What is the Sex Change Surgery?
Sex change surgery refers to the administration of surgery to change the sex appearance according to one’s sex identity. There are two kinds of surgery.
Genital surgical sex reassignment: surgery of the genitalia and/or breasts performed for the purpose of altering the morphology in order to approximate the physical appearance of the genetically other sex. Non genital surgical sex reassignment: any and all other surgical procedures of non-genitalia or non-breast, conducted for the purpose of effecting a more masculine appearance in a genetic female or for the purpose of effecting more feminine appearance in a genetic male.
As a former step of SRS, there is a hormonal sex reassignment, which is the administration of androgen to genotype females, and administration of estrogen and/or progesterone to genotype males, for the purpose of effecting somatic changes in order for the patient to more closely approximate the physical appearance of the other sex.
When is SRS performed?
The time that people start feeling of belonging to the opposite sex is 2-3 years of age. According to the outcome of many researches, early treatment would prevent unnecessary sufferings. Physical outcome of an early treatment can be expected to be more satisfactory by comparison with starting later, especially MFs (male to female). This is an enormous and lifelong advantage instead of having to live with a deep voice and other scar. Thus, the earlier the SRS is performed, the easier transsexuals can adjust themselves according to their sex identity, and they can avoid the confusion about themselves. But SRS is usually performed at the age of 18-21. There are two reasons for this long delay. First, most children with gender identity disorder will not grow up to become transsexuals. Second, adolescents in many countries are still legally dependent on the consent of their parents when deciding on medical treatment.
How do transexuals feel after SRS?
On the whole, most of the transsexuals who have performed SRS were satisfied with sex change itself. Nevertheless, many of them were dissatisfied with the way their new physical Appearance. The reason for dissatisfaction is first, MFs have to do with retention of bodily features and aspects of the overall appearance that could not be changed completely by either surgery or hormonal manipulation. For example, remains of the beard, large feet and hands, quality of the voice, and persistence of Adam’s apple. Social pressure on woman to pay more attention to their appearance is also one of the reason. FM transsexuals are usually dissatisfied with their new genitals. But, the most important thing is that they could live in the new gender role feeling that their identity is fitting to themselves. They have more comfortable relationship with other people around their environment.
The procedure, technique and result
1.) “Penile inversion technique”vaginoplasty (not recommended for a case more than 200 lbs. and who who needs more depth)
Dr Bhatti uses the “Penile Inversion Vaginoplasty” technique which turns the penile skin “inside out” and uses it to line the new vaginal cavity. The penis and testes are removed. A pure penile inversion limits the size of the vagina that can be created which depends on the amount of penile skin available. The vaginal depth depends on the amount of penile skin in the resting state and not in the erectile state. This technique is called SRS with penile inversion vaginoplasty. The recovery is fast and healing is very good with this technique.
2.) “Scrotal Graft Technique” Vaginoplasty
In some patients the peno – scrotal junction stays in a high position and if the first technique is performed, this shall limit the vaginal depth. In such cases Dr Bhatti uses the “Scrotal Graft Technique” combined with penile skin to form the vaginal lining to create the new vaginal depth or new vagina, which is a better technique compared to the penile inversion technique. You will get a depth to your new vagina between 5-7 inches according to your body structure. This is a better choice for individuals who have limited penile skin but more scrotal sac tissue. Most surgeons currently prefer Scrotal skin graft much more than penile inversion and colon graft.
3.”) Sigmoid Colon-Vaginoplasty Technique”( not recommended for weight over 200 lbs and larger abdomen.)
You will have two choices here- delayed or immediate ” Sigmoid Colon-Vaginoplasty Technique” . Your penile skin may be very short and you may have small amounts of scrotal tissue and you refuse to allow other skin for grafting to line your vaginal canal. You will need to stop smoking at least 2 weeks before surgery. So if you are a non-smoker with a flat tummy, “Sigmoid Colon-Vaginoplasty” in one stage( immediate) will be recommended . The delayed type is better for cases that have undergone previous SRS with Penile inversion or Scrotal skin graft with vaginal shrinkage. In all of cases ,Dr Bhatti will construct the labia majora , sensated Labia minora, clitoral hood and sensated clitoris in the meantime. He constructs the labia majora and labia minora by using part of your scrotal and sensated prepuce to create this part of female appearance. Dr Bhatti does not use the delayed type for this procedure. You will gain natural labia major and minora during this time lag. The clitoris is constructed by retaining a small section of the glans penis with its blood supply and nerves intact, and positioning this into an appropriate site above the urethral meatus. Since the nerves of glans in phenotypic male are analogous to the nerves of the clitoris in a female, patients can have natural feeling of erotic sensation.