Sex reassignment is a surgical procedure that aligns the genitals with the gender the patient identifies with. Understand how it is performed on trans women with specialist Dr. Ubirajara Barroso Jr
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The search for gender authenticity leads many trans women to consider sexual reassignment or gender affirming surgery or sex reassignment as an integral part of their journey.
Sex reassignment surgery for trans women is a surgical procedure that aims to create a genital anatomy in line with the patient's gender identity. It consists of removing the penis and building a new vagina.
According to Dr. Ubirajara Barroso Jr., around 70% of trans women choose to undergo procedures to adapt their genitals from their biological sex to the gender they identify with.
In this article, we'll explore in detail what this surgery involves, the necessary requirements, the procedure itself and important post-operative care.
What is sex reassignment surgery for trans women?
Sex reassignment or gender affirmative surgery involves a series of hormonal and/or surgical procedures with the aim of harmonizing the body and genitals with the gender identity with which the patient identifies.
For trans women who wish to undergo sexual reassignment, the most common procedure is carried out using the skin of the penis itself.
The sex reassignment surgery procedure covers not only surgical intervention, but also hormonal therapies, psychological support and other forms of multidisciplinary health care. Gender affirmation surgery can involve the creation of a new genital organ and the elimination of accessory organs such as testicles, breasts, uterus and ovaries.
"It is not compulsory for a transgender person to undergo sex reassignment surgery or any other body change. This should be a personal decision, and the patient should be fully aware that this is an irreversible procedure," says Dr. Ubirajara Barroso Jr., coordinator of the Urology discipline and the division of urogenital reconstructive surgery at the Federal University of Bahia.
Requirements for sex reassignment surgery
Since 2008, the Unified Health System (SUS) has offered outpatient and surgical procedures for individuals seeking sexual reassignment. Within the scope of public health, care for the trans population is organized through primary and specialist care.
Primary care plays an important role in providing assessments and guidance, directing patients to specific treatments and medical areas according to their individual needs.
Specialized care is divided into outpatient care, involving psychological support, therapies and the application of hormones, and inpatient care, including surgery for genital and/or body modification, as well as pre- and post-operative support.
Before undergoing sex reassignment surgery, trans women usually go through a rigorous assessment process. This can include psychological counseling sessions, hormone therapy and prior experience with the social name.
"At SUS, in order to start the therapeutic process and undergo hormone therapy, you need to be over 18 and have already lived with your social name. To undergo sexual reassignment surgery, you must be over 21 and receive authorization from the multidisciplinary team that has been accompanying you for at least two years to carry out the procedure," says Dr. Barroso.
In the private network requirements The patient can decide to undergo the procedure at any time, provided that they are over 18, have lived with their social name and have been authorized to do so by a psychologist or psychiatrist.
How sex reassignment surgery is performed on trans women
"Sex reassignment surgery for women involves the removal of the clitoris, urethra, vaginal canal and labia minora and labia majora. Clitoroplasty is performed by reducing the glans, preserving its innervation and vascularization and, consequently, maintaining its sensitivity," she describes.
In this procedure, the urologist reports that the urethra must be reduced and implanted in the perineum in the same position as cis women. The neovagina is normally constructed using the skin of the penis which will form the vaginal canal. When this channel fails, intestinal tissue can be used.
Part of the penis is removed, preserving the urethra, the skin and the nerves that give sensitivity to the region, and a neovagina and a neoclitoris are built.
"The neoclitoris is made from the tissue of the glans where the irrigation and innervation of the organ are preserved. When there isn't enough skin or in cases where the vaginal canal is lost in the first surgery, the large intestine can be used for this purpose with good results, also allowing for erogenous sensitivity," explains the doctor on how the procedure is carried out.
Dr. Ubirajara points out that around 60% to 70% of trans women achieve orgasm with gender-affirming surgery. "The sensitivity and the form of pleasure will just become different from before the surgery and this should be made clear to the patient before the procedure," he advises.
Post-operative sex reassignment surgery
"After sex reassignment surgery, daily vaginal dilation is necessary, for at least 30 minutes, for probably a lifetime if there is no sexual activity with frequent penetration," says the doctor.
The recovery time for sex reassignment surgery is short and hospitalization is around 2 to 3 days for trans women.
The post-operative guidelines for sex reassignment surgery encompass several essential recommendations:
- Exercise restriction: The patient should avoid physical activity for a period of 1 month;
- Return to sexual relations: Sexual intercourse is permitted two months after the intervention;
- Follow-up appointments: The patient must attend follow-up appointments to ensure that recovery is proceeding as expected.
Strictly adhering to these conditions contributes to a proper recovery and the prevention of complications.
For more information on the subject, follow me on social media and, if you're considering sex reassignment surgery, book an appointment.
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