What Are The Different Types Of Sex Change Surgery?

Sex Reassignment surgery can be broadly divided into 2 kinds:

Male to Female (MTF): Trans women undergo this procedure. The surgeries in this category are aimed at reshaping the male genitalia that is present in these individuals, into a form that resembles female genitalia. It also tries to provide the functionality as far as possible too. The procedures include Hormone Replacement Therapy, Facial Hair Removal, Facial Feminization surgery, Breast Augmentation, etc. 

Female to Male (FTM): Trans Men undergo this procedure. Most of these Trans Men do not opt for Genital Reassignment Surgery as the clitoris tissue available to make a viable penile tissue is very less. Also, this procedure seems to have more post-op pain. They opt for the other less extreme options available to them such as Bilateral Mastectomy (removal of breasts), Chest contouring (to provide a male physical shape) and Hysterectomy (removal of internal female genitalia). FTM procedures are also initialized by Hormone Replacement Therapy, which uses Testosterone. 

What To Do Before A Sex Change Surgery?

• Gender identification is the first, most essential part of the procedure. The transperson has to identify themselves as belonging to either of the 2 sexes and hence undergo the procedure in order to become more like that sex to maximum possibility. The identification can be done by themselves after reaching a certain mental maturity or should be done by the doctors even when the Trans babies are born. 

• At the very start, when the trans person first goes to consultation, he/she has to introspect within themselves and be doubtlessly sure that they want to undergo the procedure as a procedure like vaginoplasty is irreversible. A person entering into such a procedure without appropriate forethought, will be emotionally and psychologically overwhelmed after. 

• Like all other major surgeries, this surgery too demands a decent medical history and the surgeons will be very sure to ask for it. 

• The patient will have to quit smoking a few weeks prior to surgery as nicotine slows down the recovery. Patients needing nipple grafts should not consider smoking at all as nipple tissue is extremely sensitive to Nicotine and the graft might get rejected otherwise. 

What Is The Post Operative Care For Sex Change Surgery?

Male To Female Surgery Care:

• After 3 days in the hospital for the surgery, for the recovery time, the patient has to stay in the area for 10 to 12 days. 

• The patient can perform light work in 4 to 6 weeks. Strenuous work and exercise can begin by 6 to 8 weeks. 

• Dilation (stretching the vagina walls periodically) should be done as per the surgeon's after care instructions, with a frequency of twice a week till 13 weeks. 

• A good dilator that is large and comfortably fits inside the vagina should be used. 

• The vagina should be douched (cleaned in a particular way) as per surgeon’s instructions.

• Painkillers according to the surgeon's prescription should be administered in the different stages of healing after the gender reassignment. 

Female To Male Surgery Care: 

• After 2 days in the hospital, the patient will have to stay in the area for about 5 to 6 days. 

• Small work can be resumed in 2 weeks. More strenuous exercise can only be started after 4 to 6 weeks. 

• A compression binder might have to be worn during the recovery stages for 6 weeks. It primarily depends on the surgeon's advice. 

• There will be less than moderate pain after surgery for a few weeks depending on how the surgery was done.  This will be taken care of by the surgeon who will prescribe necessary painkillers. 

• Sutures in the top surgery will be removed in about a week. 

What Are The Realistic Expectations From A Sex Change Surgery?

• Sex change is not a short term procedure. While the surgery lasts only a few hours, the duration for a complete sex change, in both psychological and physical terms, can take upto a few years. Gender is a prime identity of any individual, it defines his/her preferences, lifestyle, habits, and so on. Hence, the decision to undergo the surgery should be taken with much consideration. 

• While more than 97% individuals undergoing the surgery find gender reassignment results satisfactory, it is best to be sure about the resulting effect of the treatment before undergoing it. 

• Since the surgery is irreversible and lasts for a lifetime, you should consult in detail with your doctor whether you are an ideal candidate for the surgery.

• The procedure is ideally suited for two types of individuals; for those who were not biologically assigned a gender at birth, or those who do not feel comfortable with their current sex. Generally, such people do not wish to be associated with the gender that they biologically posses or have a gender dysphoria.

Who Should Avoid A Sex Change Surgery?

Gender reassignment surgery is not ideal for you, if: 

• You’re under 18 or above 60 year of age

• You’re under mental stress and are deemed incapable of making the right decision by a doctor

• Your therapist does not recommend you to undergo the surgery 

• Your gender identity is too strong to change as can be determined by your therapist/doctor 

What Are The Alternatives To Sex Change Surgery?

While this is the best and most permanent treatment for such a condition, a few other alternatives are available for a trans individual. 

In children diagnosed with gender dysphoria, synthetic hormones known as  gonadotropin-releasing hormone (GnRH) analogues can be used. These help to suppress the hormones naturally produced by one’s body. 

At a later stage of the condition, one can consider taking the help of cross-sex hormones, which offer a relatively permanent and stronger solution by assisting trans individuals to fit better into their gender identity. While trans men take testosterone, trans woman take estrogen. This therapy aims at making one comfortable not only with their physical appearance, but also about how they feel psychologically. 

Adults who face gender dysphoria and transsexuals must rely on specialist gender identity clinics in conjunction with hormonal treatments, which provide mental health support, However, while some may consider these treatments sufficient to feel comfortable in their gender identity, others may require more extensive and surgical solutions. 

Will Sex Change Surgery Lead To Scarring?

As with any surgical procedure, there is a risk of scars developing after a gender reassignment surgery.

MTF:

• For first few months, the scars are pink, fleshy and elevated. 

• Between six months and a year, they become flat, white and soft. 

• Within a year they completely heal and are barely visible. 

FTM:

• Severity of the scar depends on the kind of incision made. Different incisions done include:

  •  Keyhole incisions - ideal for small chests, leads to minimal scars

  •  Peri-areolar incisions - ideal for moderate size

  •  Double incisions - ideal for large chests, big scars

• The first 6 weeks after surgery,  the scars will look dark and raised against the skin background. 

• By 12 to 18 months they would have healed, will lighten and fade but slightly visible also. 

What Are The Temporary Side Effects Of Sex Change Surgery?

• Most of the complications relating to this surgery are more psychological and hormonal, than physical. 

• Undergoing sex change surgery is easy. But to completely fit into the role of a different gender takes a longer span of time, generally, a few years. 

• You will need to undergo therapy before and after the surgery to help you change your sex mentally, and to adjust to other’s opinion of you based on your sex. 

• The surgery changes your genitalia. However, the hormones that determine secondary sexual characteristics such as your voice and hair growth are not affected by the surgery.  

• You will need to undergo some other treatments to change the hormonal composition of your body that suits your re-assigned gender more appropriately. 

How To Choose A Surgeon For A Sex Change Surgery?

A surgeon has to be highly trained to be able to perform a complex surgery such as the sex-change surgery. He/she should follow the WPATH (World Professional Association for Transgender Health) standards of care in order to ensure that there is no discrepancy in the quality of operation and the postoperative care. Any surgeon will require a letter of confirmation from credible sources such as a psychiatrist or a family member encouraging the requirement of a sex reassignment surgery for the patient.

In addition, the surgeon should also consult with the patient’s counsellors on his behalf to ensure that he/she is the ideal candidate and will not regret the surgery afterwards. The doctor will also have to perform more than one cosmetic procedures such as breast augmentation, and should be proficient with the same. In addition, the surgeon should also test for STD, such as HIV, along with other lab tests to ensure that the patient is 100% ready for the reassignment.