Archives of Sexual Behavior

, Volume 35, Issue 6, pp 717–727 | Cite as

Patient-Reported Complications and Functional Outcomes of Male-to-Female Sex Reassignment Surgery

Original Paper

Abstract

This study examined preoperative preparations, complications, and physical and functional outcomes of male-to-female sex reassignment surgery (SRS), based on reports by 232 patients, all of whom underwent penile-inversion vaginoplasty and sensate clitoroplasty, performed by one surgeon using a consistent technique. Nearly all patients discontinued hormone therapy before SRS and most reported that doing so created no difficulties. Preoperative electrolysis to remove genital hair, undergone by most patients, was not associated with less serious vaginal hair problems. No patients reported rectal-vaginal fistula or deep-vein thrombosis and reports of other significant surgical complications were uncommon. One third of patients, however, reported urinary stream problems. No single complication was significantly associated with regretting SRS. Satisfaction with most physical and functional outcomes of SRS was high; participants were least satisfied with vaginal lubrication, vaginal touch sensation, and vaginal erotic sensation. Frequency of achieving orgasm after SRS was not significantly associated with most general measures of satisfaction. Later years of surgery, reflecting greater surgeon experience, were not associated with lower prevalence rates for most complications or with better ratings for most physical and functional outcomes of SRS.

Keywords

Transsexual Sex reassignment surgery Vaginoplasty Follow-up Complications 

References

  1. Allesandrescu, D., Peltecu, G. C., Buhimschi, C. S., & Buhimschi, I. A. (1996). Neocolpopoiesis with split-thickness skin graft as a surgical treatment of vaginal agenesis: Retrospective review of 201 cases. American Journal of Obstetrics and Gynecology, 175, 131–138.CrossRefGoogle Scholar
  2. Blanchard, R., Legault, S., & Lindsay, W. R. N. (1987). Vaginoplasty outcomes in male-to-female transsexuals. Journal of Sex and Marital Therapy, 13, 265–275.PubMedGoogle Scholar
  3. Bouman, F. G. (1988). Sex reassignment surgery in male to female transsexuals. Annals of Plastic Surgery, 21, 526–531.CrossRefPubMedGoogle Scholar
  4. Cohen-Kettenis, P. T., & Gooren, L. J. G. (1999). Transsexualism: A review of etiology, diagnosis and treatment. Journal of Psychosomatic Research, 46, 315–333.CrossRefPubMedGoogle Scholar
  5. Bowers, M. L. (2004a). GRS /SRS FAQ. Retrieved May 27, 2005, from http://www.marcibowers.com/grs/grs-faq.html
  6. Bowers, M. L. (2004b). MTF: Genital surgery. Retrieved May 27, 2005, from http://www.marcibowers.com/grs/surgery.html
  7. Edgerton, M. T. (1993). Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals (Discussion). Plastic and Reconstructive Surgery, 91, 901–902.Google Scholar
  8. Edgerton, M. T. (1995). Twenty years of experience in managing gender dysphoric patients: I. Surgical management of male transsexuals (Discussion). Plastic and Reconstructive Surgery, 96, 933–934.Google Scholar
  9. Eldh, J. (1993). Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals. Plastic and Reconstructive Surgery, 91, 895–900.PubMedGoogle Scholar
  10. Eldh, J., Berg, A., & Gustafsson, M. (1997). Long-term follow up after sex reassignment surgery. Scandinavian Journal of Plastic and Reconstructive and Hand Surgery, 31, 39–45.CrossRefGoogle Scholar
  11. Fang, R.-H., Chen, C.-F., & Ma, S. (1992). A new method for clitoroplasty in male-to-female sex reassignment surgery. Plastic and Reconstructive Surgery, 89, 679–682.PubMedGoogle Scholar
  12. Futterweit, W. (1998). Endocrine therapy of transsexualism and potential complications of long- term treatment. Archives of Sexual Behavior, 27, 209–226.CrossRefPubMedGoogle Scholar
  13. Giraldo, F., Mora, M. J., Solano, A., Gonzáles, C., & Smith-Fernández, V. (2002). Male perineogenital anatomy and clinical applications in genital reconstructions and male-to-female sex reassignment surgery. Plastic and Reconstructive Surgery, 109, 1301–1310.CrossRefPubMedGoogle Scholar
  14. Green, R., & Fleming, D. T. (1990). Transsexual surgery follow-up: Status in the 1990s. Annual Review of Sex Research, 1, 163–174.Google Scholar
  15. Hage, J. J. (1995). Twenty years of experience in managing gender dysphoric patients: I. Surgical management of male transsexuals (Discussion). Plastic and Reconstructive Surgery, 96, 931–932.CrossRefGoogle Scholar
  16. Hage, J. J. (1999). Vaginoplasty in male-to-female transsexuals by inversion of penile and scrotal skin. In R. Ehrlich, & G. Alter (Eds.), Reconstructive and plastic surgery of the external genitalia: Adult and pediatric (pp. 294–300). Philadelphia: W. B. Saunders.Google Scholar
  17. Hage, J. J., & Karim, R. B. (1996). Sensate pedicled neoclitoroplasty for male transsexuals: Amsterdam experience in the first 60 patients. Annals of Plastic Surgery, 36, 621–624.PubMedGoogle Scholar
  18. Hage, J. J., Goedkoop, A. Y., Karim, R. B., & Kanhai, R. C. J. (2000). Secondary corrections of the vulva in male-to-female transsexuals. Plastic and Reconstructive Surgery, 106, 350–359.PubMedGoogle Scholar
  19. Huang, T. T. (1995). Twenty years of experience in managing gender dysphoric patients: I. Surgical management of male transsexuals. Plastic and Reconstructive Surgery, 96, 921–930.PubMedCrossRefGoogle Scholar
  20. Karim, R. B., Hage, J. J., Bouman, F. G., & Dekker, J. J. M. L. (1991). The importance of near total resection of the corpus spongiosum and total resection of the corpora cavernosa in the surgery of male to female transsexuals. Annals of Plastic Surgery, 26, 554–557.CrossRefPubMedGoogle Scholar
  21. Karim, R. B., Hage, J. J., & Mulder, J. W. (1996). Neovaginoplasty in male transsexuals: Review of surgical techniques and recommendations regarding eligibility. Annals of Plastic Surgery, 37, 669–675.CrossRefPubMedGoogle Scholar
  22. Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: W. B. Saunders.Google Scholar
  23. Krege, S., Bex, A., Lümmen, G., & Rübben, H. (2001). Male-to-female transsexualism: A technique, results, and long-term follow-up in 66 patients. BJU International, 88, 396–402.CrossRefPubMedGoogle Scholar
  24. Kuiper, B., & Cohen-Kettenis, P. T. (1988). Sex reassignment surgery: A study of 141 Dutch transsexuals. Archives of Sexual Behavior, 17, 439–457.CrossRefPubMedGoogle Scholar
  25. Laub, D. R. (1997, September). Erotic aspects of male to female anatomy. Paper presented at the XV Harry Benjamin International Gender Dysphoria Association Symposium, Vancouver, BC, Canada.Google Scholar
  26. Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior, 32, 299–315.CrossRefPubMedGoogle Scholar
  27. Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166.CrossRefPubMedGoogle Scholar
  28. Levin, R. J. (1991). VIP, vagina, clitoral and periurethral glans: An update on human female genital arousal. Experimental and Clinical Endocrinology, 98, 61–69.PubMedCrossRefGoogle Scholar
  29. Levin, R. J. (2002). The physiology of sexual arousal in the human female: A recreational and procreational synthesis. Archives of Sexual Behavior, 31, 405–411.CrossRefPubMedGoogle Scholar
  30. Masters, W. H., & Johnson, V. E. (1961). The artificial vagina: Anatomic, physiologic, psychosexual function. Western Journal of Surgery, Obstetrics, and Gynecology, 69, 192–212.PubMedGoogle Scholar
  31. McEwen, L., Ceber, S., & Daws, J. (1986). Male to female surgical genital reassignment. In W. A. W. Walters & M. W. Ross (Eds.), Transsexualism and sex reassignment (pp. 103–112). Oxford: Oxford University Press.Google Scholar
  32. Muirhead-Allwood, S. K. (1998). Questionnaire on results of gender reassignment surgery. Unpublished manuscript.Google Scholar
  33. Muirhead-Allwood, S. K., Royle, M. G., & Young, R. (1999a, August). Factor analysis of satisfaction with vaginal reconstructive surgery in male-to-female transsexuals. Poster session presented at the Harry Benjamin International Gender Dysphoria Association XVI Biennial Symposium, London.Google Scholar
  34. Muirhead-Allwood, S. K., Royle, M. G., & Young, R. (1999b, August). Sexuality and satisfaction with surgical results in male-to-female transsexuals. Poster session presented at the Harry Benjamin International Gender Dysphoria Association XVI Biennial Symposium, London.Google Scholar
  35. Perovic, S. (1993). Male-to-female surgery: A new contribution to operative technique. Plastic and Reconstructive Surgery, 91, 703–711.PubMedGoogle Scholar
  36. Perovic, S. V., Stanojevic, D. S., & Djordjevic, M. L. J. (2000). Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU International, 86, 843–850.CrossRefPubMedGoogle Scholar
  37. Pfäfflin, F., & Junge, A. (1998). Sex reassignment. Thirty years of international follow-up studies after sex reassignment surgery: A comprehensive review, 1961–1991 (R. B. Jacobson & A. B. Meier, Trans.). Retrieved May 27, 2005, from http://www.symposion.com/ijt/pfaefflin/1000.htm (Original work published 1992).
  38. Pierce, W. P., Klabunde, E. H., O’Connor, G. B., & Long, A. H. (1956). Changes in skin flap of a constructed vagina due to environment. American Journal of Surgery, 92, 4–8.CrossRefPubMedGoogle Scholar
  39. Rehman, J., & Melman, A. (1999). Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: Functional and cosmetic outcome. Journal of Urology, 161, 200–206.CrossRefPubMedGoogle Scholar
  40. Ross, M. W., & Need, J. A. (1989). Effects of adequacy of gender reassignment surgery on psychological adjustment: A follow-up of fourteen male-to-female patients. Archives of Sexual Behavior, 18, 145–153.CrossRefPubMedGoogle Scholar
  41. Rubin, S. O. (1993). Sex reassignment surgery male to female. Scandinavian Journal of Urology and Nephrology (Suppl. 154), 1–28.Google Scholar
  42. Schroder, M. (1995). New women: Sexological outcomes of gender reassignment surgery. Unpublished doctoral dissertation, Institute for Advanced Study of Human Sexuality, San Francisco, CA.Google Scholar
  43. Schroder, M., & Carroll, R. (1999). New women: Sexological outcomes of male-to-female gender reassignment surgery. Journal of Sex Education and Therapy, 24, 137–146.Google Scholar
  44. Small, M. P. (1987). Penile and scrotal inversion vaginoplasty for male to female transsexuals. Urology, 29, 593–597.CrossRefPubMedGoogle Scholar
  45. Smith, Y. L., van Goozen, S. H., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine, 35, 89–99.CrossRefPubMedGoogle Scholar
  46. Stein, M., Tiefer, L., & Melman, A. (1990). Followup observations of operated male-to-female transsexuals. Journal of Urology, 143, 1188–1192.PubMedGoogle Scholar
  47. van Noort, D. E., & Nicolai, J.-P. A. (1993). Comparison of two methods of vagina construction in transsexuals. Plastic and Reconstructive Surgery, 91, 1308–1315.CrossRefPubMedGoogle Scholar
  48. Whitacre, F. E., & Alden, R. H. (1951). Changes in squamous epithelium following the surgical treatment of absence of the vagina. Annals of Surgery, 133, 814–818.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.SeattleUSA

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