Transsexuality is officially called "gender dysphoria", something that literally means gender misery. The physical sex and the internal gender of a transsexual do not match up. To use a cliché expression, transsexuals are "trapped in the wrong body". A transsexual might have male genitalia but feel like a woman, or have female genitalia but feel like a man.
Nobody chooses to be transsexual — the amount of emotional pain that accompanies this condition is something anybody would prefer to avoid. Being completely different on the outside than you are on the inside is difficult enough, but societal prejudices and discrimination add a great deal to to the "gender misery" a transsexual experiences. Thankfully, the treatment available to trans people today is more advanced than ever.
Treatment for gender dysphoria exists to help transsexuals live with their condition the way they want and need to — something that frequently means physically transitioning to the gender they identify with.
The transitioning process is lengthy and difficult. However, modern surgical methods mean that the outcome can be absolutely amazing. Not only can transitioned transsexuals achieve excellent external results, but the new genitals that can now be created through surgery can be sensational. No, that's not an exclamation. Post-op transsexuals can have genitals that aren't merely cosmetic, but also functional and feeling.
Commencing Treatment
Adults who have been diagnosed with gender dysphoria will benefit from treatment at a specialized gender identity clinic. Besides emotional counseling — which may address current feelings about the condition as well as trauma resulting from societal attitudes towards it — transsexuals could receive speech and behavorial therapy to help them transition.
Other aspects of the treatment may include hair removal treatment and in many cases plastic surgery to attain the features associated with the target sex. This may mean facial reshaping, implants in buttocks, and breast removal or augmentation. Hormone therapy is the one aspect of treatment on which most others are based, however.
Hormone therapy involves taking the hormones of the target gender. For male-to-female trans people, that means estrogen and for female-to-male trans people, that means testosterone.
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This hormone therapy begins the process of physical transitioning to the sex the trans person already identifies with. After 18 to 24 months of taking cross-sex hormones, the body will have changed to the point that some trans people are satisfied with their external appearance. Plastic surgery procedures should not be considered before this milestone, as it will be much clearer whether surgery is in fact necessary after the hormones have been doing their job for a good while.
To maintain the benefits of hormone therapy, trans people will have to continue it throughout their lifetimes. Since the hormone therapy will offer the person the chance to have an outward appearance that matches their inner gender much more closely, some trans people are satisfied with finishing their treatment with hormone therapy. Many will, however, greatly benefit from sex reassignment surgery.
Sex Reassignment Surgery: The Gory Details And Beyond
Sex reassignment surgery is becoming more advanced all the time. Various techniques are currently available, and choosing the right medical team is essential for the trans person's satisfaction with the end result. Sex reassignment surgery is sometimes covered by insurance, but not always. Because the surgery is costly, some trans people consider surgical tourism as an option. We'd urge any trans person to examine the quality of care and hygiene in clinics abroad, as well as the quality of the end result, before choosing this option.
Male To Female Sex Reassignment
Vaginoplasty is the term used to describe surgery to create a "neovagina" — a new vagina. The main question is where the skin needed for this surgery comes from. Currently, there are two options: using a portion of the bowel, or using the old penis to create the new vagina.
The latter, called penile inversion, creates the best results. This technique uses the skin of the old penis to create the new vulva. The corpora cavernosa, the inner part of the penis, is removed in its entirety. The old glans is reduced in size, and a cone-shaped, fully sensational clitoris is created from it. The urethra is used to create the inner, mucosal part of the vagina while some of the penile skin is inverted and used to create a vagina. The vagina will need to be dilated periodically to achieve a good depth and width.
The second option is using a portion of the sigmoid colon to create a vagina. The advantages of this technique is that the colon is structurally similar to the perineum. A good vaginal length can be achieved, and shrinkage is less likely to occur. This technique creates a vagina that has natural lubrication, and intercourse is possible sooner after surgery.
Female To Male Sex Reassignment
Female to male sex reassignment is more complex, and two basic options are available. The first is called metoidioplasty. This technique begins with removing female-specific sex organs, including the uterus, fallopian tubes, and vagina. A penis is constructed from the old clitoris, enlarged with hormonal creams. The urethra is lengthened to fit into the newly constructed penis, and a scrotum is created from the labia majora. Testicle prosthesis are inserted to complete this procedure.
The end result of metoidioplasty looks very much like a natural penis, but these penises do tend to be on the small side.
That perhaps one reason some trans men prefer a different form of phalloplasty, in which a new penis is created from skin elsewhere on the body. This surgery is a complex one that surgeons find challenging.
The skin that will be used for the new penis can be taken from various parts of the body, including the thigh and upper abdomen. Urethral lengthening also requires skin grafts in this case, and many different tissues — including those from the bladder or buccal mucosa — can be used.
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Looking at pictures of the end result of phalloplasty, you will noticed that an altered clitoris is still present and visible between the newly created penis and the scrotum.
Female-to-male trans people have many pros and cons to weigh, with the help of their medical team. The question is whether the person prefers a natural-looking penis that is quite small, or a more functional penis that looks more artificial. Both options can be satisfactory, however it is interesting to note that some patients end up choosing phalloplasty after they underwent metoidioplasty.
- Photo courtesy of Tim Evanson by Flickr : www.flickr.com/photos/23165290@N00/6239623664
- Photo courtesy of ismael villafranco by Flickr : www.flickr.com/photos/maelvillafranco/7328419072