Vaginoplasty: Gender Confirmation Surgery
Gender confirmation surgery (GCS) is a procedure which involves the surgical alteration of one or both genitalia in order to achieve social acceptance and/or physical appearance. GCS is performed on transsexual persons who have undergone hormonal treatment with the intention of changing their bodies into those of members of the opposite biological gender.
These individuals are referred to as transgender persons.
The term “gender” refers to the person’s sense of being a man or woman. There are two main types of gender identity: biological and cultural.
Biological gender is determined at birth; cultural gender is acquired through socialization during childhood and adolescence. The terms cisgender (nontranssexual) and transgendered refer to those whose gender identity matches their assigned sexual category at birth, while transsexual means someone whose gender identity differs from that assigned at birth.
There are many different kinds of surgeries that may be done to alter the genitals of transsexual persons. Some of these procedures involve removing parts of the body, while others do not.
The extent of the surgery, and what is removed, depends on the diagnosis.
The following procedures may be included in a gender reassignment surgery:
Clitoral release: This procedure reduces the size of the clitoris to resemble that of a typical female genitalia. The head of the clitoris is preserved for sensitivity purposes.
Labiaplasty: The removal of excess skin from the labia majora and minora.
Orchiectomy: Also known as an “orchie,” this procedure involves the removal of both testicles, which are the male gonads that produce testosterone. This may be done through an incision in the scrotum (perineal orchiectomy) or through an incision in the abdomen (abdominal orchiectomy).
Penile inversion: This procedure involves the conversion of the male genitalia into that of the female genitalia. The skin of the penile glans is used to create a clitoris, while the erectile tissue becomes the clitoral hood.
The skin around the genitals and the base of the urethra are used to create a neo-vagina.
Sigmoid colon neovaginoplasty: This procedure is similar to the penile inversion procedure. The sigmoid colon is used to create a cavity for waste.
This procedure has fallen out of favor because of high rates of complications and infections.
Vaginoplasty: Also known as “bottom surgery,” vaginoplasty involves the surgical creation of a neo-vagina. Surgeons use skin from the patient’s groin to line the vaginal cavity, while the patient’s own groin tissue forms the vaginal walls.
Like with other forms of GCS, the urethra is extended to allow for waste elimination.
Gender reassignment surgery may also be used to treat conditions other than gender dysphoria. For instance, it may be used to reduce the size of an enlarged clitoris in patients with a condition known as intersexuality (a person whose sexual anatomy doesn’t fit typical definitions of male or female).
Gender reassignment surgeries have been performed for transsexuals since 1930. However, when the procedure was first introduced, doctors reported high levels of dissatisfaction among their patients.
One of the most common complaints was the lack of sensation in the genitals following surgery. As such, many surgeons would avoid using the term “reconstructive” and instead use the term “feminization” to describe these surgeries.
By the 1970s, medical professionals had abandoned genital reassignment surgeries in favor of more conservative procedures that focused on the transfer of hormones and plastic surgeries. However, the surgery saw a revival in the 1990s with the advent of modern plastic surgery techniques.
Most countries worldwide do not routinely perform gender reassignment surgeries. However, many regions have slowly been adopting such procedures since the 1960s when they were first introduced.
One of the first places to do so was Denmark, who has offered state-funded reassignment surgeries since 1979.
The United States provides insurance coverage for GCS in some cases, and as of 2016, 21 states have seen gender reassignment surgery become available to Medicaid recipients. The surgeries are also fairly common in Canada, where they are funded for transgender people over the age of 18.
Many medical professionals and religious groups have opposed the practice of GCS on ethical and moral grounds. Many argue that doctors have no right to “play God” with the body, while others claim that these procedures can never make someone into another gender.
However, many of those who oppose these procedures often condemn the surgery without putting themselves personally at risk.
These procedures also raise ethical questions within the medical community. Many physicians oppose the procedures on the basis that they are not effective and may promote transphobia by allowing people to “reverse their mistakes.” Others argue that the surgeries should be used for those with intersexual conditions (and only on adults) so as to promote a more positive body image.
Another major concern with GCS is the high rate of complications and side effects associated with the procedure. People who have undergone the surgery may suffer from genital tissue death, causing the genitals to be less sensitive or function improperly.
The procedures can also cause scarring, urinary tract infections, and many other dangerous conditions.
Despite these issues, GCS remains a highly sought-after procedure for transgender people and those with certain intersexual conditions. Since gender dysphoria is classified as a psychological issue (and not a physical one), patients are often recommended to seek therapy before undergoing genital surgery.
While these steps make the process longer and require more resources, many transgender activists believe it is worth it.
Sources & references used in this article:
Gender confirmation surgery: guiding principles by LS Schechter, S D’Arpa, MN Cohen, E Kocjancic… – The Journal of Sexual …, 2017 – Elsevier
Vaginoplasty for gender confirmation. by DR Laub, DR Laub 2nd, S Biber – Clinics in Plastic Surgery, 1988 – europepmc.org
Feminizing genital gender-confirmation surgery by M Hadj-Moussa, DA Ohl, WM Kuzon Jr – Sexual medicine reviews, 2018 – Elsevier
Male-to-female gender confirmation surgery: intestinal vaginoplasty by KEY Claes, P Pattyn, S D’Arpa… – … plastic surgery, 2018 – plasticsurgery.theclinics.com
Gender-confirmation surgery using the pedicle transverse colon flap for vaginal reconstruction: A clinical outcome and sexual function evaluation study by OJ Manrique, MD Sabbagh… – … surgery, 2018 – cdn.journals.lww.com
Pudendal Nerve Blocks for Vaginoplasty in Gender Confirmation Surgery by TCT Huang, K Adabi, K Arendt, A Niesen… – … Surgery–Global …, 2018 – journals.lww.com
Transfeminine Gender Confirmation Surgery with Penile Inversion Vaginoplasty: An Initial Experience by JT Loree, MS Burke, B Rippe, S Clarke… – … Surgery–Global …, 2020 – cdn.journals.lww.com