A guide to lower surgery for trans men - Gender Identity Research ...

either as part of a metoidioplasty or the larger phalloplasty, will require the urethra
to be extended to reach the end of the phallus. Not all trans men choose to have
the urethral extension. If you don’t have it, it will not be possible to urinate standing
up, and this is an important consideration for some trans men.
Some trans men prefer to retain the vagina as it may still be utilised during sex. If
you are having vaginal intercourse, your partner should use a condom to protect
you against sexually transmitted diseases (see section 14 below).
There are several ways to remove the vaginal opening in order to create a more
male appearing genital area.
colpectomy (a full vaginectomy – removal of the vagina) is a risky procedure
with a high, serious complication rate. The risk of haemorrhage, damage to
the bladder and rectum are significant even with an experienced surgeon.
The vaginal mucosa (lining of the vagina) is removed and the deep pelvic
muscles are sewn together. Again, prior to having this procedure,
consideration of the implications for future surgery should be discussed.
colpoplasty (vaginoplasty) is a newer procedure that involves closure of the
external opening of the vagina whilst opening the internal (cervical) end into
the abdominal cavity. The operation is less risky than a vaginectomy but still
preserves the vaginal mucosa. Vaginal cancer is therefore still possible. If
such a cancer were to develop it would therefore go unnoticed and be
difficult to get at. The risk of developing vaginal cancer is slight: one in a
million.
colpoclesis involves ablation (complete removal) of the vaginal mucosa and
fusion of the muscular walls of the vagina. It is well tolerated with a low
complication rate. Additionally since there is no vaginal mucosa, there is no
risk of vaginal cancer.
8 Will there be an impact on my sexual sensation?
During orgasm, the muscles of the uterus and the vagina contract (see diagram on
page 41), so removal of the uterus will limit the spread of orgasm, and removal or
closure of the vagina will restrict it further. The vagina and the nerves around it
provide some erogenous (sexual) sensation so this will also be lost. However, the
clitoris should be unaffected and you should have no difficulty in reaching orgasm.
If you are on testosterone, the clitoris will enlarge and your experience of orgasm is
likely to intensify which more than compensates for any diminished area of
stimulation.
© GIRES A GUIDE TO LOWER SURGERY FOR TRANS MEN
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