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Transgender and Gender Diverse Care
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Transmasculine procedures includeHysterectomy (ovary sparing preferable if patient consents)Metoidioplasty or phalloplasty (“bottom surgery”)
Surgical treatment of disorders of sexual development
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rafael V. Pieretti, Patricia K. Donahoe
In adolescents and adults, the most frequently used phalloplasty procedure is the radial forearm flap, which is a complex and rare operation, performed only in highly specialized centers. The description by De Castro of a phalloplasty technique and complete urethroplasty using a quadrangular lower abdominal flap can bridge the interval between childhood and adolescence until a more definitive procedure can be performed (Figure 80.24a–c). The quadrangle of lower abdominal flap fashioned to create the new penis is 4 cm × 5 cm for babies, and slightly larger in an older child. De Castro recommends the use of oral or bladder mucosa for the urethroplasty, although the single-stage buccal mucosa urethroplasty has had a high complication rate.
The person
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
If a trans man needs to be catheterised, then it will need to be based on their genital presentation; trans men with a phalloplasty can be catheterised the same as with other men. A phalloplasty is a construction or reconstruction of a penis using veins and arteries from forearm or thigh to create a graft and shaft of the penis. A metoidioplasty is the creation of a penis and scrotum done by cutting the ligament surrounding the clitoris to create these.
Pleasure please! Sexual pleasure and influencing factors in transgender persons: An ENIGI follow-up study
Published in International Journal of Transgender Health, 2023
Noor C. Gieles, Tim C. van de Grift, Els Elaut, Gunter Heylens, Inga Becker-Hebly, Timo O. Nieder, Ellen T. M. Laan, Baudewijntje P. C. Kreukels
The follow-up questionnaire included questions regarding one’s current gender identity, education level, relationship status, social transition and gender-affirming therapy. If participants had received any gender-affirming therapy since entering the clinic, questions were asked specifying the type of gender-affirming hormone therapy and/or surgery. To reduce analytical complexity, surgical procedures were later grouped into three categories: breast/chest surgery (mastectomy or mamma augmentation), genital/pelvic surgery (hysterectomy with or without oophorectomy, vaginoplasty, phalloplasty, metoidioplasty or erection prosthesis) and face/throat surgery (facial surgery, Adam’s apple reduction or vocal cord surgery). All participants were asked if they had a wish for future gender-affirming surgery and if so, which surgical procedure they had planned. All participants who expressed any wish for surgery in the future were coded as having a wish for future surgery.
Preferences for and barriers to gender affirming surgeries in transgender and non-binary individuals
Published in International Journal of Transgender Health, 2022
Bita Tristani-Firouzi, Jacob Veith, Andrew Simpson, Kelly Hoerger, Andy Rivera, Cori A. Agarwal
Fear of complications was a major barrier for bottom surgery and facial procedures but less so for top surgery. This is not surprising as major complications for vaginoplasty and phalloplasty are reported as high as 16% and 33% respectively in the literature (Ascha et al., 2018; Ives et al., 2019). Not being ready for bottom surgery was nearly as important a barrier as cost and fear of complications. Many people interested in phalloplasty mentioned that although interested in bottom surgery, they were waiting until the surgical outcomes improve. One comment from a transgender man was, “I am waiting for advancement in surgery for more realistic appearance, better healing and reduced cost.” The fear of complications for all procedures was predominately listed as barriers by the younger generation of respondents.
Penile reconstruction: An up-to-date review of the literature
Published in Arab Journal of Urology, 2021
Nicholas Ottaiano, Joshua Pincus, Jacob Tannenbaum, Omar Dawood, Omer Raheem
Phalloplasty is the surgical creation of a penis-like structure. The first successful phalloplasty was reported in 1936 using rib cartilage and an abdominal flap [23]. Over time, there have been many advances in flap techniques and neophallus designs [24]. Typically, two operative teams work simultaneously; the plastic surgery team harvests the donor site flap while the urological team prepares for and then places the flap as a neophallus [25]. Phalloplasty can be performed in a single procedure, but more commonly it is performed as staged procedures that can be done months apart [26]. There are various indications for phalloplasty, including penile insufficiency in cis-males and female-to-male gender reassignment surgery. In cis-males, penile insufficiency can be secondary to congenital disorders, surgical or traumatic amputation of the penis, penile fracture, and Fournier’s gangrene [23,25,27]. Relative contraindications include a body mass index of >35 kg/m2 and truncal obesity due to added postoperative risk and increased thickness of donor sites [26]. Additionally, compliance and health literacy should be assessed, as there are frequent postoperative appointments and enormous health and lifestyle consequences [26].