Feminizing genitoplasty in adult transsexuals: early and long‐term surgical results
Authors: Goddard Jonathan C. , Vickery Richard M. , Qureshi Assad , Summerton Duncan J. , Khoosal Deenesh , Terry Tim R. 
Published: July 2007

OBJECTIVE

To examine the early and late surgical outcomes of feminizing genitoplasty (FG) in adult transsexuals in a UK single surgeon practice over a 10‐year period.

PATIENTS AND METHODS

Computerized and manual databases were searched over the period 1994–2004 to identify patients who had undergone male to female FG. Case‐notes were retrieved and analysed to identify epidemiological data, the number and type of perioperative problems, early results at outpatient review, late occurring problems and patient satisfaction. A telephone questionnaire was then conducted targeting all FG patients in our series. The questions were directed at identifying surgical complications, outcome and patient satisfaction.

RESULTS

In all, 233 case‐notes were identified and 222 (95%) were retrieved. All patients had penectomy, urethroplasty and labiaplasty, 207 (93%) had formation of a neoclitoris, and 202 (91%) had a skin‐lined neovagina. The median (range) age was 41 (19–76) years. The median hospital stay was 10 (6–21) days. A record of the first outpatient visit was available in 197 (84.5%) cases. The median time to follow up was 56 (8–351) days. Over all, 82.2% had an adequate vaginal depth, with a median depth of 13 (5–15) cm and 6.1% had developed vaginal stenosis. Three (1.7%) patients had had a vaginal prolapse, two (1.1%) had a degree of vaginal skin flap necrosis and one (0.6%) was troubled with vaginal hair growth. In 86.3% of the patients the neoclitorizes were sensitive. There was urethral stenosis in 18.3% of the patients and 5.6% complained of spraying of urine. Minor corrective urethral surgery was undertaken in 36 patients including 42 urethral dilatations, and eight meatotomies were performed. At the first clinic visit 174 (88.3%) patients were ‘happy’, 13 (6.6%) were ‘unhappy’ and 10 (5.1%) made no comment. Of the 233 patients, we successfully contacted 70 (30%). All had had penectomy and labioplasty, 64 (91%) had a clitoroplasty and 62 (89%) a neovagina. The median age was 43 (19–76) years and the median follow up was 36 (9–96) months. Overall, 63 (98%) had a sensate neoclitoris, with 31 (48%) able to achieve orgasm; nine (14%) were hypersensitive. Vaginal depth was considered adequate by 38 (61%) and 14 (23%) had or were having regular intercourse. Vaginal hair growth troubled 18 (29%), four (6%) had a vaginal prolapse and two (3%) had vaginal necrosis. Urinary problems were reported by 19 (27%) patients, of these 18 (26%) required revision surgery, 14 (20%) complained of urinary spraying, 18 (26%) had an upward directed stream and 16 (23%) had urethral stenosis. The patients deemed the cosmetic result acceptable in 53 (76%) cases and 56 (80%) said the surgery met with their expectations.

CONCLUSION

This is largest series of early results after male to female FG. Complications are common after this complex surgery and long‐term follow‐up is difficult, as patients tend to re‐locate at the start of their ‘new life’ after FG. There were good overall cosmetic and functional results, with a sustained high patient satisfaction.