55970 Intersex surgery; male to female

Name of the Procedure:

Intersex Surgery; Male to Female
Common names: Gender Confirmation Surgery (MtoF), Gender Reassignment Surgery (MtoF), Vaginoplasty

Summary

Intersex surgery (male to female) involves reconstructing male genitalia into a form more characteristic of female genitalia. It is a complex procedure that typically includes the creation of a neovagina, clitoris, and labia. This surgery is part of a broader process of gender transition for male-to-female individuals.

Purpose

This surgery addresses gender dysphoria, a condition where an individual experiences significant distress due to a mismatch between their gender identity and assigned sex at birth. The goal is to align the patient's physical appearance with their identified gender, thereby improving mental health, quality of life, and social functioning.

Indications

• Persistent and well-documented gender dysphoria
• Ability to make a fully informed decision and to consent for treatment
• Age of majority or as required in the individual's country
• Significant improvement in mental health following initiation of hormone therapy
• Completion of at least 12 continuous months of hormone therapy
• Completion of at least 12 months living in a gender role congruent with their gender identity

Preparation

• Psychological assessments and therapy to ensure readiness for the procedure
• Hormone therapy to develop secondary female sexual characteristics
• Pre-surgical consultations and informed consent process
• Blood tests and general health assessment
• Instructions for fasting before surgery
• Adjustments to current medications, as advised by the medical team

Procedure Description

1. Administer anesthesia, typically general anesthesia.
2. Marking incision sites after ensuring patient comfort and positioning.
3. Removal of penile tissue while preserving nerves and blood vessels for sensation.
4. Construction of a neovagina using the inverted penile skin or other graft materials.
5. Creation of a neoclitoris utilizing preserved glans tissue to retain sexual sensation.
6. Formation of labia minora and majora using scrotal and penile skin.
7. Placement of a stent in the neovagina to maintain shape during healing.
8. Suturing and dressing of the surgical area.

Duration

The surgery typically takes 4 to 5 hours, depending on the complexity.

Setting

The procedure is performed in a hospital or a specialized surgical center equipped for complex reconstructive procedures.

Personnel

• Lead Surgeon (specializing in plastic or urological surgery)
• Surgical Assistant(s)
• Anesthesiologist
• Operating Room Nurses
• Post-anesthesia care staff

Risks and Complications

• Common: Infection, bleeding, bruising, pain, swelling
• Less common: Blood clots, tissue necrosis, urinary issues, fistulas, loss of sexual sensation
• Rare but severe: Deep vein thrombosis, anesthetic complications, severe allergic reactions

Benefits

• Alleviation of gender dysphoria
• Enhanced congruence between physical appearance and gender identity
• Potential improvement in mental health, social integration, and self-esteem
• Sexual function, including the ability to achieve orgasm

Recovery

• Hospital stay of 5-7 days, followed by several weeks of rest at home.
• Pain management using prescribed medications.
• Dilation of the neovagina to maintain depth and width.
• Hygiene instructions to prevent infection.
• Gradual resumption of normal activities; usually, full recovery takes 6-12 months.
• Regular follow-ups with the surgical team.

Alternatives

• Hormonal therapy alone: Benefits include less risk, but does not alter genitalia.
• Counseling and psychotherapy: Improves coping mechanisms but does not change physical appearance.
• Combination of non-surgical aesthetic procedures: Less invasive but with limited results in changing genital appearance.

Patient Experience

Patients may experience pain and discomfort immediately after surgery, managed with medication. There is expected to be a period of adjustment as the body heals. Emotional support and ongoing counseling may be necessary to address the psychological aspects of undergoing such a significant transformation.