Gender dysphoria is a state where the individual shows a strong and persistent identification with the opposite gender and a belief of being born in the wrong sex. Gender reassignment surgery (GRS) is a complex surgical undertaking. Although this group of patients is rapidly increasing worldwide, the literature is limited in terms of the outcome. Sweden has a long history of GRS in male-to-female (MtF) patients. In this study, we present the surgical outcome, mortality and short-term post-operative complications in MtF GRS surgery at our centre over a period of 14 years.
Material and methods
This is a retrospective cohort study on consecutive patients who underwent primary MtF GRS at the Department of Plastic and Reconstructive Surgery at Karolinska University Hospital from 2000 to 2013. Demographics along with surgical complications were registered and analysed.
During the study period, a total of 205 primary MtF GRS were performed. Median age of patients was 33 years (range 18–76). Major complications such as deep infection, rectovaginal fistula and pulmonary embolism were rare. Minor complications affected approximately one in four patients. The most common minor complication were bleeding and infection.
MtF GRS can be performed with a low rate of major complications. Our data indicate that increasing surgical experience leads to shorter operating times and less complications. This suggests that GRS surgery should be performed at few centres so that surgical experience and volume may be optimized.
A transgender woman who underwent a vaginoplasty to have her penis turned into a vagina has described in graphic detail what the process was really like.
Jessica, who identifies as a queer woman, had already started hormone replacement therapy and gone all the way to South Korea to have vocal chord surgery to transform her baritone voice when she decided to have a breast augmentation surgery and a vaginoplasty in one operation.
After her vaginoplasty, which she had near her home in East Bay Area, California, she warned 'there are going to be parts of you that are going to melt off' in an interview with Truth Speak Project.
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Melting: A transgender woman has described what it is like to undergo gender reassignment surgery; a video reenactment by the European Association of Urology shows what genitals might look like after the procedure
Jessica, whose partner was also born male and had already had the surgery, said there were elements of her recovery that she was not warned about by doctors, adding that it was 'really scary'.
She said: 'There are going to be parts of you that are going to melt off...It is really scary. But it’s also perfectly normal and most people recover from that completely as if nothing has happened.
'Basically the furniture down there gets rearranged during the surgery. One of the many things I learned along this journey is that male genitalia and female genitalia aren’t that different. They’re arranged differently, but the individual parts are really similar.
'So vaginoplasty consists of a re-positioning and folding of all these tissues using the existing tissues.
'When that’s done, some of the tissues might not get as much blood flow as they did before, so they get starved of nutrients and oxygen.
'That’s when the surface tissue tends to die off — which is as gross as it sounds. It is really really awful.'
Warning: Jessica, who was born male, said: 'There are going to be parts of you that melt off' after surgery (medical diagram shown)
Although Jessica said she was expecting her vagina to 'look like Frankenp***y' after surgery, it was much worse that she could have imagined.
At one point she claims she thought she was 'dying'.
'It’s red, there’s stitches and it’s swollen, you can see the stitch lines. You expect that,' she said.
'What you don’t expect is this yellow-y, clumpy, almost mucus-y, looks-like-someone-sneezed-on-your-p***y kind of residue.
'So you might have a chunk of your inner labia just die off, just fall off, and it’ll just grow right back. It’s hard to believe because when you lose a limb or a toe it doesn’t grow back. But it turns out that your p***y does. It’s strange.
'And it’s gross and it’s funky and it’s awful and you think, "Oh my god, What is happening? My p***y is melting. I’m dying." But it turns out that it is perfectly normal.'
She said doctors should better prepare patients for what will happen following the surgery.
'It’s something doctors should tell patients beforehand. Because you’re already dealing with so many changes, working with so many geographic changes on your body.
Healing: She said she had anticipated her vagina looking 'like Frankenp***y' after surgery, pictured in diagram, but said it was much worse than she expected (medical diagram shown)
'Your clitoris, which used to be the head of your penis, is positioned in a completely different way,' she said.
In the early days after the operation, Jessica said there were occasions when she thought she still had male genitalia.
She said: 'There were times early on when I felt like I could feel my penis. I figured out what was going on though.
'Basically, my clit was telling me that it was still the head of my penis, that the most sensitive part of it was still there. It took a lot of adjusting and it was pretty weird at first.'
She said she has shown her new sexual organs to cisgender females who have told her the surgeon 'did a great job'.
Jessica said she has a G-spot and that she has had orgasms - but they are 'very different' to what she experienced before surgery.
She said: 'I do have a G-spot. In fact, I still have a prostate, even though it’s much smaller than it was because of hormone replacement therapy. But it’s still there and it can still be stimulated. It’s still very enjoyable...
'Orgasms are very different. Oh my goodness. They were different even before my surgery after I started hormone replacement therapy. That’s when I started having more full-body orgasms.
Icon: Transgender actress Laverne Cox, 31, left, has previously said she was pleased she could undergo gender reassignment in private; transgender model Andreja Pejic, right, also underwent the procedure in 2014
'The sensation wasn’t just concentrated immediately around my genitals anymore. It was more like waves of pleasure throughout my body.
'So that started happening with just hormones. But then, of course, the surgery changes everything.'
She added: 'I didn’t think that I would get such good results from my surgery but there they are.
'I definitely experience internal stimulation orgasms and they are different from the orgasms I get from clitoral stimulation.
'They’re deeper and they’re more intense — always gush from internal orgasms.'
She said the development of surgery has made experiences for people undergoing the procedure 'a lot better' in the last decade.
She added: 'Some things are different for trans feminine people who had their surgery ten years ago.
'Doctors have gotten to a point now where they can make a vagina that allows you to come and really gush from internal vaginal stimulation just like a cis-gendered woman does, if that’s something that you’re capable of doing.'
Jessica paid for her breast augmentation herself but the vaginoplasty was covered by her insurance as required by California law after a doctor said it was medically needed.
Despite having done so herself, Jessica warned against having both surgeries in one operation.
'I woke up in the recovery room in a world of pain, unable to move,' she said. 'I really underestimated how much the recovery from breast augmentation takes out of you.'
She said she opted for a full vaginal canal because she wanted to experience penetrative sex and to 'relate to cis-gendered women'.
Content: Jessica said she is pleased with the surgery, pictured above, and said since then she has found she has a G-spot and has had orgasms
Progress: Jessica said vaginoplasty surgery, pictured in diagram, has developed considerably over last decade
She added: 'I had to wear a pad every day and I get it. The struggle is real...I have this newfound respect and empathy for my fellow sisters. I get it now...
'I just had my first p-in-v sex as a vagina-haver and it was different from what I expected. It was more intense than I expected.
'I had gotten used to the process of dilating my vagina, which I do with a medical phallus one to two times a day, to keep the new vagina from closing up.
'I’ve been doing that for 9.5 months since my surgery. So having something in my vagina is a normal sensation for me because I experience it every day.
'There are going to be parts of you that are going to melt off... It is really scary. But it’s also perfectly normal
Jessica, transgender woman
'But having a person inside my vagina was a relatively new experience for me. I’ve had fingers but I’ve never had a penis.
'It was a little overwhelming, but it was pleasant and fun and I would totally do it again. The person I had sex with was a preoperative trans woman.'
Transgender model Andreja Pejic underwent gender-reassignment surgery, also known as gender-reconfirmation surgery, in 2014.
Talking about the decision last year the Bosnian model told Vogue: 'Society doesn't tell you that you can be trans. I thought about being gay, but it didn't fit…
'I thought, well, maybe this is just something you like to imagine sometimes'.
Orange Is The New Black star Laverne Cox said she does not like the focus on gender reassignment surgery - saying she is 'grateful' she could have gender reassignment surgery in 'private' unlike Caitlyn Jenner.
The transgender actress told Entertainment Weekly last year: 'I’m so grateful that I had the luxury of transitioning in private because when you transition in the public eye, the transition becomes the story.
'I’m always disturbed when I see conversations about trans people that focus on surgery. But I believe Caitlyn will transcend this moment.'
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