Genital reassignment surgery for transsexual people

Abstract

Summary Transsexualism is defined as a persistent and strong cross-gender identification, combined with the patients persistent discomfort with his or her sex and a sense of inappropriateness in the gender role of that sex (Diagnostic and Statistical Manual of Mental Disorders, revision 4, [DSM-IV-TR]). This disturbance causes clinical distress or impairment in social, occupational or other important areas of functioning. The specifically trained mental health professional is obliged to find out, if the patient fulfills all criteria of an irreversible gender transposition and if he or she will benefit from medical (hormonal and surgical) sex reassignment treatment. After absolving 12 months of real life-experience and after at least six months of continuous hormonal treatment, the indication for surgical sex-reassignment may be given. Genital sex-reassignment in male-to-female transsexuals include vaginal-plasty, preferably by inversion of penoscrotal skin flaps, clitoral-plasty and vulvoplasty. Operative procedures may be performed in one or two sessions. In female-to-male subjects, no operative standards are available up to now. During the last decade, neophallus creation from a sensate free forearm flap has emerged as the most promising approach for those patients, who want to have a neophallus reconstruction. There exist other alternative techniques such as metoidoioplasty or neophallus reconstruction from regional flaps, but they are also accompanied by multiple possible complications and reinterventions. Best results have to be expected, when multidisciplinary teams of plastic surgeons, urologist, gynecologist and experts in sexual medicine in large volume-centers are involved in indication and performance of operative procedures.