Transsexuality is a gender identity disorder. Those affected do not feel that they belong to the gender to which they have been assigned. Further information on gender reassignment and doctors for transsexuality can be found in the text below.
Transsexuality is a gender identity disorder. Those affected do not feel that they belong to the gender that was socially and legally assigned to them at birth. They therefore have a strong desire for an artificial sex change.
Male-to-female or female-to-male transsexuality can occur in equal measure.
The cause of transsexuality is still not scientifically proven. Transsexuality is influenced by many factors. A congenital predisposition is discussed as a cause of transsexuality, as are genetic or environmental causes.
Surgery for transsexuality is colloquially referred to as gender reassignment surgery . However, the individual surgical steps should rather be understood as gender reassignment. A true transformation to the opposite sex is not possible even with the most modern surgical procedures.
Surgery for transsexuality is usually performed in cooperation with various medical specialties. Depending on the gender, the surgical team consists of urologists, gynecologists and plastic surgeons.
Not feeling assigned to the gender you identify with is very stressful for those affected © Good Studio | AdobeStock
In Germany, the Transsexuals Act forms the legal basis for a change of first name or civil status. The medical procedure is specified by the Standards of Care and the MDS guidelines of May 19, 2009. These two guidelines are not legally binding, but are applied in practice.
The diagnosis is usually confirmed by two independent psychiatric or psychological reports. Both reports must clearly establish the indication for gender reassignment surgery for transsexuality. The reports also allow for opposite-sex hormone therapy before the first surgical steps.
Both reports are currently sufficient for a change of first name and a change of civil status. Marriage is then possible.
Opposite-sex hormone therapy must be continued for the rest of the patient's life, even after gender reassignment surgery. The antiandrogen for male-to-female transsexuality is no longer necessary. During this time, everyday life should also be positively evaluated by the accompanying psychotherapy .
As a rule, several stages of surgery and therefore several hospital stays are necessary for gender reassignment surgery. The inpatient stay is between 4 and 20 days, depending on the stage of the operation.
Depending on the extent of the procedure, a general anesthetic may be required. Only minor secondary or additional procedures can also be performed under local anesthesia and on an outpatient basis.
No special preparation for gender reassignment surgery for transsexualism is necessary. The only thing you should avoid is taking painkillers such as aspirin for 14 days before the operation, as these delay blood clotting.
The use of sleeping pills as well as alcohol and nicotine consumption should also be avoided as far as possible.
Various surgical methods are available for female-to-male gender reassignment surgery:
The first step is usually the removal of the female breast.
In the case of small breasts, this can be done via an incision in the nipple area. Almost no visible scars remain after the operation (subcutaneous mastectomy).
In the case of very large mammary glands and a large soft tissue mantle, the breastis usuallytightened and the nipples reduced at the same time.
The removal of the internal female reproductive organs, i.e.
is also part of the sex change operation. This procedure can be performed before the first gender reassignment surgery or simultaneously as part of another surgical step.
Two surgical methods are routinely offered for penoid augmentation, also known as phalloplasty. Depending on the patient's wishes and physical conditions, phalloplasty can be performed through a groin flap or a forearm flap (radial flap). B
n special indications, however, other surgical methods can also be used (round pedicle flap/free fibula flap).
The inguinal flap penoid arises from a part of the straight abdominal muscle, covered with skin from both inguinal regions. It is a pedicled myocutaneous flap (skin and muscle tissue). In addition, a rod-shaped silicone prosthesis is implanted to achieve flexible rigidity.
Phalloplasty using autologous tissue from the forearm is a much more complex operation. A skin flap with the underlying tissue is removed from the non-dominant forearm.
For the free tissue transfer, the blood vessels supplying the forearm are first prepared. The surgeon then connects them to the inguinal vessels using the surgical microscope. The same procedure is used to connect the nerves of the former clitoris to the former cutaneous nerves of the forearm. In this way, the transplant achieves sensitivity and the ability to orgasm.
The urethra is extended to the tip of the penoid and the vagina is removed in the same surgical session. In the case of the inguinal penoid, the vagina is removed and the urethra lengthened in subsequent stages of the operation.
The creation of a scrotum only takes place in subsequent operations. The skin of the labia majora is shaped into a scrotum. The implantation of testicular prostheses made of silicone completes the alignment.
In the case of a penoid made from forearm tissue, wound healing must first be complete. An erectile pump prosthesis is implanted in a later operation.
Gender reassignment surgery for male-to-female transsexuality involves the following in detail
The glans penis (glans penis) is preserved and is used to form the clitoris.
The sheath of the former penis is then used to line the newly formed vagina.
Immediately after gender reassignment surgery, painkillers are necessary. Thrombosis stockings and medication prevent blood clots and embolisms.
It takes about 14 to 20 days for the skin to heal and for the swelling and bruising to subside. However, final healing can only be expected after several weeks.
Depending on the surgical procedure, further treatment of the newly formed urethra in the urology department may be necessary.
Special precautions are necessary in the case of certain pre-existing conditions. These include
Despite the greatest care, complications can occasionally occur during or after the operation. As larger wound areas are involved, bruising and secretions or bacterial infections can interfere with healing.
Major blood loss must be compensated for by infusions or blood transfusions. For this purpose, autologous blood can be prepared before the sex reassignment surgery.
Excessive scars rarely occur with the appropriate predisposition. Nevertheless, the surgical scars will remain permanently visible. Skin sensation and lymphatic drainage only regenerate slowly over the course of several months and may remain reduced in scarred areas.
Thromboses and embolisms are extremely rare, but can lead to serious cardiovascular problems.
Specific complications that can occur after penoid augmentation are
In rare cases, they can lead to complete flap loss. Urethral fistulas can occur particularly at the sutures (anastomosis) of the urethra. However, they usually heal on their own.
Other very rare complications include rejection reactions or intolerance to the suture material or silicone implants. Prosthesis infections are also possible.
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