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Purpose:Gender-affirming vaginoplasty creates the vulva and vaginal canal for individuals assigned male sex at birth who have gender dysphoria. Dissection of the neovaginal space can be particularl...

Introduction:There is a paucity of data on contemporary practice patterns regarding gender affirming surgery among reconstructive urologists.Methods:We surveyed members of GURS (Society of ...

BACKGROUND Increasingly more nonbinary patients are obtaining better access for gender-affirming chest surgery (top surgery), representing an important subset of patients who undergo such surgery. OBJECTIVE We review our experience at gender-affirming chest surgery in nonbinary versus transmasculine patients in an integrated health care setting. METHODS We performed a retrospective study of nonbinary and transmasculine patients who underwent gender-affirming chest surgery from May 1, 2012, to December 27, 2017. RESULTS There were 111 nonbinary patients and 665 transmasculine patients included in the final analyses. Nonbinary patients were more likely to seek more than 1 surgical consultations than transmasculine patients (24.3% vs 1.7%, respectively, P < 0.0001). More nonbinary patients (17.3%) indicated nipple sensation to be important relative to their transmasculine counterparts (0.4%, P < 0.0001). Fewer nonbinary patients were on testosterone before surgery (33.64%) in comparison to transmasculine patients (86.14%, P < 0.0001). When only prior reduction mammaplasty or top surgery were considered, nonbinary patients (8.1%) were more likely than transmasculine patients (3.5%) to have had a prior chest surgery. When evaluating patients who did not have prior chest surgery before undergoing top surgery at our institution (n = 721), rates of major complications, minor complications, as well as revisions, were comparable between nonbinary and transmasculine patients. CONCLUSIONS This study demonstrated that more nonbinary patients requested nonflat chests relative to their transmasculine counterparts. Both groups in our sample displayed comparable rates of complications after top surgery.

BackgroundGender-affirming care, including surgery, has gained more attention recently as third-party payers increasingly recognize that care to address gender dysphoria is medically necessary. As more patients are covered by insurance, they become able to access care, and transgender cultural compe

Gender dysphoria, or the distress caused by the incongruence between a person's assigned and experienced gender, can lead to significant psychosocial sequelae and increased risk of suicide (>40% of this population) and assault (>60% of this population). With an estimated 25 million transgender individuals worldwide and increased access to care for the transgender population, trauma surgeons are more likely to care for patients who completed or are in the process of medical gender transition. As transgender health is rarely taught in medical education, knowledge of the unique health care needs and possible alterations in anatomy is critical to appropriately and optimally treat transgender trauma victims. Considerations of cross-gender hormones and alterations of the craniofacial, laryngeal, chest, and genital systems are offered in this review. Further research on the optimal treatment mechanisms for transgender patients is needed.

The authors present their grading scale and the outcomes of the largest cohort of top surgery published to date. Application of this grading system can help determine which patients will benefit from a subcutaneous mastectomy with free nipple graft versus a circumareolar technique, with the primary endpoint being need for aesthetic revisions.The authors reviewed their database of transgender males who underwent bilateral mastectomy between 2006 and 2015. Data collected included age, body mass index, American Society of Anesthesiologists class, smoking, diabetes, testosterone use, months of social transition, technique used, postoperative complications, and need for revision. Two techniques were used, circumareolar incision and free nipple graft technique.Between 2006 and 2015, 1686 consecutive mastectomies were performed on 843 patients. Of those, 548 patients were excluded because of inadequate follow-up. Of the 295 included, 109 were treated using a circumareolar incision and 186 were treated using a free nipple graft technique. There was no statistically significant difference in complications between the two groups; however, there was a statistically significant difference in the rate of aesthetic revisions in the grade 2B circumareolar incision group (34 percent versus 8.8 percent).The authors' outcomes are comparable to the literature, and demonstrate that these procedures can safely be performed in an outpatient setting. The authors' grading scale classifies patients and helps the surgeon select a surgical technique. The authors show a statistical difference in rates of aesthetic revisions in Fischer grade 2B patients when a circumareolar incision is selected over a free nipple graft technique.Therapeutic, III.

Gender confirmation surgery can be an important component in helping individuals alleviate gender dysphoria. Increased advocacy, awareness, and acceptance of these medically necessary procedures have resulted in a greater demand for such procedures, exceeding the number of qualified surgeons able to perform them. It is recognized that formal training guidelines and fellowship programs are needed so as to assure that surgeons performing these procedures are adequately experienced. Here, the authors discuss a potential framework by which a multidisciplinary training program in gender confirmation surgery can be developed and implemented.

This study compared the brain activation patterns associated with visual sexual arousal in connection with sexual hormone levels in postoperative male-to-female (MTF) transsexuals and normal premenopausal and menopausal women using 3.0 T functional MRI. A total of 30 volunteers including 10 premenopausal women, 10 menopausal women, and 10 postoperative MTF transsexuals who had undergone sex reassignment surgery participated in this study. Brain activity was measured while viewing erotic male and female nude pictures. The free testosterone and estradiol levels of the postoperative MTF transsexuals were not in the normal range seen in normal premenopausal women, but were in range seen in menopausal women. The postoperative MTF transsexuals showed significantly higher activities in the hippocampus, parahippocampal gyrus, amygdala, putamen, globus pallidus, thalamus, and head of caudate nucleus in response to erotic male nude pictures in contrast to female pictures (P

The purpose of this article is to report on the most recent findings on the current surgical treatments for sex reassignment surgery for both male-to-female and female-to-male transsexuals.For male-to-female sex reassignment surgery, researches aim to refine the inverted peno-scrotal flap surgical technique in order to increase the neovaginal length and width, prevent complications and ameliorate the cosmetic outcome.Bowel segment vaginoplasty, used mainly for secondary cases, is becoming more and more common.For female-to-male sex reassignment surgery, the radial forearm flap is the only procedure that has proved to fulfil most of the patient expectations; however, because of a high complications rate, long recovery time and a large number of the required operations, and the absence of guarantee that patients will be satisfied, the free radial forearm flap is not the best option for every patient. Alternatives such as abdominal/groin flap, thigh flap and metaidoioplasty are very much used.In order to provide the best care for transsexual patients, centres performing sex reassignment surgery should co-operate and implement both the refinements and the new techniques offered and/or requested.

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Sex reassignment surgery has proved to be the best resolution for primary transsexuals. In 1980, Dr. Rubin stated that preservation of the glans to reconstruct the clitoris in male-to-female sex reassignment surgery gave good cosmetic and functional results. In his series, Rubin used the corpus spongiosum as the vascular pedicle of the neoclitoris, but urine leakage is a complication. From 1988 to the present, the dorsal portion of the glans penis with the dorsal neurovascular pedicle has been used here for clitoroplasty in nine male-to-female primary transsexuals. All neoclitorides survived well, with good preservation of light touch and sexual sensation. No urine leakage has occurred. Six patients who were followed reported sexual satisfaction.

Progress in evaluating and treating the patient who seeks a change of sex is reviewed. The causes of transsexualism and the clinical differentiation of transsexualism, transvestism, and homosexuality are discussed. Criteria for selecting candidates for sex reassignment surgery are given, and preliminary results of work at Vanderbilt University are reported.

A follow-up is presented for 67 male transsexuals who had surgery, along with detailed information for 55 patients. The operative technique used is first described by Stuteville, Pandya, and Arieffin 1971. The main principle of this technique is that the vagina is lined with inverted penile skin like a flap on an abdominal pedicle. All the erectile tissue is removed. In the follow-up, special attention was paid to the patients' reactions to the surgery and to the anatomical and functional results. There was only 1 patient who regretted having had the operation. All the others were well pleased and content that their external sexual organs at last fitted their body image. There were few complaints about the appearance, and only 4 patients needed further surgery to increase the size of the vagina. Some patients had a vagina that would be judged too small. They did not complain because the vagina was unimportant in their sexual activities.