For many transwomen, gender confirmation surgery (or “genital reconstruction surgery”) is the final step in their transition process. The decision to have gender confirmation surgery (GCS) is a very personal, private matter, and not all transwomen will elect to undergo this procedure. It is important to keep in mind that GCS is not a requirement for transition, and many transwomen feel happy and content with their bodies without undergoing GCS. However, GCS can have a number of positive benefits for those patients who do choose to undergo the procedure, including decreased gender dysphoria and improvements in both mental health and sexual functioning. While there is no one right answer regarding GCS, working with your therapist can help you to decide whether undergoing GCS is the right decision for you.
In general, gender confirmation surgery includes several procedures performed at once. The testicles and part of the penis are removed, and this tissue is used to create fully-functioning external female genitalia (vagina, labia, and clitoris). Most commonly, a technique referred to as “penile inversion” is performed, in which the penis is essentially turned inside out to form the inner walls of the vagina. A small piece of the head of the penis is then used to create a clitoris. Outer labia are formed from the testes, and inner labia are formed using penile tissue.
Additionally, the surgeon will remove erectile tissue from the penis so that they newly-formed vagina and clitoris do not become swollen during sexual arousal. The urethra, which is the tube that carries urine from the bladder, will be shortened and repositioned. The prostate will be left intact. A successful GCS will provide the patient with external female genitalia that permit sexual penetration and orgasm, maintain touch sensation, and allow for downwards urination in a steady stream.
GCS is usually performed as the last gender transition procedure, and patients must meet several requirements set out by the World Professional Association for Transgender Health (WPATH) in order to be eligible for this surgery. These requirements include two letters of recommendation (one from your mental health clinician and one from the physician who provides your hormone therapy), at least one year of continuous hormone therapy, and at least one year of living full-time as a woman. Following the WPATH guidelines will help to ensure that you feel satisfied with the results of your GCS and with your decision to undergo the surgery.
GCS is considered a major surgery, and it is essential that patients follow all pre-procedure instructions in order to obtain the very best surgical outcome. It is important that the ICTC staff have all your pertinent medical information prior to scheduling any surgery. Your pre-operative appointment will be scheduled one week to two days before the GCS, and you’ll also need to start a bowel prep two days in advance, followed by a clear liquid diet (e.g., clear broth, coffee, tea, water, soda). Do not consume anything during this time period that is red, orange, purple, or caramel in color. Hormones and other drugs may need to be discontinued temporarily. On the day of your surgery, you’ll arrive at ICTC in the morning and meet with your anesthesiologist and surgeon. Make sure that you leave cash and any other valuables at home.
The average recovery period for GCS ranges from 4-6 weeks. We do require one overnight with an RN following the procedure, and we also recommend making arrangements to stay close to ICTC for the first week or so, as you’ll need to visit your surgeon frequently. Our staff can assist you in booking a hotel near-by with special medical rates. We also suggest packing personal care and comfort items (e.g., a robe and slippers, throat drops, lotion and other toiletries), and a laptop or books to pass the time in the coming days. During the initial recovery period, focus on resting, drinking plenty of water, and making sure that your surgical site is well-iced in order to prevent swelling.
While most patients do report feeling sore after their GCS, any discomfort is typically quite manageable when pain medications are used as directed. Packing will be placed in the vagina, which causes a sensation of “fullness” (similar to the sensation of needing to have a bowel movement), and a urinary catheter will be placed in the bladder—these will be removed at your one-week post-operative visit. Minor bleeding is expected after catheter removal. You’ll also receive a set of vaginal dilators during this visit. Proper vaginal dilation is essential to achieving optimal results from your GCS, so make sure that you carefully follow these instructions.
GCS is performed under general anesthesia. As with any surgery, this procedure does carry some potential risks; these can include infection, pain, bleeding, scarring, blood clots, or negative reaction to anesthesia. Potential complications that are specific to GCS can include fistula (an opening between the vagina and rectum), narrowing or closure of the vagina, and death of the tissue used to create the female genitalia. Therefore, it is very important to choose a skilled surgeon with plenty of experience in performing GCS.
It is normal for transwomen to have concerns about sexuality and sexual functioning following GCS. For the majority of patients, sexual outcomes are very good. Additionally, many post-GCS transwomen report an increased capacity for sexual intimacy related to greater comfort and satisfaction with their bodies. Sexual activity can typically be resumed 8 weeks post-surgery, and after vaginal dilation has been completed. However, it is important to note that GCS does carry a potential long-term risk for decreased sexual sensation. Please do not hesitate to discuss any concerns you may have about post-surgical sexual functioning with your surgeon.
At ICTC, we know that each patient has her own unique needs and expectations, which is why we take an individualized, patient-centered approach to gender transition services. During the preoperative consultation, your surgeon will take the time to discuss and understand your goals for GCS. He will also perform a physical exam of the genitalia, which will help to determine the best GCS procedure for your unique anatomy. Additionally, he’ll thoroughly explain the procedure and answer any questions you might have.
For many transwomen patients, GCS is a vital component of their transition. Because this procedure is so important, it is paramount to choose a surgeon with specialized knowledge and skill. At the International Center for Transgender Care, our board-certified surgeons have more than 20 years of experience treating transgender patients. We are proud to offer all of our services in a respectful, welcoming environment at our world-class surgical center in Dallas, Texas. We look forward to assisting you in achieving the very best possible results for your gender confirmation surgery. Contact us today to schedule a consultation or call us at (972) 543-2477.