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

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There will be important choices to be made about intended outcomes. Your wishes may have to be adjusted in light of the view of your surgeon about what is possible, or likely to be achievable, in your case. Everyone’s anatomy is slightly different, and your surgeon will take this into account. Your penis will need to be created from your own tissue, as a graft, taken from a donor site. Some surgeons prefer one donor site rather than another – forearm rather than abdominal flap – for instance. The donor tissue is rolled into a basic penis shape and may be positioned slightly differently, depending on: whether the clitoris is to be buried under the penis or scrotum (if no metoidioplasty has taken place) or left visible and accessible between the testes; whether or not metoidioplasty has already been carried out; if it has, then the micro-penis will be incorporated into the penis by wrapping the donor tissue around it; and where the graft is taken from – an abdominal flap allows little choice of exact position, whereas the forearm flap is ‘free’ and positioning is a little more flexible. You will also have to consider the various refinements that can be made on your phallus. Do you want a phallus that looks good but is not functional? Is it important to you to be able to urinate standing up? Are you hoping to be able to make the penis erect and have penetrative sex? As with the metoidioplasty, your surgeon should be able to provide you with images, and may be able to refer you to other patients whom he or she has treated. You will need to understand the risks associated with this complex surgery, so that you are able to make joint decisions with the surgeon, and give properly informed consent to each of the procedures. N.b. The following text should only be regarded as an introduction to the possible procedures that may be involved in phalloplasty. Techniques depend not only on your choices, but also on the practice and experience of your surgeon, and your own particular anatomy. It is not within the scope of this booklet to cover all these possibilities. © GIRES A GUIDE TO LOWER SURGERY FOR TRANS MEN 25
How do I choose the donor site? One of the first decisions to be made is about the donor site – the area of your body that will provide the tissue from which the phallus is to be made. The site will depend, partly, on your surgeon’s preference and his or her view of what can be achieved in your particular case. Of course, it will also depend on what outcome you are hoping for, and where you are prepared to have the scar caused by the removal of a large area of skin. Donor flaps may be described as ‘pedicle or ‘free’; a pedicle flap is initially only freed at one end, whilst the other end remains attached and retains some of its original blood supply; the ‘free’ flap has to be detached completely and moved to the new site, and blood vessels and nerves have to be re-attached to nerves and blood vessels at the new site. Forearm flap The most common donor site is the radial forearm flap although, in a very few cases, the arm may be too thin to provide enough skin. This is a ‘free’ flap although some of the refinements to the phallus may be done before the flap is detached from the arm. If you are right handed, the flap will be taken from the left forearm, and vice versa. For good results, hair removal from the site should be complete before surgery. It may take some months, possibly as long as a year to achieve complete removal of hair from your lower arm. It can be done with light based procedures such as laser or intense pulse light, or by electrolysis. The method of hair removal will depend on your skin and hair type. You should discuss this with the professional providing this service. Blood vessels are also taken from the forearm and joined up with those in the pelvis, to ensure that the penis has an adequate blood supply. It is usual to take one artery (arteries carry oxygenated blood to the tissues), and two or three veins (veins carry the de-oxygenated blood back towards the heart). Nerves are also taken from the arm and are joined, at the base of the penis, to nerves in the abdomen. Unfortunately, the nerves do not function immediately. It takes many months – maybe up to a year – before the nerves regain function. It is, therefore, important to understand that during this time the penis will not have sensation. If you have this surgery, you will need to take care not to damage your penis while there is no feeling in it. 26 © GIRES A GUIDE TO LOWER SURGERY FOR TRANS MEN
Page 1 and 2: A guide to lower surgery for trans
Page 3 and 4: About this publication This publica
Page 5 and 6: Lower surgery for trans men 1 Intro
Page 7 and 8: 3 What are my options? It is essent
Page 9 and 10: 5 Choosing the surgeon for hysterec
Page 11 and 12: In rare circumstances, where hyster
Page 13 and 14: lot depends on how well you are whe
Page 15 and 16: 9 What next? genital surgery? The m
Page 17 and 18: You should also be made aware of th
Page 19 and 20: Clitoral release The simplest opera
Page 21 and 22: Clitoral release creating micropeni
Page 23 and 24: Disadvantages compared to phallopla
Page 25: 13 Option 2: Phalloplasty “I’m
Page 29 and 30: As this is a pedicle flap, arteries
Page 31 and 32: The disadvantage: You risk complic
Page 33 and 34: alternatively, a more complex devic
Page 35 and 36: shaft of phallus sulcus glans cathe
Page 37 and 38: 36 TR catheter emerging from the ur
Page 39 and 40: months later when sensation is esta
Page 41 and 42: Among those who had urethroplasty,
Page 43 and 44: Diagram to show the areas of sexual
Page 45 and 46: Changed sex anatomy Anatomically, a
Page 47 and 48: many years. 26,27 Since people do n
Page 49 and 50: The first and second stages of syph
Page 51 and 52: emain symptomless but can lead to i
Page 53 and 54: Symptoms include: increased discha
Page 55 and 56: Information and support a:gender Te
Page 57 and 58: The Gender trust PO Box 3192 Bright

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