Frontiers | Male-to-Female Gender-Affirming Surgery: 20-Year Review of Continued care after surgery is associated with good outcomes for long-term health. I spent three or four days at the clinic before being moved back to my hotel. That procedure is called labiaplasty. I changed my pads twice a day for a month, and every morning, the hotel staff would come and change my sheets which, despite the extra-absorptive pads I wore overnight, were soaked through with a massive pool of blood. The surgical goals are threefold, and patients can expect: 1) a sensitive and orgasmically functional clitoris and vaginal opening, 2) approximately 6 to 7 inches of vaginal depth, and 3) a natural and feminine appearance. Other complications might include: Certain types of feminizing surgery may limit or end fertility. If you have increased discharge following dilation, you may want to wear a pad to protect your clothing. A bowel flap procedure might be done if there's not enough tissue or skin in the penis or scrotum. Home Before & After Graphic Content Ahead Due to the nature of the surgery, the images you'll see are explicit in nature. This is your first point of contact with the clinical team, where you will review your medical history, discuss which procedures youd like to learn more about, clarify what is required by your insurance company for surgery, and develop a plan for next steps. Demographic and temporal trends in transgender identities and gender confirming surgery. The striking series features before-and-after diptychs of individuals undergoing gender confirmation surgery in Cuba, and in doing so, immortalizes an identity that's all too often denied. That procedure also is called breast augmentation. You can read more about this process and see one of those diagrams here. Have at hand the name, address, and contact information for any clinician you see on a regular basis. Medications. Chan School of Public Health, The Fenway Institute at Fenway Health, and the Department of Psychiatry, Massachusetts General Hospital. This means you are in a sleep-like state during the procedure. Vaginoplasty is the surgical creation of a vagina. . It's important to follow your health care provider's advice for long-term care and follow-up after surgery. Use pillows to support your back and thighs as you lean back to a 45-degree angle. In general, transgender surgery can be divided into transfeminine and transmasculine surgeries. After surgery, you should continue to work with a therapist or counselor. This material is for your education and information only. Because feminizing surgery might cause physical changes that cannot be reversed, you must give informed consent after thoroughly discussing: Before surgery, a health care provider evaluates your health to address any medical conditions that might prevent you from having surgery or that could affect the procedure. Soon, the pain started. These procedures are used to remove and alter male genitalia into traditional female genitalia. Wash your hands and the dilators with warm soapy water, rinse well and dry on a clean towel. Gender dysphoria is the distress that occurs when your sex assigned at birth does not match your gender identity. The virtual consultation will be billed to your insurance company. Find the latest information from the globally recognized leader in digestive diagnosis, treatments and surgical innovations. Male To Female Gender Confirmation. This surgical approach is called penile inversion. The typical recovery time for transfeminine and transmasculine top surgeries is one to two weeks. Gender originates not in the body but in the brain. Using the time-honored plastic surgical principle of constructing analogous structures from like tissue, Dr. Davis creates the female counterparts from their male analogs. Insurance. Vaginoplasty: Gender Confirmation Surgery Risks and Recovery - Healthline The best way I can describe dilating after I left Thailand is to liken it to inserting a serrated knife seven inches deep into an open wound and then holding it there for two and a half hours. This may include guidelines on eating and drinking. An announcement like this is usually followed by a slew of questions, often from total strangers, including, Do you have a vagina now? It doesnt mean theyre oddities or freaks. The surgeon then reduces and reshapes the cartilage. They wheeled me to a small room outside the operating theater, and someone said something about checking on me later. Pharmacy records and medical records documenting your hormone therapy, if applicable. Different can be scary. You have to dilate to maintain the size and shape of your vaginal canal and to keep it open. There's lots of emotions that are coming through all at once. In one study, a persons odds of needing mental health treatment declined by 8% each year after the gender-affirming procedure. typically include: The specialty nurse and social worker will meet with you first to conduct an assessment of your medical health status and readiness for major surgical procedures. MTF Gender Confirmation: Genital Construction - AEDIT While, the surgical results are immediately apparent, it takes several weeks to months to heal completely. Dr. Davis commonly performs a penile inversion vaginoplasty incorporating techniques and refinements from across the globe. Then I was left alone in the dark. Dissatisfaction with appearance after surgery; A facial nerve injury; Additional surgery may be needed to correct an imbalance in facial features and improve the final outcome. They also may change how you feel about your body. Criteria for Vaginoplasty Vulvoplasty in Transfeminine Patients Persistent, well documented gender dysphoria; In preparation for any procedure. To say I was born with a female brain in a male body is not just an expression, its a material and scientific fact. Many transgender individuals choose to undergo fertility preservation before their gender affirmation surgery if having biological children is part of their long-term goals. Last reviewed by a Cleveland Clinic medical professional on 05/03/2021. A lot of them say the pain was negligible as they continued to dilate to keep their vagina open. All rights reserved. Thats why I wrote this. Hold the dilator in place in your vaginal canal. Feminizing surgery, also called gender-affirming surgery or gender-confirmation surgery, involves procedures that help better align the body with a person's gender identity. AskMayoExpert. For some people, having feminizing surgery feels like a natural step. For transgender and nonbinary people interested in gender confirmation surgery, a vaginoplasty is the process during which surgeons construct a vaginal cavity between the rectum and the urethra . Following surgery, it is possible to develop urinary symptoms from enlargement of the prostate. The process began with the nurses performing the dilation, and after that, it would be up to me. For the first several days post-operatively, patients remain in hospital with either light activity or bedrest. Embracing diversity and inclusion, the Center for Transgender and Gender Expansive Health provides affirming, objective, person-centered care to improve health and enhance wellness; educates interdisciplinary health care professionals to provide culturally competent, evidence-based care; informs the public on transgender health issues; and advances medical knowledge by conducting biomedical research. Weiss Center for Gender Confirmation Surgery and Care Certain surgeries change fertility and sexual sensations. Recovery time for most of them is several weeks. Oxford University Press; 2022. Its no exaggeration to say it saved my life, and the fact that it remains inaccessible to so many people who need it is heartbreaking. It's a long process and it's not going to be easy. Penile and prepuce skin was used to construct an anatomically accurate labia minora. Pre-Surgical Requirements Dr. Alter follows the guidelines of the World Professional Association of Transgender Health. section or contact us directly! Preparing for your gender affirmation surgery can be daunting. Our office will get back to you. It seems written into our DNA to be scared of what we dont understand. Different procedures carry different risks. Hormone therapy with estrogen stimulates breast growth, but many people aren't satisfied with that growth alone. After that surgery, visits to a health care provider are needed every few weeks to have a small amount of saline injected into the tissue expanders. The sensation of something being inside my new vagina was beyond description. After that, all my travel documents had to be lined up no mean feat when youre halfway through legally changing your name. That procedure also is called breast augmentation. This time, I was awake and the anesthesia was local. Chest. However, for the first six months, it is very important to make time in your daily schedule for this critical activity. You will also have many follow-up appointments that you do not want to skip. The labia majora are formed from the scrotal tissue, and so on. All healing in the body proceeds the same way, with collagen deposition and contraction. Many insurance companies require you to submit specific documentation before they will cover a gender-affirming surgery. Plan ahead so you have a private area at home or at work. Gonzalez wanted to change that. A local anesthetic may be used, so only the testicular area is numbed. You may choose facial surgery, top surgery, bottom surgery or a combination of these operations. The second surgery had gone well, and I was starting to heal properly. If this is a medical emergency, call 911 immediately for help. Your health care team can talk with you about your options and help you weigh the risks and benefits. I remember making a bad joke about the taste of the gas in my mouth as the lights went dim and I drifted into unconsciousness. The surgeon reconnects the remaining parts of the colon. Transgender surgery before and after photos|Neda Transgender Surgery It's really tough at the beginning, but if you can get through the first month, couple months, it's going to be a lot easier and it's not going to be so much of an emotional and uncomfortable experience. Over the years, he has worked as part of a large multi-disciplinary team including therapists, fellow surgeons, and clinicians, as well as advocates in the transgender community to provide the highest level of care and the most advanced techniques to achieve his patients goals and desires. the brains of trans people are structurally closer to those of the gender they identify with than that of the gender they were presumed to have at birth. At Another Johns Hopkins Member Hospital: The Center for Transgender and Gender Expansive Health Team at Johns Hopkins, Johns Hopkins Center for Transgender and Gender Expansive Health(JHCTGEH), More about the Center for Transgender and Gender Expansive Health, Center for Transgender and Gender Expansive Health. Most patients can resume sexual activity in 2 to 3 months. Alissa (nurse): If you do not do dilation, your vagina may shrink or close. MTF transgender Breast Implant Techniques - Gender Confirmation Any condition that limits your ability to give your informed consent. The dilators have dots or markers that measure depth. The final results of transfeminine bottom surgery can help alleviate the feelings of gender dysphoria that some individuals may experience. Alissa (nurse): You can't skip days now and do more dilation later. My surgery was scheduled for Friday, May 25, 2018. You may choose to have one type of surgery or a combination of procedures. https://www.uptodate.com/ contents/search. Sex-reassignment surgery yields long-term mental health benefits, study Thank you for submitting your request. The day after I turned 19, I underwent gender confirmation surgery, or GCS, in Bangkok. Jessi: I mean, it's such a strange, unfamiliar feeling to dilate and to have a dilator, you know to insert a dilator into your own vagina. Keep gentle down and inward pressure on the dilator as you insert it. Contact your healthcare provider right away if you notice: These signs can indicate you may have an infection and need treatment right away. This content does not have an Arabic version. If that happens, these changes might not be able to be reversed. Before surgery, you should work with a trusted healthcare provider. Gender-affirming surgery gives transgender people a body that aligns with their gender. When I woke up, everything was a blur. It is important to remember that recovery time varies from person to person, so your experience may be different than someone elses. At first, it was a dull ache, but within 24 hours, it had become an unbearable agony that radiated out from the surgery site up through my entire abdomen. This field is for validation purposes and should be left unchanged. Gender Affirming Surgical Services | Cleveland Clinic Liposuction, a surgical procedure that uses a suction technique to remove fat from specific areas of the body. I had to take off my clothes in front of a room full of strangers (and my mother) and have the most intimate parts of my body examined, probed and photographed. After the first year, you may only need to dilate once a week. After approximately 5 days, Dr. Davis then removes the dressings and personally performs the first dilation with each patient, so that they are comfortable with the process. These conversations and articles may be helpful; however, keep in mind that not everything you read will apply to your situation. The result is a vagina that looks and functions, sans periods and childbirth, more or less identically to that of a cis woman. Plastic surgeons will remove the scrotum, perform a penile inversion to create the . Gender confirmation surgery (GCS), known clinically as genitoplasty, are procedures that surgically confirm a person's gender by altering the genitalia and other physical features to align with their desired physical characteristics. Before you have surgery, check with your insurance provider to see what will be covered. Were different, and different can be confusing. A tracheal shave minimizes the thyroid cartilage, also called the Adam's apple. Tangpricha V, et al. Do you have any questions? That idea was relatively simple yet revolutionary: capture sensitive and empowering portraits of transgender individuals involved with CENESEX before and after their gender confirmation. If you have other medical conditions of particular concern, these will be addressed in the weeks leading up to your surgery date also. Gonzalez's photographs combine documentary and poetry to capture the current moment in LGBT rights of a country that's still evolving. Your health care provider might advise against these surgeries if you have: Like any other type of major surgery, many types of feminizing surgery pose a risk of bleeding, infection and a reaction to anesthesia. It feels much like a foreign body entering and it doesn't feel familiar and your body kind of wants to get it out of there. See the before and after procedures done by Dr. Gary J. On-going therapy and support is preferable both before and after surgery. Im also grateful to have a family that supported me both during and after the procedure. You are also agreeing to our Terms of Service and Privacy Policy. It helps to think of transgender surgery as a journey instead of a quick procedure with instant results. You insert the dilators in your vagina to maintain, lengthen and stretch it. Part of HuffPost Personal. However, many employers still hang on to their prejudices, making it difficult for transgender individuals to find access to jobs and education. I wasnt so lucky. These are the goals photographer Claudia Gonzalez expressed to The Huffington Post. It also may lower the amount of estrogen needed to achieve and maintain the appearance you want. And there are resources available online, at your local bookstore and at LGBT community centers. You will also want to think about your recovery plan post-surgery. Before & After - Gender Confirmation F.A.Q. 2016;1(1):32-40. doi:10.1089/trgh.2015.0006. Each day, I was visited by nurses from the clinic. BEFORE & AFTER Gender Confirmation. Purpose: Gender dysphoria (GD) is an incompatibility between biological sex and personal gender identity; individuals harbor an unalterable conviction that they were born in the wrong body, which causes personal suffering. Subscribe to Must Reads. Every breath felt too shallow, like I couldnt get enough air into my lungs. Many trans women get five inches, sometimes even less. My results were then emailed to the clinic overseas. If you're feeling pain, breathe and relax the muscles. Almost all of them have one thing in common: Theyve never actually been through it. To optimize your recovery and healing process, make sure to follow all of your healthcare providers instructions. Dilation will most likely be painful at first. Genital surgery for transgender individuals, also known as gender confirmation surgery or gender reassignment surgery , refers to surgical procedures that alter the physical appearance and function of an . When I feel the right parts between my legs, most of the time I dont feel euphoric, but I feel OK, and after a lifetime of agonizing incongruity between my body and brain, just feeling OK is absolutely priceless. The evaluation might include: You also may have a behavioral health evaluation by a health care provider with expertise in transgender health. Health records that show consistent gender dysphoria. Rather than being inverted outright, the genitals are removed and then reutilized to create different parts of the neo-vagina. Accessed Aug. 17, 2022. And it was the best thing I have ever done for myself. GCS is not something you do on a whim. Patients can expect to begin dilating on a daily basis once the dressings are removed to maintain the vaginal size and depth. Jessi: I hear that from a lot of other women that it's an overwhelming experience. During recovery, youll want to have a strong support system around you that includes healthcare providers, therapists, and others. Appointments 216.445.6308. It's important to dilate even if you have pain. Mayo Clinic does not endorse companies or products. I needed GCS just to feel comfortable in my own body, but not everyone feels that way, and many people that do need it cant access it. I have.". The voices I heard sounded like they were far away, and I could feel the hands of the nurses on my body as they moved me from the operating table to a gurney. You will need to do vaginal dilation for the rest of your life. Discuss all your options, such as sperm banking and egg freezing, with your doctor so that you can create the best plan for future family building. Creation of a clitoris, called clitoroplasty. Before having female-to-male gender-affirming surgery, a person will receive testosterone replacement therapy. Gender affirmation surgery refers to procedures that help people transition to their self-identified gender. Sex reassignment surgery refers to procedures that help people transition to their self-identified gender. Other techniques don't require hair removal prior to surgery because the hair follicles are destroyed during the procedure. Hold a mirror in one hand. We do not endorse non-Cleveland Clinic products or services. Before and after photos don't tell the whole story, and can easily be altered, so consider asking for a . The vaginal lining is made up of scrotal tissue and groin skin grafts. Having a support system is vital to your continued health both right after surgery and long term. Over time, the new vagina will settle into position and the scar lines will improve, although they'll never disappear completely. Overview Feminizing surgery, also called gender-affirming surgery or gender-confirmation surgery, involves procedures that help better align the body with a person's gender identity. 3. Ferrando C, et al. Some of them almost never have to dilate after seven or eight months. Follow Us on Facebook Find Us on Linkedin Follow Us on Instagram Watch Us on Youtube. Feminizing surgery - Mayo Clinic Because the prostate gland isn't removed during surgery, you need to follow age-appropriate recommendations for prostate cancer screening. Narrator: You need to stay on schedule even when traveling. Start your dilation session with the smallest dilator. You need to be closely watched for about a week after surgery. If you wish, you can take the pain medication recommended by your health care team before you dilate. If you are a transgender woman (assigned male at birth or AMAB), other surgeries may include: If you are a transgender man (assigned female at birth or AFAB), you may have surgeries that involve: Recovery times vary based on what procedures or combination of procedures you have: Its important to understand that, for most people, surgery is only one part of the transitioning process. Creation of a vagina, called vaginoplasty. He is a board-certified plastic surgeon whose particular surgical training at Stanford involved experience in this subspecialty under the tutelage of Dr. Donald Laub a pioneer in the field. Accessed Aug. 17, 2022. You may also need physical therapy depending on the type of procedure you had and your progress after surgery. Transmasculine bottom surgery is typically performed as a multiple-stage procedure. After about a week, I was told it was time for me to start dilation. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Studies have shown that the brains of trans people are structurally closer to those of the gender they identify with than that of the gender they were presumed to have at birth. Vaginoplasty / Vulvoplasty - University of Utah Health I am aware that trans bodies exist on a spectrum. American Society of Plastic Surgeons. How you prepare. Top surgery is a surgical procedure to increase breast size that may involve implants, fat grafting or both. Check our F.A.Q. You may be able to freeze sperm with a technique called sperm cryopreservation. Every persons recovery timeline is different, so your coping strategies may also be unique. Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health. The pain started to taper off after about three months, and I barely think about it now. After surgery, you should see your healthcare provider if you experience: Gender affirmation procedures help people transition to their self-identified gender. After that, both a psychologist and a psychiatrist had to sign documents certifying that this procedure was not only very much desired but medically necessary for me. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626314/), (https://www.issm.info/sexual-health-qa/what-is-gender-reassignment-surgery/), (https://www.plannedparenthood.org/learn/gender-identity/transgender/transgender-identity-terms-and-labels). Menu. In the current . This content does not replace medical advice, diagnosis and treatment. If feminizing hormones haven't made the breasts large enough, an initial surgery might be needed to have devices called tissue expanders placed in front of the chest muscles. Your recovery timeline will depend on your surgery. Whether patients are referred to us or already have a Cleveland Clinic ob/gyn, we work closely with them to offer treatment recommendations and follow-up care to help you receive the best outcome.