Penile reconstruction surgery is said to be more risky in transgender patients who change sex than in male patients who have surgery for other reasons. These are the results of an American study published in the journal Plastic and Reconstructive Surgery.
Phalloplasty, or penile reconstruction surgery, is the operation that allows transgender people to change their gender. A person born female, wishing to become a man, resorts to this type of surgery in order to no longer have female genitalia.
But people known as “cisgender”, ie born male, can also have recourse to this type of surgery, after an accident for example. An American study, published in Plastic and Reconstructive Surgery, official journal of the American Society of Plastic Surgeons (ASPS) and relayed on the site EurekAlert, shows how this operation is riskier for transgender patients.
Phalloplasty, how does it work?
Changing sex is no small task. In France, it requires psychological follow-up of around two years. A psychologist (or psychiatrist) is responsible for determining if the patient is sure of his choice and if the change of sex will not have too serious psychological consequences. This follow-up also allows the patient to obtain reimbursement from Social Security.
Then the operation involves suturing the vagina. Part of the skin is removed from the forearm and rolled to form a penis. The skin of the labia majora is used to form the scrotum, which surrounds the silicone testicles. The labia minora form the urethra, the conduit that passes urine from the bladder. It is important to note that the patient, with his new penis, cannot have a “normal” erection. You either need a penile implant or install a pump system in the scrotum. It is the person himself who activates the pump to have an erection.
What are the risks ?
A penile reconstruction operation lasts about ten hours. It’s a lot. And the risks of complications are numerous: ncrushes of the penis (which then requires ablation), formation of blood clots, infection, hematoma … Sometimes these complications lead to a new operation. This has repercussions on the patient’s health, but also on his psychological well-being.
Why are transgender people the most at risk?
Jeffrey B. Friedrich, doctor at Wasgington University, USA and his colleagues analyzed the results of fifty studies relating to phalloplasty. One part was about sex changes, another part was about males.
The main difference between the two groups concerns the complications related to the urethra. Of 869 transgender patients, 39.4% of them had it, compared to 24.8% for “cisgender” patients (out of 482). According to Dr. Friedrich, reconstruction would obviously be more difficult in patients who did not have a penis before. In addition, there would be fewer complications when the formation of the urethra, or urethroplasty, is done once and not in several. For researchers, this should push healthcare professionals to adapt their surgery to the patient.
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