ICL 17.6: Surgical Care of Transgender Patients

Question 1

what is gender dysphoria?

Answer 1

refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)

gender dysphoria is not a mental “disorder”.

Question 2

what is the incidence of gender dysphoria?

Answer 2

not certain

male as high as 3:1000

MTF > FTM

Question 3

what is the etiology of gender dysphoria?

Answer 3

1. biological
2. social earning
3. cognitive development

high Incidence of co-morbid psychiatric illness (20-40%)

Question 4

what are disorders of sexual development?

Answer 4

congenitally ambiguous genitalia; abnormal physical sexual characteristics

DSD formerly known as intersex

but this is distinct from gender dysphoria!

Question 5

what is biologics or genetic sex?

Answer 5

reproductive anatomy and secondary sex characteristics (male or female)

Question 6

what is gender identity?

Answer 6

psychological identity along the gender spectrum

ex. masculine, feminine, “agender”

Question 7

what is sexual orientation?

Answer 7

preferred gender of sexual partners

Question 8

what is transgender?

Answer 8

identify as, or desire to live and be accepted as, a member of the biological sex opposite to that assigned at birth

transman, transwoman, gender variant, and/or gender incongruent are now preferred terms

use pronouns for target gender

Question 9

what are teh requisites for sex reassignments surgery?

Answer 9

1. consolidation of gender identity; continuing mental stability
2. age 18*
3. chest surgery (mastectomy, breast augmentation)

need 12 months continuous hormone therapy for breast augmentation and 1 letter of readiness

4. genital surgery (vaginoplasty, phalloplasty)

need 12 months successful continuous real life experience, 12 months of hormonal therapy and 2 letter of readiness from mental health professionals

Question 10

when is departure from the standards of care for TG people justified?

Answer 10

1. a patient’s unique anatomic, social, or psychological situation
2. an experienced health professional’s evolving method of handling a common situation
3. a research protocol
4. lack of resources in various parts of the world
5. the need for specific harm-reduction strategies

Question 11

what are the urinary and sexual outcomes of penile inversion vaginoplasty?

Answer 11

URINARY
1. 4% urethral steosis

2. 28% mental stenosis
3. 33% misdirected urine stream

SEXUAL
1. 95% no regreta

8.7/10 satisfaction with sex life

76% improvement in sex life

78% orgasm with masturbation

Question 12

what are the urologic complications associated with female to male surgery?

Answer 12

1. urethral fistulas*
2. urethral stricture*
3. metal stenosis
4. failure of standing micturition
5. neophallus necrosis
6. decreased erogenous sensation
7. anorgasmia
8. prosthesis infection or erosion