Female Transsexuals Research Articles

175: Combined Buccal Mucosa Graft and Local Flap for Urethral Reconstruction in Female Transsexuals

You have accessJournal of UrologyModerated Poster 7, Sunday, May 20, 2007, 8:00 - 10:00 am1 Apr 2007175: Combined Buccal Mucosa Graft and Local Flap for Urethral Reconstruction in Female Transsexuals Miroslav L. Ojordjevic, Sava V. Perovic, and Harold M. Reed Miroslav L. OjordjevicMiroslav L. Ojordjevic More articles by this author , Sava V. PerovicSava V. Perovic More articles by this author , and Harold M. ReedHarold M. Reed More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30440-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "175: Combined Buccal Mucosa Graft and Local Flap for Urethral Reconstruction in Female Transsexuals." The Journal of Urology, 177(4S), p. 59 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 59 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Miroslav L. Ojordjevic More articles by this author Sava V. Perovic More articles by this author Harold M. Reed More articles by this author Expand All Advertisement PDF downloadLoading ...

Cross-sex hormone administration changes pain in transsexual women and men

Chronic pain is gender-related, since there is a clear predominance of one sex with respect to the other in most pain syndromes. Gonadal hormones are known to affect the occurrence and incidence of pain. Transsexuals receive cross-sex hormones to develop and maintain somatic characteristics of the opposite sex: male to female transsexuals (MtF) are administered estrogens and anti-androgens, while female to male transsexuals (FtM) are administered androgens. Hence, these subjects represent a model to study the relationship between sex hormones and pain. Questionnaires dealing with sociodemographic data and pain (occurrence, frequency, duration, intensity, location and associated symptoms) were administered to both MtF and FtM transsexuals under hormone treatment for sex reassignment for at least 1 year. Forty-seven MtF and 26 FtM completed the questionnaires. Fourteen of the 47 MtF (29.8%) reported painful conditions, which in 11 subjects were not present before the beginning of hormone treatment. Pain consisted mainly of headaches and breast and musculoskeletal pain. Five subjects suffered from more than one pain condition. Sixteen of the 26 FtM (61.5%) reported pain. In 11 subjects, the pain was present before the beginning of hormone intake, and in 6 of them it improved after testosterone administration. These data suggest that marked changes in sex hormones affect the occurrence of pain in a high percentage of humans but not in all of them. Whether these effects are due to peripheral or central actions of sex steroids is unknown.

Endoscopic Laryngeal Web Formation for Pitch Elevation

Endoscopic laryngeal web formation has been used to elevate the speaking voice, primarily in male to female transsexuals as part of gender reassignment intervention. The goal of this article is to review the literature regarding surgical treatment for pitch elevation and to describe a novel method of laryngeal web formation. The results of this technique are also reported in a series of six patients. All patients were assessed and treated at the St. Michael's Hospital Voice Disorders Clinic, a tertiary referral centre for voice disorders. Pre- and postoperative voice recordings, acoustic analysis, and videostroboscopic examinations were performed in this series. The acoustic data collected included isolated vowel samples, a reading task, and a modified voice range profile. The patients all underwent successful endoscopic web formation with a Gelfoam augmentation technique. The voice results collected at least 6 months after vocal fold web formation demonstrate a dramatic increase in the habitual speaking fundamental frequency. This new modification for endoscopic web formation has been shown to be a successful procedure for permanent elevation of pitch with little or no morbidity.

Male to female transsexualism

The transsexual is a person who suffers from a deep identity disturbance caused by physical characteristics which do not correspond to mental traits and tendencies. The persistent sense of contradiction between his or her deceptive sexual appearance and his or her inner perception, causes a strong desire to achieve harmonization of the two. This aspiration, even if modification of chromosomal sex is impossible, can be fulfilled by undergoing SRS (Sex Reassignment Surgery). SRS represents the last major step of a clinical, therapeutic and diagnostic program involving skilled professionals in the physical and psychological sciences. Their assistance and counseling helps the patient to calmly and consciously decide to undergo SRS. A surgeon has the obligation not only to validate the operation outcome, but to also to maintain a long-term follow-up. A transsexual is not just like any other person; he or she should therefore be treated with sympathy and understanding. The surgeon should try his best to establish a relationship of mutual trust, taking into account the causes of anxiety and stress felt by the patient, and keeping in mind the ultimate objective, which is an improvement in the quality of life. At present, the most widely used surgical techniques are the Simple Penile Skin Inversion, the Penile-scrotal flap Inversion and the enterovaginoplasty. Each surgical technique has its own advantages and disadvantages, and it is up to the surgeon, in discussion with the patient, to make the appropriate choice. The surgical technique performing the Simple Penile Skin Inversion seems to ensure a better cosmetic appearance and an adequate lubrication, but a lower rate of satisfaction, in relation to the neocavity depth. On the contrary, the Penile-Scrotal Flap Inversion guarantees an adequate vaginal depth and lubrication, even though the cosmetic appearance is not always completely satisfactory. In our experience, a significant number of patients were satisfied with the chosen surgery and felt comfortable with their new post-operative gender. Taking into account all the complications involved, none of the patients did regret; actually, they would recommend the same operation to others. The overall results of some studies carried out on patient satisfaction before and after SRS show a marked post-surgery improvement of sexual life.

The effect of oestrogen on cytokine and antioxidant levels in male to female transsexual patients

Objective Whilst hormone replacement therapy (HRT) can be beneficial, it can be associated with deep venous thrombosis (DVT) and stroke. As male to female transsexuals take much higher doses of oestrogen than women on HRT, they provide a unique opportunity to study the long-term effects of oestrogen in a group of relatively young individuals who are largely free of established vascular disease. Methods Thirty-eight male to female gender patients were enrolled into the study. Of these, 25 were receiving oestrogen treatment and 13 who were not on treatment served as a control group. Serum levels of cholesterol, HDL, triglycerides, Interleukin 6 (IL-6), nitric oxide (NO), glutathione, and superoxide dismutase (SOD) were measured in all patients. Results The results showed that compared to the control group, patients on oestrogen had significantly raised levels of NO (32.1 ± 14.3 versus 20.3 ± 10.0, P < 0.05) and reduced levels of IL-6 (0.75 ± 0.6 versus 1.37 ± 0.7, P < 0.05) and SOD (13.2 ± 3.0 versus 24.0 ± 10.0, P < 0.05). These changes were not accompanied by any significant change in plasma lipid levels. Conclusion It would appear that the very high levels of oestrogen taken by the gender patients produce similar beneficial effects to those seen in women on HRT. However, in this patient group it appears that these changes are independent of changes in cholesterol, triglyceride, and HLD.

Sex reassignment surgery for male to female transsexuals: initial experience in Okayama university hospital.

The first case of sex reassignment surgery (SRS) in our hospital was performed in January 2001; as of February, 2005, 4 cases of MTF-SRS had been performed. In the 2 most recent cases, we used penile and scrotal skin flaps to avoid complications. The depth and width of the new vagina was made to be adequate for sexual intercourse. Future attention should be focused on devising a surgical technique that will help prevent the complications of partial necrosis of the epidermal skin and wound dehiscence. Although ours is only an initial experience, we describe our surgical technique herein.

Providing culturally sensitive care for transgender patients

Culturally sensitive information is crucial for providing appropriate care to any minority population. This article provides an overview of important issues to consider when working with transgender patients, including clarification of transgender terminology, diagnosis issues, identity development, and appropriate pronoun use. We also review common clinical issues for transgender individuals seeking mental health care, how these can be addressed within a CBT framework, and the process of setting up a CBT support group within a VA hospital system. CBT group outcome data and demonstrative examples from male to female transsexuals are also presented.

Lesbian Community

SUMMARY This article is about the Lesbian-hatred the author and her first lover experienced as teenagers and how finding a strong Lesbian-identified community in 1970 made all the difference for her as a lifelong Lesbian. The Lesbian Feminist politics and ideals of equality and support and questioning all patriarchal/heterosexual/mainstream values and oppressive attitudes in the Lesbian community also made a huge difference for her since she is working-class. It was a wonderful time of female-only space with many kinds of events, and later Lesbian writing and Lesbian music (euphemistically called “Women's Music.”) That community is mostly gone now and what remains is often segregated by more privileged Lesbians from less privileged Lesbians because of classism and other oppressions. Increasing acceptance of “Male to Female Transsexuals” as Lesbians, as well as increased embracing of male-identified “femininity,” continues to damage what remains of Lesbian community.

An analysis of the Minnesota multiphasic personality inventory on female transsexualism

目的 了解女性易性症的人格特质.方法 对32例女性易性症患者和32例正常女性进行了明尼苏达多项人格(MMPI)测验.结果女性易性症的精神病态(60.14±10.66)和女性男性化(67.86±8.08)量表分超过60分,MMPI各项大多是女性易性症患者高于正常女性.结论 女性易性症患者存在特殊的人格特质,同时也存在较多的心理问题。

Vaginoplasty in Male to Female Transsexuals Using Penile Skin and Urethral Flap

ABSTRACT. Objectives: Vaginoplasty presents the main problem in male to female surgery. There are many operative techniques that can be used, but none is ideal. We present our one stage vaginoplasty in male to female sex reassignment surgery. Patients and Methods: The principle of our technique is based on penile disassembly and usage of all penile entities for vaginoplasty except corpora cavernosa. We developed our disassembly technique on a very large number of severe hypospadias reconstruction and adrenogenital “conversions.” Penile skin flaps and urethral work are used in each of these. Our new vagina consists of two parts: a long vascularized urethral flap and a pedicled island tube skin flap created from the penile skin. The urethral flap is embedded into the skin tube. The tube, consisting of skin and urethral flap, is inverted, thus forming the new vagina. The new vagina is inserted into the previously prepared perineal cavity between the urethra, bladder, and rectum. The new vagina is fixed to the sacrospinous ligament. The labia minora and majora are formed from the remaining penile and scrotal skin. Results: The follow-up ranged from 3 months to 6 years (mean 4.6 years). Good cosmetic and functional results were obtained in 77 out of 89 patients (87%). Conclusions: The technique provides results that have the most normal anatomical and physiological characteristics, in comparison to other methods, since all penile entities are used (except corpora cavernosa) to form almost normal external female genitalia. Vaginoplasty using pedicled penile skin with a urethral flap could be a very good alternative to other methods of vaginoplasty.

EUROPEAN COURT OF HUMAN RIGHTS

ABSTRACT The applicant was born in 1948 as a male child. In 1990, the applicant instituted proceedings before the Schoneberg District Court, asking it to change the first name Bernhard Friedrich into Carola Brenda. The District Court granted this request and considered the applicant as a male to female transsexual. In 1992 Van Kuck brought an action with the Berlin Regional Court against a private health insurance company. Having been affiliated to this company since 1975, she claimed reimbursement of pharmaceutical expenses for hormone treatment. Furthermore she requested a declaratory judgment to the effect that the company was liable to reimburse 50% of the expenses for gender reassignment operations and further hormone treatment. The Regional Court dismissed her claims. She then lodged an appeal with the Berlin Court of Appeal but unsuccessfully; in 1995 the Court of Appeal dismissed her appeal on two grounds: first, she could not prove the necessity of the gender re-assignment measures - Ms Van Kuck had undergone a gender re-assignment surgery in November 1994 - and, secondly, she herself had deliberately caused her disease of transsexuality. Ultimately, she went to the European Court of Human Rights, and claimed that the German courts had violated her right to a fair hearing of article 6 §1 of the Convention, next to her right to respect for her private life within the meaning of article 8 of the Convention. The Court agreed with Van Kuck that there has been a violation of article 6 §1 as well as of article 8 of the Convention. What follows is the judgment of the European Court of Human Rights, as far as relevant (the dissenting opinion of Judges Cabral Barrreto, Hedigan and Greve and the concurring opinion of Judge Ress are also omitted):

Laparoscopic Technique for Secondary Vaginoplasty in Male to Female Transsexuals Using a Modified Vascularized Pedicled Sigmoid

Between 1995 and 2002, 53 primary sex reassignments in male to female transsexuals were performed at our division. The objective of this procedure is to mimic the female external and part of the internal genitalia both esthetically and functionally. In 11 of the 53 patients, a secondary vaginal lengthening had to be performed due to a short neovagina. This was achieved using a pedicled sigmoid segment, with an open approach in the first 2 patients and using a laparoscopic method in the following 9. This paper focuses on the laparoscopic technique, its benefits and potential complications. Where a primary vaginoplasty, combining inversion of the penile and scrotal skin flaps, yields unsatisfactory functional results, a secondary vaginoplasty using the pedicled sigmoid represents an elegant means to achieve functional improvement. Furthermore, we report a modified surgical approach to the conventional sigmoid transition.

Metoidioplasty: a variant of phalloplasty in female transsexuals.

To describe metoidioplasty, a technique for creating a neophallus from an enlarged clitoris in female transsexuals, without needing the complex, multi-staged surgical construction of a large phallus, as this reconstruction is one of the most difficult in female transsexuals. From September 1995 to April 2002 metoidioplasty was used in 22 patients (aged 18-33 years). The technique is based on the repair of the most severe form of hypospadias and intersex. The 'urethral plate' and urethra are completely dissected from the clitoral corporeal bodies, then divided at the level of the glanular corona, and the clitoris straightened and lengthened. A longitudinal vascularized island flap is designed and harvested from the dorsal skin of the clitoris, transposed to the ventral side, tubularized and anastomosed with the native urethra. The new urethral meatus is brought to the top of the neophallus, and the skin of the neophallus and scrotum reconstructed using labia minora and majora flaps. The mean (range) follow-up was 3.9 (0.5-6) years; the neophallus was 5.7 (4-10) cm, considered satisfactory in 17 patients but the remaining five required additional phalloplasty. The complications were urethral stenosis in two and fistula in three patients. Metoidioplasty is an alternative to phalloplasty, allowing voiding while standing. In patients who desire a larger phallus, various techniques of phalloplasty can also be used.

Bone mass, bone turnover, vitamin D, and estrogen receptor gene polymorphisms in male to female transsexuals: effects of estrogenic treatment on bone metabolism of the male.

The effect of chronic administration of estrogens on bone and mineral metabolism in men is not known. We have studied the effect of chronic administration of estrogens on bone mineral metabolism in a group of transsexual (TS) Canarian men, who were taking estrogens for a minimum of 3 years. This is a cross-sectional study of cases and controls and we studied biochemical markers of bone remodeling, bone mineral density (BMD), and selected biochemical and hormonal features. TS subjects had shorter stature than controls, and after adjusting for height and weight, we found that they had lower values for serum-free testosterone and higher values for BMD, both in the lumbar spine and in femoral neck. Biochemistry, bone remodeling markers, and calcitropic hormone values were similar in both groups. Finally, the distributions of vitamin D receptor (BsmI) and estrogen receptor (ER-Pvu and ER-Xba) polymorphisms were also similar in both groups. We conclude that the chronic administration of estrogens in men may produce an increase in serum estradiol, a decrease in free testosterone levels, and an increase in BMD-both in lumbar spine and in femoral neck. We found no association between the transsexual phenotype and the distribution of vitamin D receptor (BsmI) and estrogen receptor (ER-Pvu and ER-Xba).

Urethroplasty in female-to-male transsexuals.

Female-to-male transformation includes total phallic reconstruction. Construction of a neourethra is necessary to achieve the goal of voiding while standing; however urethral fistula and stricture formation occur in a significant percentage of patients. 25 patients with primary female transsexualism underwent phalloplasty with a free radial forearm flap, vaginectomy and urethroplasty in a one-stage procedure. In 16 of these patients the fixed part of the neourethra ("bulbar urethra") was constructed from a vaginal flap. In 9 patients flaps of the labia minora (5 patients) or the "urethral plate" (4 patients) were used. In 14 (58%) patients fistulas and/or strictures in the newly constructed urethra occurred. 11 (69%) of 16 patients in whom the "bulbar urethra" was constructed from a vaginal flap experienced fistulas and/or stricture formation. Fistulas and/or strictures occurred in 3 of 5 patients with labia minora flaps and none of 4 patients with the urethral plate procedure. Repair of fistula and strictures was performed by primary closure of fistulas, staged urethroplasty with local pedicle flaps or distant tissue grafts using buccal mucosa (2-6 procedures). One-stage total phalloplasty and urethroplasty is associated with a significant rate of fistulas and strictures. However, these complications can be corrected by the techniques used in modern urethral surgery.

Effect of a change in gender on coronary arterial size: A longitudinal intravascular ultrasound study in transplanted hearts

ObjectivesWe sought to document whether a physiologic change in gender has any effect on coronary arterial size. BackgroundThe coronary arteries are smaller in women, even after correction for body surface area (BSA). These differences may contribute to adverse clinical outcomes after coronary artery bypass graft surgery and myocardial infarction in women. In male and female transsexuals, pharmacologic doses of estrogens and androgens significantly influence vascular diameter. Thus, gender differences in the coronary vasculature may be a reflection of the hormonal environment. MethodsIn 86 patients who had undergone orthotopic heart transplantation, serial intravascular ultrasound studies of the proximal left anterior descending coronary artery (LAD) were analyzed. Changes in vessel area (VA) over the first or second post-transplant year were recorded, and comparisons were made between donor hearts that were transplanted in a patient of the same gender and those that were transplanted in a patient of the opposite gender. ResultsVessel area of the proximal LAD increased over time in all patient groups. In hearts transplanted within the same gender and in male donor hearts transplanted to female recipients, the change was small and not significant. However, in hearts transplanted from female donors to male recipients, there was a substantial and highly significant increase in LAD VA (median 16.13 to 17.88 mm2; p = 0.01). This increase was not explained by confounding due to changes in BSA or left ventricular wall thickness. ConclusionsThis pattern of arterial remodeling early after heart transplantation supports a link between host gender and coronary arterial size.

Psychophysiological correlates in male to female transsexuals studied with a P300 investigation

Transsexualism is thought to be related to cortical processes reflecting a complex mosaic of biological, psychological and social/cultural information. Since the P300 component of event-related potentials is considered as an index of attentional processes, the present study focuses on auditory P300 elicited during a short memory test in male to female (MF) transsexuals, compared with that in healthy controls. The P300 component was evaluated during the anticipatory period of a short memory test in 13 MF transsexuals who had a gender reassignment operation, at least 3 years previously (mean time 17-6 years, range 3-31 years) and 26 healthy subjects (11 males and 15 females) matched for age and educational level. MF transsexuals exhibited significant reduction of P300 amplitude in the left frontal and temporoparietal areas in comparison to the control group. Furthermore, the group of transsexuals showed a significant delay of P300 latency in comparison to the controls, at the central frontal region. These findings point to significant psychophysiological alterations of distributed cortical circuits in MF transsexuals. These alterations may be critically related to the biological substrate of MF transsexualism.

P1785 Interaction of gender and large artery elasticity: a non-invasive study in male to female transsexuals

P1785 Interaction of gender and large artery elasticity: a non-invasive study in male to female transsexuals

The ‘Common European Approach', ‘International Trends', and the Evolution of Human Rights Law. A Comment on Goodwin and I v. the United Kingdom

On 11 July 2002, the Grand Chamber of the European Court of Human Rights (Eur. Ct. H.R.) ruled unanimously in the cases of Goodwin and I v. the United Kingdom that the failure of British law to recognize gender re-assignment and to permit male to female transsexuals to marry persons of their newly opposite sex violated the applicants’ right to privacy (Article 8 ECHR) and to marry (Article 12). These two cases, apart from constituting an explicit deviation from previous constant jurisprudence, gave the Court (sitting as a Grand Chamber) an opportunity to creatively apply its longstanding interpretative principles, including the search for a ‘common European approach’ – now increasingly an ‘international trend’ –, in order to evolve human rights law. The following observations will focus on this aspect, while paying due attention to the other implications of the present cases. Finally, the two cases will be placed in the context of the current jurisprudence of the Court which, unfortunately, does not show a consistent tendency to progressively advance human rights law.

Hand preference, sexual preference, and transsexualism.

Atypical handedness patterns, i.e., persons being less exclusively right-handed, have been found previously in large samples of male and female homosexuals and in small samples of male and female transsexuals compared to controls. The posited role of prenatal androgen influencing both cerebral hemispheric dominance and psychosexual development warrants further study with large samples of transsexuals. 443 male-to-female transsexuals and 93 female-to-male transsexuals were studied for their use of the right or left hand in six common one-handed tasks. Both male and female transsexuals were more often nonright-handed than male and female controls were. Results suggest an altered pattern of cerebral hemispheric organisation in male and female transsexuals.