Jul 042016
 

On June 17, 2016 The Lancet, one of the UK’s most prestigious medical journals, published an entire series dedicated to global transgender health.

The World Professional Association for Transgender Health biennial conference happened over the weekend of June 17-21. I wasn’t able to go this time around, so I can’t report on it directly. But! It looks like it was a fabulous conference. Topics ranged from surgical techniques to cancer prevention to health and psychological care for transgender youth. You can see the schedule yourself.

The Pentagon has announced that it will begin allowing transgender people to openly serve in the US military next month. No details on what that means for veterans or formal military who were dismissed from service because of that status have yet been revealed. Source.

President Obama has declared Stonewall a national monument.

Feb 222016
 

Phalloplasty is one of two options for genital surgery for trans men. While it’s more expensive and extensive than the metoidioplasty, the additional size is often appreciated by the men who opt for it.

Suggestive flower is suggestive

Suggestive flower is suggestive

Why would I want a phalloplasty?

Everyone has their own reasons. Here are some that I have heard:

  • Ability to “pass” in male spaces, such as bathrooms and locker rooms. With genital surgery, the fear of having a towel around the waist slip at an awkward moment is gone.
  • Relieving gender dysphoria. What’s not to like about that?
  • Ability to pee standing up. Only with a urethral lengthening procedure, which carries its own risks.
  • Having a large penis. It both clearly identifies you as male and allows for penetrative sex.

What is involved in phalloplasty? What are my options? And what different techniques are there?

Phalloplasty is one of the most complex genital surgeries, with a lot of different varieties. Phalloplasty is anywhere from 1 to 4 surgeries, and often includes these procedures:

  • Creation of a phallus. There are two basic techniques: either a pedicled flap or a free flap. Pedicled flaps are from nearby areas and remain attached to the body at all times. Free flaps can be from other areas of the body (common areas are the forearm and back) and are fully detached and then reattached. Here’s an NSFW diagram comparing the two. We’ll talk more on these in a moment…
  • Urethral lengthening. The inner labia, among other tissues, are used to lengthen the urethra so you can pee from the tip of the penis. Not all surgeons do this.
  • Vaginectomy and scrotoplasty with implants. The vaginal tissue is removed and may be used in urethral lengthening. The labia are stitched together to make a scrotum, which can then have testicular implants.
  • Hysterectomy and oophorectomy. Removal of the uterus, fallopian tubes, and ovaries.
  • Penile implant. An implant to allow for erection is inserted. This is an additional surgery after the original surgeries have well healed, often 9 months or more.
  • Glansoplasty. Refinement of the appearance of the head of the penis.

Different surgeons do these parts at different stages. Some surgeons don’t do certain techniques at all — I know of at least one surgeon who doesn’t do urethral lengthening in their phalloplasties.

Now, what about where the penis comes from? The tissue is typically “rolled up” to make a penis, no matter where it’s from. That’s an unflattering description, but it produces some fabulous results. As for the technique — they’re either a pedicle technique or a free flap technique. Pedicle techniques take tissue from the abdomen or inner thigh and rotate it into its final place. Pedicles have their original nerves and blood supply, so some say they have less erogenous sensation. Pedicles do have less visible scarring than free flap.

Free flap detaches tissue completely from its old location and attaches it using microsurgery to its new home as a penis. Sensation is often intact because of this microsurgery. The tissue is usually from the forearm, back, or inner thigh. Scarring can potentially be an issue.

Both techniques provide erogenous and non-erogenous sensation. Both can be used for penetrative sex and for urinating while standing. Both are considered aesthetically pleasing — it’s up to what you want and what your chosen surgeon recommends for you.

Can you tell me more about the surgery? Does it require full anesthesia? How long would I be in the hospital? What kind of recovery time am I looking at?

Phalloplasty is an intense surgery. All phalloplasties require full anesthesia. Pedicle generally requires less surgery time than free flap. I’ve seen hospital stays vary from 2-6 days, and initial recovery lasting 2-4 weeks. Return to work is often from 4-8 weeks depending on the surgery, your recovery, and how strenuous your work is.

For multiple stage phalloplasties, the first stage is often the longest and additional stages take less time and are less expensive.

What are the possible risks of phalloplasty?

The usual risks with surgery apply here: adverse drug reactions, bleeding, infection and the like. Permanent loss/reduction in sensation may occur, as with all surgeries. And pain can persist for a long time.

The penis itself can end up twisted (torqued), which is repairable by surgery. And rarely some or all of the tissue can become infected or even die.

Penile implants occasionally have complications. They can slowly erode through the penis or be associated with infection. These complications are rare with today’s techniques and implants.

Urethral lengthening caries its own risks, including urethral narrowing or blockage, and urethral fistula. Urethral fistula is when a hole forms between the urethra and somewhere it shouldn’t be — so urine may spray from the underside of the penis, for example. Narrowing, blockage, and fistula can be repaired surgically. The stream of urine may also spray or be not what you expect.

What about scars?

Pedicle techniques have less scarring than free flap. Free flap scars can be significant but aren’t always — it depends on how you heal.

How will phalloplasty affect my long-term health?

The phalloplasty itself doesn’t generally have long-term health implications unless there were complications. The same applies to the urethral lengthening.

Vaginectomy removes your risk for vaginal cancer. If you also had a hysterectomy/oophorectomy, you no longer are at risk for those cancers. However in order to maintain bone health it’s important to stay on sex hormones (testosterone) life-long.

Can I have penetrative sex with my partners after a phalloplasty?

If you have a penile implant, yes. A penile implant is required to achieve an erection.

Can I stand to urinate after a phalloplasty?

If you have a urethral lengthening procedure, yes.

What about the clitoris?

The clitoris can be buried at the base of the penis or tucked just underneath the penis. Either way, it can and does provide erogenous sensation.

Can I have a phalloplasty if I’ve already had a metoidioplasty?

Yes!

More information?

I am not a surgeon, nor an expert on surgeries! Check out some of these other resources and surgeon websites for more information:

Jan 252016
 

800px-Mercury_fig_leafThe metoidioplasty is one of two potential genital surgeries for trans men. It takes advantage of the fact that trans men already have a penis: their clitoris!

With testosterone, the clitoris grows. A metoidioplasty removes tissue around the clitoris. This exposes more of it and helps it to hang in a more male position. That’s why a metoidoplasty is sometimes also called a “clitoral release” or a “free-up”. That’s it — that’s the core of a metoidioplasty.

In addition, the urethra can also be routed through the neopenis. At the same time the vagina can also be removed, and a scrotum made from the labia. A metoidioplasty does not remove the cervix, uterus, or ovaries. That would be a different surgery. However some surgeons will perform a hysterectomy at the same time as a metoidioplasty.

All in all, a metoidioplasty preserves the tissues that are already there. It shuffles them around into a masculine shape. Not everybody will have everything done, and there are many options.

Why would I want a metoidioplasty?

Everyone has their own reasons. Here are some that I have heard:

  • Ability to “pass” in male spaces, such as bathrooms and locker rooms. With genital surgery, the fear of having a towel around the waist slip at an awkward moment is gone.
  • Relieving gender dysphoria. What’s not to like about that?
  • Ability to pee standing up. Only with a urethral lengthening procedure, which carries its own risks.
  • Keeping erections and erogenous sensation. Some men are also able to have penetrative sex after a metoidioplasty.
  • Cheaper, easier to find a surgeon, and fewer surgeries than a phalloplasty with good results.

What is involved in metoidioplasty? What are my options?

Different surgeons will include different specific stages to a metoidioplasty. But the core of a metoidioplasty is clitoral release. The clitoris is freed from its surrounding tissues so it can hang the way a penis hangs.

Others steps are often included, including…

  • Vaginectomy: Removal of the vagina. May be required for some forms of urethral lengthening. Usually combined with a scrotoplasty, which fuses the labia together to make a scrotum. At the same time testicular implants can also be placed.
  • Urethral lengthening: The urethra is routed through the neopenis and lengthened using other tissue. This allows peeing through the penis and while standing.
  • Hysterectomy, oophorectomy: Removal of the uterus, fallopian tubes, and ovaries.

I’ve heard there are different techniques. What are they?

The biggest difference centers around urethral lengthening. Since the urethra is only so long, other tissue is used to lengthen it. That tissue can come from the vagina or inner labia, or it can come from the inside of your cheek (“buccal”).

Surgeons often have their own individual techniques and strategies in addition.

Can you tell me more about the surgery? Does it require full anesthesia? How long would I be in the hospital? What kind of recovery time am I looking at?

It depends on which specific procedures you have done.

For a simple metoidioplasty only without urethral lengthening, vaginectomy/scrotoplasty, or hysterectomy, some surgeons will perform it under “twilight” anesthesia. This is also called conscious sedation. You’ll be relaxed and won’t feel pain but will likely stay awake. This level of sedation is also used by some dentists, so it’s not unique to this procedure. If you’re also having more intense procedures, like urethral lengthening, then you’ll be under general anesthesia.

The surgery itself lasts anywhere from 2-5 hours depending on what procedures you’re having. You’ll likely spend one night in recovery in the hospital. Full recovery time also varies. One surgeon advises bed rest for 24 hours, plus either 7-14 days off work with no heavy lifting for 2-4 weeks. Again — this depends on the intensity of your surgery.

What are the possible risks of metoidioplasty?

The usual risks with surgery apply here: adverse drug reactions, bleeding, infection and the like. Permanent loss/reduction in sensation may occur, as with all surgeries. And pain can persist for a long time.

The penis itself can end up twisted (torqued), which is repairable by surgery. The length may also be less than was hoped.

Urethral lengthening caries its own risks, including urethral narrowing or blockage, and urethral fistula. Urethral fistula is when a hole forms between the urethra and somewhere it shouldn’t be — so urine may spray from the underside of the penis, for example. Narrowing, blockage, and fistula can be repaired surgically. The stream of urine may also spray or be not what you expect.

What about scars?

The beauty of metoidioplasty is that it doesn’t leave very visible scars.

How will metoidioplasty affect my long-term health?

The metoidioplasty itself (the clitoral extension) doesn’t generally have long-term health implications unless there were complications. The same applies to the urethral lengthening.

Vaginectomy removes your risk for vaginal cancer. If you also had a hysterectomy/oophorectomy, you no longer are at risk for those cancers. However in order to maintain bone health it’s important to stay on sex hormones (testosterone) life-long.

Can I have penetrative sex with my partners after a metoidioplasty?

It depends, but the answer is definitely not “no”. Different people have different results, and different surgeons have different results too. Some surgeons report 4-6cm (1.6-2.4″) long penises, others boast 6-12cm (2.4-4.7″).

If being able to penetrate a partner is the most important thing for you, then you might want to consider a phalloplasty.

More information?

I am not a surgeon, nor an expert on surgeries! Check out some of these other resources and surgeon websites for more information:

Apr 012014
 

CC - see linked URLBeen a busy month here. First, let’s have the news!

Transgender

  • A study has failed to find support for the theory that transgender people can be separated into different typologies based on sexual orientation. Source.
  • Gender dysphoria has been found to be correlated with autism/asperger’s and attention deficit disorder. Source.
  • Among trans people seeking care in the emergency department, 52% have at least one negative experience. 32% heard insulting language and 31% were told their provider didn’t know how to provide care. These statistics were gathered in London, Ontario. Source
  • Cross-sex hormones change cortical thickness in the brain. Source.
  • A meta analysis found that the type and dose of estrogen does not impact breast size for trans women. They also did not find an effect, positive or negative, for progestins. Source.
  • A panel lead by a former U.S. surgeon general has urged the US military to eliminate its ban on transgender service members. Source.

Sexuality

  • Pap smears may soon be replaced by HPV-only testing. Source.
  • 43% of young adult and teenaged men report having experienced sexual coercion. 95% of those were initiated by a woman. 18% of those incidents were physical force, 31% verbal, 26% via seduction, and 7% via drugs/alcohol. Tell me again how sexual violence is a woman’s problem. Source.
  • Shout Out Health posted their reminder of how you can find a gay-friendly health care provider

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On an administrative note, I’ll be attending a medical school in Connecticut come the Fall. I don’t know yet what that’ll mean for post frequency here at Open Minded Health, but be warned that things may shake up a little bit.

As always…  Stay healthy, stay safe, and have fun!