Sex reassignment surgery (SRS) or a gender reassignment surgery, also known in English as 'gender reassignment surgery' or 'bottom surgery', includes a number of plastic and reconstructive surgical procedures with the aim of making the patient's genitals conform to their gender identity.
In the case of MtF ('Male to Female'), this means that the male genitalia with which the patient was born are transformed into an aesthetically accurate and functional vagina. Under the care of an expert surgeon, normal urination, minimal scarring, and maintenance of erogenous sensitivity can be achieved.
Male-to-female operations are a series of complex procedures such as orchiectomy (= the removal of the testicles), clitoral reconstruction, reconstruction of the labia majora and minora, creation of the venous hump and vaginoplasty. These procedures are often bundled and known as one primary vaginoplasty. In some cases, the orchiectomy can be performed several months in advance.
We recommend the method of:
Dr. Hendrik Schöll & Dr. Susanne Morath “The Combined Method”
Based in Munich in their own practice and also head of the plastic surgery department at the Red Cross Hospital in Munich, both aesthetic plastic and reconstructive surgeons, specialized in the field of SRS, FFS, breast surgery and in the entire field of body contouring. More than 10 years ago, the “Combined Method” for gender reassignment surgery (MtF) was devised here and continuously refined to achieve an even more optimal functional and aesthetic result. Since then, this surgical method has been performed several times a week as a standard procedure with great success. In contrast to other techniques, such as penile inversion, this technique always uses the scrotal skin and part of the urethral mucosa to line the neovagina, in addition to the penile skin. This not only allows for significant depth of penetration, but also creates the possibility of a self-lubricating vaginal cavity. A sensitive clitoris is formed from the glans, which is capable of orgasm. The clitoris itself is protected by a clitoral hood and labia minora, which are formed from part of the foreskin. Even after circumcision there is a possibility to form it. Of course, the labia majora are also made aesthetically attractive.
Below you will find the conditions for who can and may undergo a primary vaginoplasty. These are laid down in the publication 'Standards of Care' (7th edition) of the World Professional Association for Transgender Care (WPATH).
The procedure is reviewed and explained during the intake interview. Questions are answered. Previous medical and personal history is noted and a determination is made whether the patient is a good candidate. The clinical examination will determine the procedure (amount of skin, need for epilation, specific procedural elements…).
If all conditions for surgery are met, your surgery date will be scheduled. The operation requires a 14-day hospital stay. The night before the operation, the intestine is cleaned (by drinking fluids).
Surgical wounds are cleaned daily and should be kept dry and clean until completely healed. The vaginal canal must be cleaned daily to prevent complications and infections.
4 to 6 weeks after surgery it is generally possible to return to work (depending on the type of work).
Dilation (= gradually enlarging and widening the vagina using rods or dilators) is usually recommended for the first 6 months after surgery.
Until the transplantation of female reproductive organs becomes possible due to medical advances, it is pregnancy not possible for transgender women.
When revision surgery is requested, it is usually to improve the aesthetics of the result, but sometimes corrective interventions are necessary to improve the functionality of the neovagina. They are usually performed 6 months after the initial procedure.
Risks and complications of male-to-female gender reassignment surgery include general risks that are not specific to this operation, but are general to all operations. This includes risks associated with general anesthesia, intraoperative and postoperative bleeding, infections, scarring, delayed healing, accidental damage to surrounding tissues.
Among the specific risks associated with SRS there are urethral strictures, stricture of the neovagina, meatal stricture of the new urethra, rectovaginal fistulas, necrosis or rejection of a skin graft, loss of sensation, undesirable dimensions of the neovagina, etc.
This operation is irreversible. That's why you need to be sure. You must pass the process, including psychological guidance, hormone therapy and a real-life test period. You must also obtain permission from a certified psychiatrist and endocrinologist. This is required by law.
Particular treatment adjustments, medical tests, blood tests whether blood donations are mandatory:
Permanent epilation of the scrotal skin before surgery is not mandatory. These hairs can be permanently removed by the surgeon during the operation, with the aim of a hair-free vagina.
During our preoperative consultation we decide together where we can obtain the skin graft to complete the inside of the vagina. This may be necessary if the existing penile skin and scrotal skin are insufficient to line the neovagina due to its size.