What is Breast Augmentation?
Male to female reassignment surgery is almost synonym to the penile inversion technique, which is universally accepted as the most significant procedure in this area. The advantages of this technique are many and it is much less traumatic than other techniques, such as the usage of colon to create the neovagina. However, there are some limitations, which have to do with penile skin available, where other methods have to be considered. As a general rule, all patients who achieve an erected length of above 12cm and have not underdone any trauma or procedure such as circumcision are considered excellent candidates for the penile inversion procedure.
Preparation
Preparation for surgery includes psychiatric evaluation, which can be carried out from local mental health specialist, or by our partner psychiatrists. Patients who have dense genital hairs, especially on the penile skin should perform epilation prior to surgery, since hair removal intravaginally can prove problematic. Also, anal intercourse should be avoided at least one month before the operation, because regular injury of the colon from intercourse can lead to higher risk of surgical injury of the bowel.
Steps
The technique itself is very flexible and surgeons around the world have modified their methods, in order to achieve better results. In our clinic, the method can be broken down to the following ten steps:
1. Orchectomy: the scrotum is incised in the midline and the testicles are removed alongside with the spermal ducts
2. Penile skin flap: the degloving of the penis begins below the glans and is carried out up to the base of the penis
3. Clitoral flap: the glans is divided and the upper portion, which will serve as the clitoris is dissected together with the nerves and vessels
4. Urethral flap: the urethra is dissected from the corpora cavernosa and the lower portion of the glans is maintained at the end of the urethra. This will serve later as the deep wall of the neovagina (cervix)
5. Removal of the corpora cavernosa: all erectile tissue is completely removed.
6. Preparation of the neovagina: the penile skin flap and the urethral flap are combined, creating the neovagina pouch, which at this stage is inverted inside-out. The urethral flap serves to both widen the vagina up to 2cm and also create a lubricated mucosal surface on the upper vaginal wall. Portion of the glans, which was maintained is now used to create the deep vaginal wall, which will avoid pouch effect and also provide more support during intercourse.
7. Insertion of the neovagina: the plane between the colon and cyst is dissected, creating the space to insert the new vagina. The vagina is fixated on the pelvic wall.
8. Formation of the clitoris: the innervated part of the glans is trimmed and portion of the skin is removed, in order to create an anatomically correct clitoris, which will be covered by a clitoral hood at the upper part and transition smoothly over a cervix to the urethral opening.
9. Formation of inner and outer labia: at the end, the base of the penile skin flap is used to create the inner labia, while the scrotal skin is trimmed and used to create the outer labia.
10. Dressing: a condom filled with soft material is inserted in the vagina to promote healing and soft dressings are placed on the labias.
Recovery
After genital reassignment surgery, patients are monitored in our clinic for 2-4 days and stay in one of our affiliated hotels for one week. Mobilisation begins on the day after surgery and the drains are removed after the days. After one week, the vaginal tampon and the urethral catheter are removed. Dilatation of the vagina usually begins after 2-3 weeks, after the first vaginoscopy, using silicone dilatators of different sizes from Vagiwell. A program for daily dilatation for 6 months is handed out.
Patients who have undergone penile inversion can return to normal daily activities after 2-3 weeks and resume exercise after one month. Sexual vaginal intercourse is possible after 6-12 months, depending on efficiency of the dilatation and healing. Vaginal discharge is expected for up to 6 months, which requires some vaginal disinfection and hygiene. All patients experience sexual arousal of the clitoris in the first 6 months. In some cases, minor aesthetic improvements of the outer genitals can be performed after one year, like for example scar corrections.