Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients

Objective To report experience of a new surgical technique in male-to-femal e transsexual patients, the complications. and the functional and psychosoc ial long-term results. Patients and methods From April 1995 to July 2000. 66 male patients underwe nt gender-transforming surgery at our institution and were registered prosp ectively. The operation should result in a normal appearing introitus, a va ginoplasty allowing for sexual intercourse and a sensitive clitoris. This w as achieved by preserving the neurovascular bundle. The glans was transform ed into a clitoris, the phallic cylinder used as a vagina and labia were fo rmed from the scrotal folds. Results Major complications during, immediately and some time after surgery occurred in nine of the 66 patients (14%), including severe wound infectio ns in six, a rectal lesion in three. necrosis of the glans in three and nec rosis of the distal urethra in one. Minor complications, e.g. meatal stenos is in seven patients, occurred in 24 (36%) or patients. Tell patients xvith insufficient penile skin had the phallic cylinder augmented with a free-sk in mesh graft, but in three of these patients all ileal augmentation was fi nally constructed because scarring occurred at the suture line between the penile skin and the augmented graft. A long-term follow-up questionnaire ab out the functional and psychosocial aspects was completed by 31 patients. M ore than 90% of the patients were satisfied with the cosmetic result and ca pacity for orgasm: 58% reported having sexual intercourse. Conclusion Male-to-female surgery call achieve excellent cosmetic and funct ional results. Although the operative technique is partly standardized, sur gery remains challenging because Of several possible complications. None of the present patients claimed to regret their decision to undergo gender-tr ansforming surgery.