist.

Einar first felt comfortable in women's clothing when his wife asked him to pose in place of a sick model. Gradually Wegener realized that he was a woman, by an error of nature, imprisoned in male body. He for a long time appeared in wide circles V female form, introducing herself as her own sister. And then he decided to have surgery.

From 1930 to 1931, the artist lay on the surgical table 5 times. The operations were experimental at the time, but the first four were surprisingly successful. And only the fifth intervention became fatal. In September 1931, Lily received a uterus transplant, which did not take root. The world's first person to officially change gender has died at the age of 48.

The first sex reassignment operation performed in the USSR is described in the book “My Time” by Riga surgeon Viktor Kalnbers. In it, he talks about his patient, whom he turned into a man in 4 years (from 1968 to 1972). Then everything was done in the strictest secrecy, otherwise the doctor could have gone to prison. About the fate of the patient (Dr. Kalnberz indicates only his name: Inna - Innocent) all that is known is that he survived and even married several times.

After the operation, there was a correspondence for some time in which Innocent thanked the doctor and talked about some of the features of his new life, the fear of medical examinations and legends that the scars on his body were allegedly the result of an attack by bandits and an accident in his youth.

This is interesting! Today, from 15 to 30 thousand (!) gender reassignment operations are performed annually all over the world.

How is gender reassignment performed?

Some people find this topic frightening and even somewhat disgusting. Deeply religious people have a negative attitude towards this, believing that you need to live in this body and in that appearance which is given by God. But most are still curious about how such operations are done.

Preparatory actions

IN different countries their laws regarding the psychological period of preparation for sex change. In Russia, a person must first be registered with a psychiatrist for 2 years.

Then, based on the results of a medical commission, which includes at least three doctors, a diagnosis of “transsexualism” is made, which can then be addressed to surgeons. If the diagnosis is not confirmed, no one will undertake the operation.

Physiological preparation begins with hormone replacement therapy. A person must prepare the body for radical changes. The course of hormones can take from 3-5 months to a year, depending on the degree of transsexuality of the person and the external manifestations of the signs of the desired gender. A woman who plans to become a man is prescribed androgens. They will allow you to achieve the following changes:

  • menstruation ends;
  • the voice will become rough;
  • facial hair will appear;
  • the figure will become less feminine (the roundness will disappear);
  • the clitoris will enlarge, which will subsequently be modified into a penis.

A man who decides to transform into a woman will have to take estrogens. Thanks to them, reverse processes will begin in the male body: facial hair growth will slow down, adipose tissue will begin to be distributed differently, strength and muscle mass will decrease.

Important! Hormone replacement therapy can cause a number of side effects on the part of deteriorating health, therefore, those who plan to change their gender are recommended to change their lifestyle: give up bad habits, exercise, sleep more.

Surgical stage

Includes several operations with an interval of 3 or more months. If the operation is performed to change sex from a man to a woman, then initially a penectomy and orchiectomy are performed - removal of the penis and testicles. In parallel, the doctor can perform several more manipulations that will prepare the tissue for future intervention to form the vagina and clitoris. The final operations for gender reassignment are plastic surgery: new woman they make breasts, if necessary, perform facial correction or insert implants into the buttocks, etc.

Making a man out of a woman is more difficult. The sequence is something like this:

The ovaries and uterus do not need to be removed, and then the “newly made” man will retain reproductive function. Thomas Beaty is the first man in the world to carry and “give birth” to three children. He was originally a girl, then changed gender, but retained female reproductive organs. A sperm donor was found for him and an embryo was implanted. As a result, three children were born.

Possible difficulties of gender reassignment

Surgical gender reassignment is difficult not only physiologically, but also psychologically. The first problems may begin during hormone therapy. Some patients require constant monitoring from doctors and care from loved ones to cope with ongoing changes. Many compare this to a change in consciousness, because new sensations and feelings arise.

The patient's physical health should also be at its best. high level. Contraindications to sex reassignment surgery include cardiovascular problems, oncology, alcoholism and chronic infectious diseases (HIV). The operation is not performed on people under 18 years of age, or the elderly (after 55-60).

The high cost of gender reassignment surgery can also be an obstacle. The patient will have to pay not only for surgical interventions, but also for post-operative care, as well as for the services of doctors who will observe him before and after. By the way, MtF type surgery will cost less. The cost also depends on the clinic. You will have to pay a hefty sum for the work of doctors from European or Israeli clinics, but it is of high quality. On average, a full “course” of gender reassignment costs 600-700 thousand rubles.

You need to deal with people who have changed their gender or are in the process of changing their gender delicately. You should not put pressure on the patient, ask about sensations, is there a difference, etc. It can be hard, especially at first. Therefore, loved ones must learn to accept the “updated” relative and not show their dissatisfaction, especially if the decision has been made or things have already begun. You need to get used to it and provide the necessary support.

Changing gender from female to male has always been considered some kind of quirk. People are ready to undergo complex operations not to save their lives, but to become a man instead of a woman, or vice versa. Many are sure that this is complete recklessness or mental illness. But the problem is that there are many more people who feel not in their own body than it might seem.

What is it?

Transsexuality is the medical name for the discrepancy between the gender unit (abnormal sex) and the anatomical sex of an individual. According to the International Specification of Diseases, transsexuality is one of the types of behavioral and mental disorders of a person. According to the assumption of most experts, hormonal and surgical adjustment of biological sex in relation to psychological sex is considered the exclusive method of treating this ailment.

Who can change gender

Changing gender from female to male begins, first of all, with the desires of the person himself. However, intention alone will not be enough. The patient must be an adult and have full civil capacity. In addition, medical data is required - a diagnosed transsexualism disease. Anyone who wants to change their gender must first visit psychiatrists and get a report from at least two of them.

The remaining directions of the analysis are carried out by examining the general health of the patient and his chromosomal set. If the medical commission unanimously approves the decision on the permissibility of gender reassignment, then the event itself begins, which continues for several years.

Procedure for changing gender

Gender change from female to male occurs in several stages. It is a very complex and complex process that may not always end well.

  1. The individual will be recommended to work and live as a person of the opposite sex for a year.
  2. In addition, hormonal treatment is included. Its duration is usually also about one year. Due to the use of hormones, the voice and body shape change, and women begin to sprout facial hair.
  3. As a result of a series of operations, the body is reconstructed.


It follows that a person must prepare for long-term communication with various specialists: psychologists, surgeons, psychiatrists and endocrinologists.

Operation stages

Changing gender from female to male takes a very long time a long period and is carried out in stages. The first two stages are preparatory and they can go more than a year. And only then the surgeon begins the last stage - the operation. What levels of training exist:

  • proof of transsexuality (difference between social and biological sex);
  • long-term hormonal treatment (you need to undergo a full diagnosis, excluding infectious diseases, liver disorders and anemia);
  • surgeries to change genital organs.

The course of all three stages lasts about 2 years.

How is surgery performed?

Gender reassignment surgery is performed in several stages. At first, excess skin and mammary glands are cut out (the patient stays in the clinic for 3 days), and he is not allowed to lift weights for 2-3 months. The next surgical procedure removes the vagina, uterus and ovaries. The small labia are used to make a cover for the testicles (made of silicone) and the penis. The member's standard itself is created as a result of several operations.

Other aesthetic correction techniques can be used, such as liposuction of excess fat, correction of the chin and the shape of the calf muscles.

Then the person is given a document on the basis of which he changes his civil gender, first and last name, about which a note is created in acts of civil order.

How to do gender reassignment: removal of mammary glands

This is, first of all, a surgical intervention that is performed under general anesthesia. The postoperative period of time itself is on average 2 weeks. The event takes place through:

  • periareolar incision (in cases where the patient’s bust is small);
  • a peripheral incision is used when a woman has breasts of medium volume;
  • vertical, when it is necessary to remove a large bust.

After such an operation, you need to go through a long rehabilitation period.

Ovariectomy

Future transsexual women primarily face surgery to remove the fallopian tubes and ovaries. However, before prescribing such an operation, 2 experimental manipulations should be carried out:

  • salpingoscopy (examination of the fallopian tubes);
  • hysteroscopy (examination of the uterus).

They are performed under general anesthesia. Only after the specialist has made sure that the patient has no tumors, especially those of an oncological nature, is an oophorectomy performed.

Surgery to remove the fallopian tubes and ovaries can be performed by laparoscopy (this method is less traumatic) or by a simple abdominal procedure. In both cases, the operation is performed under general anesthesia. You can see photos before and after it in various medical sources.

The postoperative period itself as a result of laparoscopic surgery usually takes up to 6 days. After abdominal surgery, the sutures are removed on the 7th day, and the duration of the recovery stage is determined by the patient’s well-being. In any case, all this takes at least a month.

Metoidioplasty

It is performed in those women who, with the help of hormone therapy, have acquired an enlargement of the clitoris of more than 6 cm. New channel is made from vaginal mucous material, and the approximate length of the penis after the procedure is 5 cm. During the postoperative stay, a urinary catheter must be used for 14-16 days.

As a result of metoidioplasty, only a small number of postoperative deteriorations are detected, and erogenous areas retain their sensitivity. Moreover, it is a one-stage operation. However, after changing gender they do not have penetrating ability.

Phalloplasty

It makes it possible to create a penis that is real from an aesthetic point of view and has the appropriate dimensions. At the same time, he will have high sensitivity and susceptibility to sexual intercourse, which is acquired by placing an erectile prosthesis in the vagina.

It should be noted that phalloplasty is a complex and lengthy operation that requires tissue transplantation (usually skin tissue is taken from the abdominal area, forearms or thighs). After surgery, the catheter should be used for 2 weeks. Photos before and after the procedure can be found in various medical literature.

Stages of phalloplasty

This procedure takes place in three stages:

  • creation of the urethra;
  • penis production;
  • design of the head of the penis and the formation of a scrotum with artificial testicles.

The patient usually goes through these 3 stages in no less than 1 year.

What are the contraindications to gender reassignment?

There are certain restrictions that do not allow surgical interventions for gender reassignment:

  • too young (under 18 years old) or old age;
  • severe system-wide and mental illnesses;
  • homosexuality;
  • lack of an approved conclusion on transsexuality by doctors in the field of sexual syndrome;
  • alcoholism.

What not to do after surgery

In the postoperative period, as a result of a change from female to male, it is necessary to minimize physical activity. Also, experts do not advise having sexual activity until the final scarring of the operated area. The patient must visit the attending physician to monitor the progress of healing.

How much does gender reassignment cost?

As such, there is no exact cost for carrying out such an event. The price will vary in different countries. But there are some examples, as evidenced by people who have undergone such operations. In England, changing gender will cost $20,000, in America - $15,000, and in Israel - $8,000.

Plastic surgeons, using the latest developments, work wonders and can help those who wish to find their true beginning through gender reassignment surgery. The procedure for making such changes is carried out in stages, may include several operations and takes a long time.

General information about the operation. Stages and prices

Sex reassignment surgery is recognized as the only treatment method for transsexuality today. This intervention is designed to eliminate the dissonance between a person’s psychological and physical gender. In many countries, medical intervention is required before changes can be made to documents. Surgical correction is not a complete gender change.

The cost of the operation depends on the desired gender and the country in which the procedure will be performed. Changing the male to female gender is more common and has a lower cost. High quality work is guaranteed European countries. Germany ranks first in the cost of such operations, since new body parts are actually grown from own cells body.

The initial stage of gender reassignment is confirmation of transsexuality (discrepancy between biological and social sex). This includes numerous studies, psychiatric commissions, examinations of doctors (gynecologist, urologist, endocrinologist). The second stage is long-term hormonal therapy.

Female Male. This includes plastic surgery removal of breasts, creation of a new masculine nipple shape, creation of breast relief, removal of female genital organs, creation of a penis in their place - hair transplantation. Every intervention is separate species operations, so they are paid differently.

Man Woman. This includes: breast augmentation, hip augmentation, lower leg augmentation, removal of lower ribs, testicle removal, vaginoplasty, Adam's apple removal, chin reduction, lip and facial surgery.

Related procedures: blood tests, anesthesia, hospital, psychiatry, diagnostic examination, testing.

The average cost varies from 200 thousand to several million rubles. This does not include the amount of expensive hormonal drugs that are used for a long time after the operation.

Consequences of sex reassignment surgery

Like any operation, gender reassignment negatively affects a person’s health; after it, one has to go through a rather long recovery period. It’s good if the patient is satisfied with the external result, because everything should look natural. Many expect a miracle from doctors, hoping that they will wake up healthy, but later they realize that nothing has changed inside, and the body cut up after surgery can cause inconvenience for a long time.

There are rare cases when it is possible to achieve external perfect proportions, basically it is clear to others that there is “something wrong” with the person and psychological pressure for a transsexual increases even more.

Separately, it is worth mentioning the extensive hormonal disturbances in the body after such operations. The functioning of organs is completely disrupted; after surgical changes are made to the reproductive system, a favorable environment for development arises oncological diseases, the consequences can be the most dire.

Sex reassignment surgery in financial terms is significantly less than that the price that a person subsequently pays with his health, so it is better to carefully weigh all the arguments before undergoing surgery.

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