Feminising Surgery

    What does lower feminising surgery include?

    Content warning: the content below uses some anatomy/biological terms where it is important to be precise

    There are multiple surgical options for lower feminising surgery. At CCGS we offer bilateral orchidectomy, vulvoplasty and vaginoplasty, It is important to be aware that feminising genital surgery is not reversible, therefore you need to consider all the options available before you make this important decision.

    It is also important to be aware that these options for lower feminising surgery all involve removal of both testicles, which means you will be infertile after the surgery. If you wish to consider sperm cryopreservation (freezing and storing your sperm for use in future fertility treatment) prior to surgery please speak to your GP regarding referral to your local fertility service.
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    What is Vaginoplasty Surgery?

    Vaginoplasty is a surgical procedure where we remove the genitalia you were born with (the penis and the testes) and we create a neovagina, and vulva (clitoris with hood, labia minora and labia majora).

    During surgery, a neovagina is created by making a space between the rectum (the bowel inside your back passage) and the prostate. The neovagina is lined with skin from the penis or scrotum or sometimes both.
    The erectile tissue of the penis is largely removed, as are the testicles and this is completely irreversible. The urethra (water pipe) is shortened, and its opening is placed in a position to resemble female anatomy. Neo-labia minora and majora (inner and outer lips) are made from the penile (minora) and perineal (majora) skin. An innervated (sensitive) clitoris is fashioned out of part of the glans penis (head of the penis). This is placed under a small hood at the front of the neolabia

    In order to keep the vaginal cavity patent you will need to commit to lifelong vaginal dilatation.

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    Image: a view of the anatomy before and after vaginoplasty. Ref: Mayo Foundation for Medical Education and Research

    What is Vulvoplasty?

    This is surgery where we remove the genitalia you were born with (the penis and the testes) and we create a vulva (clitoris with hood, labia minora and labia majora). Whilst there will be the appearance of a vaginal opening externally, there will be no vaginal cavity (i.e. no internal depth”), so receptive vaginal intercourse will not be possible.

    The operation will be performed whilst you are asleep under a general anaesthetic. The erectile tissue of the penis is largely removed, as are the testicles and this is completely irreversible. The urethra (water pipe) is shortened, and its opening is placed in a position to resemble female anatomy. Neo-labia minora and majora (inner and outer lips) are made from the penile (minora) and perineal (majora) skin. An innervated (sensitive) clitoris is fashioned out of part of the glans penis (head of the penis). This is placed under a small hood at the front of the neolabia.
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    Your surgical pathway

    We offer patients an individualised consultation with a Clinical Nurse Specialist (CNS) with the aim to collect a detailed holistic history of the patient, and to identify potential matters that require referral to other services (e.g. dietician, endocrinology, physiotherapy, and psychologist). An appointment with one of our surgeons is then arranged. This will provide an opportunity for patients to ask any questions they may have regarding their surgery.

    If your surgeon feels you are fit to proceed with surgery at this stage, a member of our administration team will contact you to offer you a date for surgery. You will also be scheduled for a pre-operative assessment appointment to prepare you for surgery. If your surgeon feels further investigation or management from other specialists is required before you can be listed for surgery, they will discuss this with you during your consultation. A second virtual surgical consult will take place, where a clear understanding of the implications, risks, cosmetic and functional outcomes of the chosen surgical procedure will be discussed with the patient prior to their surgery date. Once a TCI (To come in) date for surgery has been provided to the patient, they can be expected to be admitted to the Surgical Admissions Lounge (SAL) on the day of surgery within the main hospital. Depending on which type of surgery the patient undergoes will depend on their length of admission and recovery, all details will be explained within our CNS and surgeon consultations. If the outcome determines that the patient is not fit for surgery this will be communicated to the patient via telephone or via a virtual clinic with their surgeon.
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    Risks and complications

    If you are accepted for surgery, your consent form will explain the potential risks and complications of your surgery. Details of this will also be discussed in your surgical consultations.