Genital reconstruction for the transgendered individual

Abstract

Introduction: Gender dysphoria is defined as one's belief that his/her body does not reflect his/her true "inner" identification of physical sex and requires medical and/or surgical treatment that will alter his/her body to better reflect what he/she believes is his/her true gender.

Objective: The aim was to describe current surgical techniques available in genital reconstruction for female-to-male (FTM) and male-to-female (MTF) transgender patients.

Study design: We reviewed recently published papers concerning the most common procedures in genital reconstruction in FTM transgenders and in MTF transgenders.

Results: There is a wealth of available surgical procedures for FTM transgenders that will adjust their body and genitals toward the male gender. Chest masculinization combined with either metoidioplasty or phalloplasty are the most common procedures resulting in high patient satisfaction. Standardization of the procedures for vaginoplasty in MTF transgenders led to the penile inversion skin technique becoming a "gold standard" for vaginal lining in MTF patients, providing satisfying functional and esthetical outcome of the surgery. In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from hairless skin grafts, or a section of intestine may be used (bowel vaginoplasty).

Conclusion: A multidisciplinary approach including psychiatrists, psychologists, plastic surgeons, urologists, and gynecologists is the only effective treatment in transgenders. The surgeons' familiarity with the surgical procedure and the patients' desired body images should meet at the same level to guarantee a successful outcome.

Keywords: Female-to-male transgenders; Genital reconstruction; Male-to-female transgenders; Metoidioplasty; Phalloplasty; Vaginoplasty.