By Danni Hawkins
© 1995 Danni Hawkins & Transgender Forum
A series of articles on M. to F.
S.R.S. techniques for the assignment of inappropriately gendered
persons to
their correct gender.
© 1995 Danni Hawkins & Transgender Forum
A series of articles on M. to F.
S.R.S. techniques for the assignment of inappropriately gendered
persons to
their correct gender.
(Ed. note: As Danni points out in her introduction she is NOT a medical doctor with specialized training in this area, but rather a scientist who is writing these articles to illuminate and inform)
This surgical technique is the primary method utilised by many surgeons today. Like all techniques there are a number of variations on a common theme, I will deal with those in a later series of articles. In this article I am going to provide information relating to the basic operation which was first successfully performed by Edgerton in the late 1960's with the results being published in 1970. The article is illustrated by line drawings which have been adapted from various papers but are mainly attributable to those used by Edgerton & Bull (Journal of Plastic and Reconstructive Surgery 46: 529, 1970).
It is worth noting at this point not all girls requiring SRS are endowed with a large penis, the 10" penis is more myth than fact. In consequence depth and width problems with the neovagina do frequently occur and either may require further surgery or even the use of another primary technique. A girlfriend of mine (thanks Liberty), who's comments and experiences I intend to draw heavily upon during writing these articles, has commented that her penis certainly seemed to get smaller after some four years of hormone usage. Published statistics would indicate that a mean width of some 20 to 30 mm (approx 1") and a mean depth of 9 to 10 cm (approx 4") can be expected when this method is utilised. Regular sexual intercourse must be carried out or the vagina must be manually dilated in order to maintain its width and depth. A failure to observe these prerequisites will almost certainly lead to stenosis (narrowing or constri ction) of the vagina.
Before I get into the actual operation it is important to understand the anatomy of the penis, the following labelled diagram gives its morphology and should help with the nomenclature used later in this section.
The operation is performed under general anaesthetic with the patient in the lithotomy position (similar to that used in childbirth, on your back, buttocks raised, legs spread). An inverted "T" shaped incision is made with the vertical line from the base of the scrotum to the base of the penis and the transverse incision at the base of the scrotum giving two skin flaps.
After bilateral orchidectomy (removal of the testicles and resection of the spermatic chords up to the external inguinal ring) the penis is degloved by circular dissection of the penile skin. The urethra and spongious bodied are transected after amputation of the cavernous bodies at the pubic arch. A cavity is c
reated by blunt dissection between the urethra, prostate, seminal vesicles and the rectum. The penile tube is closed distally and inverted. The urethra and spongious body are pulled through an incision in the penile skin and sutured to the surrounding tissue. The scrotal skin is largely resected but parts of it are used to form the labia.
The penile skin is immobilised by a vaginal stent for five days.
Perhaps the most common complication, provided that the surgery was carried out correctly, is that of vaginal stenosis. This complication can affect as many as 36% of those who have this method of SRS. Most surgeons, at least those who publish, tend to lay the blame for this squarely on the patient's inadequate or lack of post-operative dilation. A real life experience comes again from Liberty. I quote: "It hurts, its messy as hell, its really inconvenient if you'r e trying to have a life as well and you need to do it so often that it becomes an incredible chore."
Not all skin flaps used in this operation may remain vascularised. Some tissue may die. The causes of these necroses may relate to surgical technique (damage by stitching, kinking of pedicles etc.) or more commonly post-operative use of a hard stent restricting blood supply to the tissue. Edgerton, in a discussion of a paper by Eldh ( Plast. Reconstr. Surg. 91: 895, 1993) recommends against using a rubber or elastic stent in favour of a simple gauze dressing. Any necrosis of the neovagina will require further surgery.
Liberty underwent SRS some 13 years ago, techniques have improved considerably since then, her initial surgery was a version of the penile inversion technique, the subject of this article. She has since had FOUR more visits to the operating table, not as she puts it "as a bizarre search for perfection", but for the correction of problems caused by the original surgery. Liberty was 21 when she first had surgery and describes herself as naive in the extreme. She tells me that her neovagina was so poorly constructed that she couldn't believ e that the surgeon had ever seen a woman before.
My main reason for writing these articles is that I feel that the more informed we are the more we can influence, within the realms of physical possibility, future surgical techniques. I know that for each of us, going through the preamble of having our bodies changed into those which fit our minds, the choice of a suitable surgeon is something that may be considered well after we have started hormone therapy, RLT, coped with traumatised families etc. I maintain that if we want to save ourselves considerable money, pain and disappointment we should consider the capabilities of the surgeon and the surgical technique which may be employed at an early stage. We have to be aware of our options, the capabilities of individual surgeons, possible complications and costs. Quoting Liberty again:" I know that if I had been a little more aware of things when I had surgery I'd have saved myself a bundle of problems." but she also adds, "do it again? Absolutely, no question."
We must work together as a community and let our voice be heard!
Hugs to you all,
Danni.
