Sex Reassignment Techniques (Program 391)
When Rebecca and I were preparing the Transmission Time segment on Sex Re-assignment methods we decided to put together a very detailed “script” so there was a logical flow to the discussion, but more importantly not to leave anything out. What follows is that “script” and while we tried to follow it fairly closely it is by no means an accurate record of the programs content, it is really just a content guide. See also the companion program 392 on post SRS surgery aftercare.
The actual program is available from the JOY 94,9 website www.joy.org.au by clicking on the podcast icon and following the Transmission Time links to the podcast. You can access this particular program and our other podcasts directly at http://www.cpod.org.au/page.php?id=87&page_style=joy.css&no_brand=1
Jayne
Topic of the Week > Different SRS Methods
Jayne
Introduction
Just as a warning for our male listeners, we would like to let you know that tonight we are going to be talking about Sex Reassignment and what happens to the male genitalia during reassignment surgery. So if you are a bit squeamish, now might be a good time to go and make a cup of coffee.
For many transgendered people Sex Reassignment Surgery is seen as a necessarily for them to complete their transition either from male to female or from female to male. Tonight we are going to talk about some of the Sex reassignment methods currently on offer for those transitioning from Male to Female. This is a topic that you will seldom see or hear discussed, especially on radio, but it is something that is of great importance to transgendered people.
What Rebecca and I will talk about tonight is the result of a lot of research over the years and discussion with other trans women who have been through re-assignment surgery. Most surgeons use similar techniques for each method, but they all have their own variations and you will have to consult with your surgeon to determine exactly how they will perform the operation.
Tonight Rebecca will be talking about her personal experience with going through her surgery. It should be noted that these are her own personal experiences, and each person should do their own research, to make sure they are making the right decisions for their own personal needs.
Terminology
There are a number of terms for reassignment surgery, Sex Reassignment Surgery (SRS), Gender Reassignment Surgery (GRS) and Affirmation Surgery. I prefer the term Sex Reassignment Surgery; I think it is more descriptive of what is done, it is your external sex organs that are being changed. To me, your Gender is something with in you and cannot be changed.
Rebecca
A few years ago I found the terminology Genital Realignment Surgery and I tend to use that term, for people I don't know. For those who do know me, and my past, I usually use the term Genital Origami, due to having my surgery done in the Asian region. I really don't have an issue with any of the terms, but the term Sex Change irritates me a bit, and Chop Your Bits Off is just crude, rude, and shows a complete lack of intelligence.
Jayne
History
We tend to think of Sex Reassignment as being relatively new, but it appears to have been happening for many many years, though not to the standards that we currently enjoy.
In doing research for this segment I came across a reference to Roman emperor Nero who was said to have forced a male slave by the name of Sporus to have a form of sex change (most likely a penectomy – removal of his penis) and married him because he looked like Nero's slain wife. Now there is no way that we can verify this, but if it is true, represents one of the first know cases of sex reassignment surgery.
As far as I could find, the first successful modern reassignment was reported in 1931 by F.Z. Abraham on Dutch painter Einar Wegener (aka Andreas Sparrer) who adopts the name Lili Elbe. There is suppose to be a film in production about Lili, but I believe it is currently on hold.
We would be amiss if we did not mention the famous and well publicised case of in 1952 of George Jorgensen who has Sex reassignment surgery. Word leaks out about the operations and the world press had a field day. The headline of the New York Daily News screams “Ex-GI Becomes Blonde Beauty”. Later Christine Jorgensen as she is better known was cheered by audiences all over the world when she made personal appearances.
Penile Inversion
The first form of Male to Female reassignment surgery was what is often referred to as Penile Inversion. This involves a number of steps including:
1. removing and discarding the testis and the scrotal skin
2. cutting a hole between your legs where the vagina will go,
3. striping the penis of its skin and sewing it inside out into a tube,
4. inserting the tube of penile skin into the hole to form a neo-vagina.
This is a relatively simple method as only the penile skin is used, although part of the “head” or “gland” of the penis is now retained –still with all the nerves attached and is positioned to form a clitoris. Usually a small amount of skin is placed over the new clitoris to form a hood to give it a bit of protection.
The main disadvantage of this method is that the depth of the neo vagina is limited by the size of the person's penile material that the Surgeon has to work with. For those that have been on female hormones for a significant time, their penis will have shrunk and this reduces the amount of material the surgeon has to work with and thus the depth of the neo-vagina. The average depth of the neo-vagina achieved with the Penile Inversion technique is in the order or 4 to 5 inches though there are exceptions.
Another disadvantage of the Penile Inversion technique is that all hair on the penis and around the base has to be removed by laser or electrolysis. This is both painful and can add several thousand dollars to the cost. Removal of the hair is necessary as otherwise you will have hair growing in your neo-vagina which of course would not be nice.
Rebecca
The early Penile Inversion methods required a second operation some 3 to 4 months after the initial surgery to form the Labia Majora and Labia Minora. It seems that the later techniques don't require this to happen. In my case, the scrotal tissue was used, and it gives a more natural consistency to the labia. For example, when my legs are apart, the labia remains closed, because there is enough skin there. It also gives a softer appearance and feel to the area.
Jayne
I heard of one case in the UK a couple of years ago where the woman was told that it was not necessary to remove the penile hair and it started growing after she had her reassignment surgery. When she complained she was also told to use “hair removing” cream to remove the hair, which I believe turned out to be very painful and of course was not permanent.
Rebecca
I personally had a penile inversion surgery. There was no need for me to remove any hair, due partly to a lack of much hair in the area, and also because the hair that was there, was removed during the process. I've been post operative now for over five years, and have never had hair a issue in any form. I decided to go with this form of surgery, due to the amount of “donor material” there was to work with.
Jayne
Sounds as though were one of the lucky ones or had a good surgeon.
Rebecca
Well the surgeon can only work with the materials at hand. It's like going to a builder with three bricks, and asking them to turn it into a five bedroom home. You may have the most skilled builder in the world, but you're being unrealistic.
Jayne
One of the major risks of Sex Reassignment is with the cutting of the hole to form the neo-vagina. There is a high risk of cutting into the bowel and forming a Fistula. This can be a serious complication and some surgeons will delay the reassignment surgery until the bowel has been repaired and has healed. I have been told that if you have a fistula, you will have to wear a colostomy bag for several months while the bowel heals. While this is a major risk with and M2F reassignment surgery, in the hands of a competent surgeon, the risk is greatly reduced.
Rebecca
One of the issues that can help with increasing your chances of a fistula not occurring is the amount of weight you carry. Many surgeons will not perform surgery if the patient is overweight. Losing weight not only helps with the surgery and recovery times, but also helps with your general health too.
Jayne
The average time in hospital seems to be about 7 to 10 days depending on how you heal. How did you go?
Rebecca
My time in hospital was five days, but I did have to remain in Thailand for a minimum of 14 days post surgery, so that I could get post surgery checks, and the last thing I was given was my "letter", so I could change my birth certificate back in Australia.
Jayne
Non Penile Inversion
In the last decade or so a variation on the basic method has been developed. This still involves removing most of the Penile material, but instead of using it for forming the neo-vagina, it is used to form the labia's.
In this method, instead of just throwing the testis away they are removed and the Scrotal Skin used to line the neo-vagina. The surgeons do not require you have any electrolysis as after the scrotal skin is removed, the hair follicles are punched out with a tool something like a small hole punch. This of course is done under a microscope so that none are missed.
The two scrotal skins are then sewed together and formed into tube which is then inserted into the hole cut for the neo-vagina. One of the disadvantages of this method is that two rings of scar tissue seem to form. One at the entrance where the scrotal skin is attached to the body and one several inches in, I assume where the two pieces of scrotal skin are joined together. We will talk more about this next week when we talk about Vaginal maintenance or Dilation as it is normally referred to.
As I said before the penile skin is not used internally, but is used to form the Labia Majora and Labia Minora. This means that that neo-vaginal length is not dependant on penis length. It also means that because some penile material is retained, there can be feelings if you get sexually aroused.
Some surgeons also use skin grafts taken from either the inside leg or stomach area if they feel they will not get enough material from just the Scrotal material.
The time in hospital is about the same as the Penile Inversion technique that is about a week.
I have heard of one surgeon in Thailand who does a version of the Non Penile Inversion technique over a period over a period of a 7 days. First he does what would be termed a standard Non Penile version, but he does not initially line the neo-vagina with the scrotal skin. Instead he waits until Granulation starts to occur in the neo-vagina.
From Wikipedia, Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals.
I believe his reasoning is that the granulation tissue forms a better base for the lining to attach to. Because of this two stage process, you spend at least 14 days in hospital.
Rebecca
Sigmoid Colon Method
The third method is much more complex, more expensive and probably harder on your body. The Sigmoid Colon method is used if you have very little penile or scrotal material or if you have had a previous failed SRS surgery.
Again from Wikipedia
The sigmoid colon (pelvic colon) is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 40 cm. in length, and normally lies within the pelvis, but on account of its freedom of movement it is liable to be displaced into the abdominal cavity.
Basically the operation is similar to the previous ones, except that a portion of your Colon is removed and used to line the neo-vagina. As you can appreciate this requires two operations:
1. one to remove a segment of your Colon and
2. two to put it into the neo-vagina
Now with the two other methods, the surgeons are usually very careful to try and match the skin colour so that the final cosmetic appearance post surgery is as natural as they can get it. However the section of colon that is removed I believe is 'purple' in colour and can show at the entrance to the neo-vagina.
One of the major advantages of the Sigmoid Colon method is that the segment of colon uses is self cleaning and self lubricating which is very handy if you want to have sex as you will not have to use artificial lubricants.
Jayne
Conclusion
Sex Reassignment Surgery is a very personal matter and what is right for one person may not be right for you. Both of us recommend doing lots of research, joining one of the active transgender email discussion groups and talk to others who have had surgery. If after that you decide to go forward with Sex Reassignment Surgery, consult several surgeons and then make a decision. Remember, Sex Reassignment is permanent and is NOT reversible, so don't rush into it.
You are listening to Transmission Time with Jayne & Rebecca on JOY 94.9
BREAK
Choosing a SRS Surgeon
Jayne
Now that we have told you a little about Sex Reassignment Surgery, lets have a look at how you go about getting surgery.
Rebecca you had Sex Reassignment Surgery a few years back, what was the process that you went through to decide on a surgeon. Did you just take what was offered here in Melbourne or did go looking for someone else?
Was your decision based on cost or technique?
Rebecca
My decision was a well thought out one. I basically started researching surgeons as soon as I made the decision to transition. I did this because I knew it would be hard decision to make, so the more time I had to make it, the more informed I could be. In the end, cost didn't come into it, because the difference between surgery in Australia, or surgery overseas was only a couple of thousand dollars. If I had chosen to fly with a cheaper airline, and not in business class, the cost would have been about the same. I decided to choose the surgeon whom I felt could achieve the best result, with the material at hand, so to speak. After all, you only get one shot at this, so you may as well go for the best to suit your needs.
Jayne
I have often talked about using internet based Transgender Support Groups to help with research. Did you go down this path and if so was it useful?
Rebecca
With the online groups I took everything I read there with a grain of salt. As is the case with any group I have found on the net for any subject, you have those who are for, those who are against, those who think their surgeon is the greatest, those who complain the doctor is no good, those who blame others for every problem they have had, regardless of the cause.
It is helpful to listen to what people have to say, but you should always ask the reason behind them saying what they say. People on the net don't speak the truth, they speak personal experience, and the two things are not always the same.
Jayne
So what were your needs?
Rebecca
For me, sex wasn't much of an issue, but I wanted to have the ability if needed. I was after the most depth possible, but not at the cost of appearance. I wanted something that if I was looking at it in the mirror, looked like a vagina, and not just the opening to a hole in which to poke things. Post surgery I have had sex with men, and everything functioned fine, so I got the result I was hoping for in that department.
Jayne
Did you have any fears about going overseas for surgery?
Rebecca
Yes I did, but it was more a case of fear of the unknown, than fear of the surgery. My GRS was the 10th operation I had had, so hospitals don't concern me in the slightest. My fears were more about the conditions, and stability of the country. In regards to those, the hospital did look a little gritty on the outside, but then most places in Bangkok do. In terms of patient care and standards, they were on par with anything I've had done in Australia, public or private. You have to remember that surgery is a major industry in Thailand, and the surgeons with a high reputation want to keep that reputation. As for the stability of the country, while I was there, a coup was in the process of happening, but wasn't an issue. The Thai people make you feel very welcome, regardless of internal political issues.
Jayne
I certainly agree with the high medical standards in the Thailand hospitals. When I was I Thailand last year, I had a chance to catch up with a girl who I knew from New Zealand who was over there for her SRS. The hospital was spotless and actually looked better than some of the hospitals I have been in over here….. and her room was bigger that some of the Motels I stayed in.
Any way back to you, why didn't you have surgery in Melbourne?
Rebecca
It comes down to a variety of factors. I was on a fairly tight timeline with my work, as I had to get surgery done while on my holidays, or I would have had to wait another 12-18 months at least, and I'd really had enough of waiting already. In terms of the surgery I got, it wasn't on offer in Melbourne at the time, and I just felt more comfortable dealing with the surgeon I had.
The benefits of having surgery in Melbourne would have been the post operative care, if something went wrong, and I did take a risk there. That risk comes down to your personal circumstances, and personally having been through surgery in the past, and knowing how my body reacts to it, I was comfortable taking that risk. A cheaper price, or the chance to go overseas never entered my mind in the slightest.
Jayne
When you were over there waiting for the big day, were there any last minute concerns or hesitations
Rebecca
On the day of the surgery, I woke up with an erection, and I wondered what the hell was going on there. When it came to having the area shaved before surgery, I had to have a valium, because it was distressing having someone look at what was there. Apart from that, I was just happy it was happening.
Jayne
Are you happy with the outcomes?
Rebecca
Well that's a difficult question to answer Jayne. I say difficult because I don't have a reference point as to if it's as good as it could be, because I have what I have got. I'm happy in the sense that what is there, is better in every regard to what was there. I don't have any regrets about having the surgery, but it would have been much better to just be born with the right parts to begin with. When I get aroused the former erectile tissue that is left does get a little bit tight, but that just takes time to learn to relax before sex, or it can be a bit uncomfortable.
From a day to day point of view, I'm happy. It does everything I need it to do, and it all feels right. The decision to go down this path took many years to make, because it was a great leap into the unknown, but I know for me that was the right decision to make.
When people ask me if they should have the surgery, I never say yes. That's not a decision for me to make for them. They need to do what is right for them, and the only person who can make that decision is them.
Jayne
We have to point out again that every ones experience with Surgery is different whether it is for Sex Reassignment or other purposes. Rebecca and I talk from our personal experiences and what is right for us, may not be right for you. If you are considering Sex Reassignment surgery we encourage you to do your own research, talk to other’s who have had surgery and then make your own decisions.
You are listening to Transmission Time on JOY 94.9.
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