Morbidity
Generic: Bleeding, infection, wound haematomas and most importantly deep
venous thrombosis (1%) which in rare instances can progress to fatal pulmonary
embolism. Hospital acquired infections include MRSA and Clostridium difficile.
Neuropraxia from lithotomy position.
Clitoris: Insensate or hypersensitive clitoris. Hair growth under hood.
Ischaemia of hood leading to wound breakdown and scarring. Cosmetic issues.
Vagina: If sufficient peno-scrotal skin is present the best results are
obtained with skin flaps from these areas. Flap necrosis may occur resulting in
prolonged recovery and potentially stenosis of the vagina which may preclude
penetration. Hair growth may lead to the formation of a hair-ball. Vaginal
prolapse occurs in about 2%.Insufficient penile/scrotal skin may result in a
short, narrow vagina which may interfere with penetration. Post-operative pain
which may prevent dilatation. Cosmetic issues.
Labia: Outer lips (labia majora) maybe fashioned using a W- or V-shaped
scrotal skin flap. Necrosis and haematomas may occur as may cosmetic issues.
Urethra: Spraying, upward direction of urinary stream, stenosis causing poor
emptying and susceptibity to urinary tract infections, swelling. Cosmetic issues.
Psychological: Few patients regret having had surgery and fewer still (<1%)
request reversal but poor surgical outcome inevitably leads to patient
dissatisfaction which is why patients must be realistic about this procedure and
accept that secondary procedures may be necessary in up to 20 % cases.