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Decision-Making in Masculinizing Surgery and Feminizing Surgery

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Urological Care for the Transgender Patient

Abstract

Advances in the fields of reconstructive and gender-affirming surgery during the last three to four decades have resulted in there being a multitude of surgical options available for patients who seek genital gender affirming surgery (gGAS). Advances in gender transition-related mental health and sexual medicine have also enriched the field and improved surgical care options for people undergoing gender transition.

It follows, then, that, for a surgeon, the process of facilitating informed patient centered decision-making about surgical options has become more complex and nuanced. Which specific surgical options are offered to patients, and how these options are presented, explained, and contrasted, is essential to meeting their varied needs and expectations.

While the gGAS literature has an increasing number of studies that retrospectively study surgical outcomes, there is significantly less in the literature about discussion approaches for how to prospectively present the relative advantages and disadvantages of different gGAS options to patients.

Herein we review common surgical options and techniques, and highlight relative advantages and disadvantages with respect to functionality, cosmesis, morbidity, short- and long-term surgical risks, and self-care requirements.

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Notes

  1. 1.

    Penile foreskin that is tight owing to phimosis, or which is of poor quality due to chronic inflammation, is often unusable for use to line the vaginal canal space. In such cases, the surgeon should explain to the patient that, in order to achieve satisfactory vaginal depth, the surgeon will likely need to harvest skin or other epithelium from an additional source to line the vaginal canal (e.g., full-thickness or pedicled scrotal skin grafts or peritoneal local advancement or rotational flaps) and achieve satisfactory vaginal depth.

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Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Maurice M. Garcia

  2. Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Maurice M. Garcia

  3. Department of Urology, University of California San Francisco, San Francisco, CA, USA

    Maurice M. Garcia

  4. Department of Anatomy, University of California San Francisco, San Francisco, CA, USA

    Maurice M. Garcia

Authors
  1. Maurice M. Garcia
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Correspondence to Maurice M. Garcia .

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Editors and Affiliations

  1. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Dmitriy Nikolavsky

  2. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen A. Blakely

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Garcia, M.M. (2021). Decision-Making in Masculinizing Surgery and Feminizing Surgery. In: Nikolavsky, D., Blakely, S.A. (eds) Urological Care for the Transgender Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-18533-6_2

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  • DOI: https://doi.org/10.1007/978-3-030-18533-6_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18532-9

  • Online ISBN: 978-3-030-18533-6

  • eBook Packages: MedicineMedicine (R0)

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