Genital Surgery
This is performed by Mr Tim Terry, Consultant Urological Surgeon. His
training in feminising genitoplasty was under James Dalrymple (Charing Cross),
Michael Royle (Brighton) and Jores Hage ( Amsterdam ).He has performed over 450
procedures and has presented and published his results nationally and
internationally.
Bilateral orchidectomy: This is the removal of the testes through a small
vertical scrotal incision, usually under local anaesthetic, as a day-case
procedure. The procedure takes about 20 minutes and patients are discharged
usually 2 hours later with appropriate medication. This technique allows the
elimination of testicular testosterone but leaves an empty scrotum and may
shrink scrotal tissue.
Cosmetic genitoplasty : This is the removal of the penis, testis and scrotum
and the construction of external female genitalia. This may include the
formation of a sensate clitoris, labia majora (outer lips) and a shortened
urethra to allow voiding whilst sitting. No vagina is formed. This takes up to 3
hours and is performed under general or regional anaesthesia. Patients may be
ready for discharge after 5 days.
Feminising genitoplasty: This is the removal of penis, testis and scrotum and
the formation of a sensate clitoris, labia majora, foreshortened urethra and
vagina usually from skin flaps created from penile-scrotal tissues. This is the
most complex procedure and takes up to 4 hours under general anaesthesia.
Patients are usually discharged on the eighth post-operative day.
Pre-operative assessment / Counselling: Patients must have 2 positive
referrals from appropriate consultants (psychiatrists/psychologists) familiar
with their real life test before they can be listed for genital surgery. A full
medical history is taken and clinical examination carried out together with any
relevant investigations. Patients need to be physically and mentally robust to
undergo feminising genitoplasty which is a complex operation with significant
potential morbidity. Feminising hormones need to be stopped 6 weeks prior to
surgery to reduce the risk of deep venous thrombosis (blood clots in the
legs).Aspirin should be stopped 2 weeks before surgery to reduce post-operative
bleeding and haematoma formation. Ideally patients should have stopped smoking
and be at their ideal weight .Patients are admitted on the day prior to surgery
for further counselling, consenting and bowel preparation.
Hair growth: Some patients wish to lessen the risk of vaginal and clitoral
hair ingrowth by undergoing preoperative laser or electrolysis treatment. Whilst
both treatments undoubtedly work in the short term hair regrowth may still occur
.Furthermore it is important that to ensure that neither treatment impairs the
vitality of the scrotal/penile shaft skin as this might adversely affect the
cosmetic result of the vaginoplasty.
Colonic neovagina: Some patients have insufficient penile-scrotal skin with
which to from a skin-lined vagina in which case it may be necessary to use a
harvested isolated bowel segment (usually sigmoid colon) to create the
neovagina. This is a much more complicated operation compared to using
penile-scrotal skin flaps or an inverted penile skin tube and indeed its success
is much less satisfactory compared to the standard skin vagina. As such it is
used as a salvage procedure when either there is insufficient skin to start with
or if a previous skin lined vagina has stenosed due to flap necrosis.