Gender affirmation surgery is a pivotal aspect of transgender and gender-diverse individuals' journeys, as it plays a vital role in aligning physical characteristics with gender identity. As a complex and deeply personal process, these surgeries encompass various reconstructive procedures tailored to each person and can range from facial procedures to genital reconstruction. While these procedures often lead to increased satisfaction and alignment with one's identity, understanding post-operative care is paramount, especially in urologic health. Here, we'll cover some key elements about the surgeries and how to care for your urologic health post-op.
What is Gender-Affirming Surgery?
Gender-affirming surgery, or gender affirmation surgery, is a type of procedure that's performed to help individuals transition to their gender identity. Gender identity is the way that an individual understands their body, feels most comfortable, and presents themselves to the world. Therefore, surgery is often performed to counteract negative feelings associated with gender dysphoria from the sex assigned at birth and to make individuals feel more comfortable in their bodies.
Gender-affirming surgery encompasses a wide range of reconstructive surgery, such as facial surgery, bottom surgery, or top surgery. It can be complicated, and gender-affirming care needs to be handled by an experienced, understanding practitioner who is trained in genitourinary reconstruction.
Still, transgender and gender-diverse individuals often report high levels of satisfaction after recovery.
Types of Gender-Affirming Surgeries
There are several different types of plastic surgery and reconstructive options for gender-diverse people. Gender-affirming surgery may include one or more of the following:
Facial Reconstructive Surgery
Hormone therapy can often be extremely beneficial in either feminizing or masculinizing facial features, but some individuals require additional changes. Facial gender surgery can create feminine features, such as lifting the brows, reshaping the cheekbones or jaw, reducing Adam's apple, reshaping the nose, and more. Facial gender surgery can also create masculine features, such as jaw augmentation, cheek augmentation, forehead lengthening, and constructing an Adam's apple.
Top Surgery
Top surgery is done for transgender or nonbinary individuals who want to either remove or augment their current breast tissue. It can be performed to either add and reshape tissue, creating a more feminine appearance or remove the tissue altogether for a more masculine build.
Masculinizing Procedures
There are a variety of procedures for masculinization:
Phalloplasty
Phalloplasty is a surgical procedure designed to construct a neophallus, or new penis, typically for transgender men or individuals seeking male genital reconstruction. It involves using tissue grafted from the forearm, thigh, abdomen, or chest wall, but certain areas can result in more visible scarring than others. The procedure is complex and requires an experienced surgeon.
Penile Prosthesis Insertion
Penile prosthesis insertion, also known as penile implant surgery, is a medical procedure primarily utilized to treat erectile dysfunction (ED) that does not respond to other forms of treatment. It can be combined with a phalloplasty to provide trans patients with a functional penis that can be used during sex. There are a few types of penile implants that can be used, which can be discussed with your doctor.
Metoidioplasty
Metoidioplasty is a procedure that can be done as an alternative to creating a new phallus. It capitalizes on the effects of testosterone therapy, which typically results in clitoral growth. It's a less invasive alternative to phalloplasty and allows individuals to retain sensation and the ability to orgasm. However, the size usually only ranges from four to nine centimeters, so penetrative sex may not be possible. The surgeon may also lengthen the urethra during this procedure, allowing standing urination.
Scrotoplasty
During scrotoplasty, the surgeon creates a scrotum, the external sac that houses the testes, using tissue from the labia majora or other donor sites. This creates a more masculine appearance and can be paired with other procedures or done independently.
Hysterectomy
This surgical procedure involves removing the uterus and ovaries. It would lead to infertility, so transgender men or nonbinary individuals may want to discuss oocyte storage and fertility preservation if they're interested in starting a family in the future.
Feminizing Procedures
Feminizing procedures include the following:
Orchiectomy
This procedure is performed for transgender women or nonbinary individuals to remove one or both of the testicles and the glands inside of the scrotum. Removal of the testicles can help reduce testosterone production and enhance the feminization of an individual. An orchiectomy can be performed independently or as a part of a more comprehensive process.
Penectomy
A penectomy is a procedure that involves the partial or total removal of the penis. Although it may be performed for several medication reasons, it's also common among transgender women. Oftentimes, a penectomy is followed by a vaginoplasty.
Vaginoplasty
A vaginoplasty is performed to create or reconstruct the vagina. During the procedure, the surgeon utilizes various techniques to reshape and contour the genital area, including penile inversion, in which the penile tissue is inverted to form the vaginal canal or the use of tissue grafts from other parts of the body.
The procedure also involves creating a clitoral hood and labia minora, which enhances the external appearance of the vulva. Vaginoplasty aims to provide functional and aesthetic outcomes for trans or nonbinary individuals.
Vulvoplasty
A vulvoplasty involves reshaping or reconstructing the external genitalia, specifically the vulva. It includes constructing the mons, labia, and clitoris, but not a vagina. It's often paired with other feminizing procedures but can also be done independently.
Some individuals may choose to undergo one of these procedures, while others embark on a journey that incorporates several surgeries, hormonal therapy, voice therapy, and/or puberty blockers. Regardless of your journey, it's important to work with someone who is certified in transgender medicine and surgical procedures to ensure the standards of care are met.
Key Elements of Reconstructive Urology After a Surgical Transition
Following each procedure, it's important to understand transgender health outcomes. These are more notable for individuals who undergo bottom surgery, as they'll need specialized care in urology to ensure a healthy recovery. Finding a urologist who specializes in care for transgender and nonbinary individuals is crucial. Nonbinary or transgender reconstructive surgery does pose the potential for urologic issues, so it's important to familiarize yourself with these.
Patients who have undergone masculinizing procedures can face issues such as urethral strictures and urethral fistulas. Other issues may include urinary tract infections, overactive bladder, and urinary incontinence.
- Urethral Strictures — When the urethra, the tube that carries urine from the bladder out of the body, becomes narrowed due to scar tissue or inflammation. This narrowing can impede the flow of urine, leading to symptoms such as difficulty urinating, urinary retention, and increased risk of UTIs.
- Urethral Fistulas — Abnormal connections between the urethra and surrounding structures, often resulting from surgical complications, trauma, or infection. These fistulas can lead to urinary leakage, recurrent UTIs, and discomfort.
- Urinary Tract Infections (UTIs) — Bacterial infections that affect the bladder but can also involve the urethra, ureters, or kidneys. Symptoms of UTIs often include frequent and painful urination, cloudy or bloody urine, and discomfort in the lower abdomen or pelvic region.
- Overactive Bladder — A condition characterized by a sudden and uncontrollable urge to urinate, often leading to frequent and sometimes involuntary urination. Individuals with overactive bladder may also experience urinary incontinence, nocturia, and an increased frequency.
- Urinary Incontinence (UI) — A condition characterized by unintentional urine leakage. Depending on the underlying cause, urinary incontinence can manifest differently and have unique triggers.
This is because female-to-male surgeries require a lengthening of the urethra, which can be complicated. However, a majority of transgender men and nonbinary individuals who had masculinizing procedures were able to successfully void from the tip of the penis and presented favorable outcomes.
Creating a Positive Environment for Urologic Care of Trans and Cis Individuals
Historically speaking, transgender people and nonbinary individuals have been marginalized in healthcare systems and society. Luckily, the barriers to care are broken down, and more urologists, doctors, and surgeons specialize in trans health. To help you during your recovery, it's important to have all of the products you need for health and comfort. At Byram Healthcare, we offer a wide range of high-quality urologic supplies that can be discreetly delivered to your door. Contact us today to get started or to speak to one of our representatives.
