Sex reassignment is a surgical procedure that aligns the genitals with the gender the patient identifies with. Learn more from expert Dr. Ubirajara Barroso Jr.
Photo: Adobe Stock
Sex reassignment or gender affirmative genital surgery is a surgical procedure performed to adapt the genitals of the individual's biological sex to the gender the patient identifies with.
Specifically for trans men, sex reassignment surgery involves a series of surgical procedures, the main aim of which is to build a male genital organ.
Dr. Ubirajara Barroso Jr., a renowned specialist in sexual reassignment surgery, points out that the process is personalized, taking into account the individual needs of each patient. "Around 35% of trans men choose to have the procedure," says the urologist who specializes in genital reconstruction and is the author of the total corpora cavernosa mobilization (TCM) technique, a type of metoidioplasty that gives a larger penis.
We're going to explore the fundamental details of gender reassignment surgery for men, covering everything from what it is to the post-operative period. Read on and check it out.
What is sex reassignment surgery for trans men?
Sex reassignment surgery is a set of hormonal and/or surgical procedures whose purpose is to align the body and genital organs with the desired gender identity, overcoming the discordance between the patient's biological sex and gender identity.
In trans men, for example, surgery can involve techniques such as metoidioplasty, which consists of detaching the clitoris and correcting the genital curvature to create a larger phallus, or neophalloplasty, a more complex procedure that uses tissue from other parts of the body to create a penis.
For many trans people, sex reassignment surgery is a significant step towards affirming their gender identity. The process of sex reassignment surgery can involve not only surgery, but also hormone therapy, psychological counseling and other multidisciplinary health care.
Gender affirmation surgery can also include both the construction of a new genital organ and the removal of accessory organs such as the testicles, breast, uterus and ovaries.
"It's not necessarily necessary for a transgender person to have sex reassignment surgery or any other modification to their body. This procedure should be a private choice and the patient needs to be aware that it is an irreversible procedure," warns Dr. Barroso.
Requirements for sex reassignment surgery
Dr. Barroso points out that before undergoing sex reassignment surgery, patients undergo rigorous multidisciplinary monitoring, including psychological assessment to ensure emotional readiness. In addition to monitoring by a multidisciplinary team, factors such as minimum age, emotional stability and participation in hormone therapy are taken into account.
In order to start the therapeutic process and undergo hormone therapy, you must be over 18 and have already used your social name to undergo sex reassignment surgery.
In SUS and the private system there are some different requirements that need to be met in order to have sex reassignment surgery:
| At SUS | Private | |
| Age | 21 years old | 18 years old |
| Requirements | Requires release from psychologist or psychiatrist for at least two years | Requires release from psychologist or psychiatrist |
Since 2008, SUS has offered outpatient and surgical procedures for patients who want to undergo sexual reassignment. In public health, care for the trans population is structured by primary care and specialized care.
Primary care is responsible for evaluations and referrals to specific treatments and medical areas according to each patient's individual needs.
In specialized care, the process is divided into outpatient, with psychological follow-up, therapies and hormone application, and inpatient, with genital and/or body modification surgeries and pre- and post-operative follow-up.
How sex reassignment surgery is performed on trans men
In trans men who have a clitoris and vagina, the procedure can be carried out using the more common method of metoidioplasty, in which it is even possible to apply the total mobilization of the corpora cavernosa (TCM) techniqueand neophalloplasty, a more complex technique.
The MCT was developed by the team of urologist Dr. Ubirajara Barroso Jr. at the Urology Division of the Federal University of Bahia (UFBA) and the Bahiana School of Medicine and Public Health and published in the International Brazilian Journal of Urology (IBJU). International Brazilian Journal of Urology (IBJU)the official scientific journal of the Brazilian Society of Urology.
With metoidioplasty, the clitoris is detached from the surrounding structures and then the genital curvature and new urethra are corrected, usually using tissue from the inside of the mouth, leaving no scars.
TCM can also be indicated for SIS men with a micropenis or who have had their penis amputated due to illness or accident. "We carry out the mobilization of the corpora cavernosa, a technique of our own, which consists of separating the internal part of the corpora cavernosa that is immersed in the perineum, glued to the pelvic bone. This can allow us to make a longer phallus," explains Dr. Barroso Jr. about the surgical procedure for sexual reassignment using metoidioplasty associated with MCT.
Neophalloplasty is a more complex procedure performed with tissue from the forearm, abdominal skin, leg or other tissues, with advantages and disadvantages for the patient. "In phalloplasty surgery, the advantage is that this procedure makes it possible to acquire a good-sized phallus, the disadvantage is that penetration will require the use of a penile prosthesis, and sensitivity is reduced in some cases," describes the doctor who is also head of reconstructive urethral surgery for children and adults at the Federal University of Bahia Hospital.
In metoidioplasty, an erection is possible, but often the phallus becomes smaller, making penetration impossible. "We are enthusiastic about using our metoidioplasty technique with TCM, since the size of the phallus becomes larger, making penetration possible," describes Dr. Ubirajara, coordinator of the Urology discipline at the Federal University of Bahia, which is incorporating the new method.
Post-operative sex reassignment surgery
After sex reassignment surgery, some patients may experience some discomfort, swelling and tenderness in the operated area, requiring the use of medication to relieve pain and reduce swelling in the area.
The patient does not need to stay in the ICU. Hospitalization lasts about 5 days. After discharge, the patient is able to walk up and down stairs normally.
The recommendations for restrictions after sex reassignment surgery include:
- The patient cannot exercise for 1 month;
- Sexual intercourse is allowed two months after the procedure;
- It is essential to maintain good local hygiene, following the doctor's instructions;
- The patient must attend follow-up appointments to ensure that recovery is proceeding as expected.
By respecting these conditions, the body heals properly and complications are also avoided.
On social media, Dr. Ubirajara Barroso explains more about this subject, follow @ubirajarabarroso to find out more. And if you want to have sex reassignment surgery book an appointment.
READ MORE ABOUT TCM IN THE MEDIA:
Hupes conducts research into innovative gender affirmative surgery technique - Empresa Brasileira de Serviços Hospitalares
The right to a penis - Revista Piauí
Penile augmentation and genital aesthetic procedures: what's safe to do? - See Health
Technique recreates penis 'from scratch' by SUS and promises to restore active sex life to amputees - Estado de S. Paulo