how sex reassignment surgery works

many people are confused today about sex and gender.  if you are in a conversation about these very tough topics what would you say? before we can have a constructive conversation about the brave new world of sex and gender it’s important to understand the current thinking about sex and gender. hopefully this will give you a head start.

 many gender theorists have created separate categories for 1. sex, 2. Gender identity and 3. gender expression. some say sex is assigned at Birth by the doctor and though our sex is connected to our bodily Anatomy. they claim that disorders of sexual development are actually different sexes. claiming sex is assigned rather than acknowledged a birth allows for the possibility that sex can be reassigned later. now whether sex needed to be reassigned depended on gender identity (the second category). gender identity we are told is our internal sense of who we are.

do I feel like I’m a man, a woman, neither or both? gender is a state of mind and on a spectrum. in other words, gender is not a binary choice between male or female. Someone may for example feel 70% female and 30% male. the final category to understand is gender expression. this is the way someone chooses to express their sense of gender identity. Clothes, haircut and mannerisms can all be part of gender expression. are you assertive and tough or passive and emotional? do you like sports, knitting or painting your nails? all of these they would say are forms of gender expression. now of these three categories gender identity is most important.

this means the way you feel about who you are is more important than your biology and because feelings change they say, gender is fluid not fixed and from their perspective it would be completely appropriate for the same person to feel male/female then neither, then both on the span of a few years, weeks or even days. while this framework sounds strange to many of us, there is a point you must understand. gender theorists assure people that they are not obligated to behave in one specific way because of their Anatomy.

with this we can find some agreement God makes each one of us uniquely and social norms for being male or female are not always helpful or healthy. but transgender theorists go beyond the idea that we are all unique and say someone with a penis can be a girl and someone with a vagina can be a boy.

            All of this points to the conclusion that we have to know how sex reassignment surgery works. Read the rest to get familiar with this surgery.

Gender transition process has two sections: a medical transition and a social transition. Here we discuss the medical part.

sex reassignment surgery includes different procedures based on either it is a male to female transition or female to male transition.

Female to male surgeries include:

• Bilateral mastectomy;
• Complete hysterectomy
• Reconstruction of the genitalia with a metoidioplasty (a procedure that allows a surgeon to construct a phallus from the clitoris)
• Ring metoidioplasty (to lengthen the urethra)
• Scrotoplasty (the construction of a scrotum)
• Vaginectomy (to close the vaginal canal)
• Phalloplasty (the construction of the penis)
• Cosmetic surgeries for feminizing face

Male to female surgeries include:

• Clitoroplasty (the construction of a clitoris)
• Labiaplasty (the creation of a labia from scrotum skin)
• Orchiectomy (testicle removal)
• Prostatectomy (the removal of prostate)
• Urethroplasty (the reconstruction of the urethra)
• Vaginoplasty (the creation of the vaginal canal, made from penile tissue or a colon graft)
• Penectomy (removal of the penis) is usually done concurrently with vaginoplasty, and a clitoral hood is typically constructed from the glans penis.

What is sex reassignment surgeries statistics?

A 2016 study indicates that approximately 0.6 % U.S population is considered transgender.

According to Plastic Surgery Statistics by the American Society of Plastic Surgeons, 11000 sex reassignment surgeries were performed in 2019. This rate is 10% to 15 % higher than last year statistics.

What happens before the surgery?

before patients can undergo the surgery certain criteria have to be fulfilled:

• psychological approvals evaluation by specialists
• living in the new gender role
• change of the first name in the court for all legal documents
• 12-month hormone therapy for feminizing or masculinizing
• Psychology sessions provide by social worker or psychiatrist

How does Genital sex assignment from male to female work?

1. first the patient is placed in a dorsal position with split legs for the penile disassembly after a 16 French transurethral catheter is placed. through the scrotal medial incision both testicles are exposed and removed with the spermatic court at the external angle ring. if the foreskin is still in place the inner plate is preserved and the penile skin the circumferentially cut and pushed to the penile base. by sharp dissection the dorsal nerve bundle with the glans and the urethra separated from the corpora cavernosa.
2. second with the patient in a no thought of me position, the penis is further dissected. inverted through the scrotal incision and both corpora cavernosa are removed as close as possible to the inferior pubic bone.
3. the penile skin is inverted and skin incisions are placed at the typical location for the clitoris and urethral meatus.
4. the penile skin is reversed once again.
5. the glans is reduced to the size of the neo clitoris and situated with six zero singles stitch sutures.
6. the bulbar urethra is pulled through the neo meatus and split longitudinally up to the neo mantas after the penile skin is superficially incised to increase the circumference without risking the blood supply. the urethra is sutured into the increased circumference of the penile skin which becomes the Neo vagina. in those cases, with an inadequate length of penile skin the Bolar urethra can be used to lengthen the Neo vagina.
7. with a further distal extension of the scrotal incision, the centrum tendon will be exposed or incised. the space between the rectum and the prostate bladder base is bluntly developed by reaching the sacrum. the ligamentum sacrum finale is palpated where the two sutures are placed which are then used to position the Neo vagina.
8. for the outer female genital each half of the scrotal skin is tailored to become the lobby a menorah and majora.
9. the incision closures are strategically placed to appear as natural skin folds with a completion of the gender reassignment. an inflatable placeholder is inserted into the Neo vagina and trans urethral balloon catheter and a suprapubic catheter secures bladder drainage. the only major complication noted was a primary closed rectal injury orgasmic sensations at the NiO clitoris was reported by two-thirds of the patients underwent a Mons pubis plastic.

● see https://www.youtube.com/watch?v=R9TGQIP-VLg for the animated surgery procedure.