Lecture 30: Transhealth Symposium, anatomy and surgery

Question 1

What happens when there is a catastrophic trauma to the genitalia?

Answer 1

46XY
Recommended gender reassignment to these patients
However, patients exhibited masculine childhood behavior
Most experts now recommend assigning gender concurrent with karyotype

Question 2

What is insensate?

Answer 2

Lacking physical sensation

Lacking sympathy or compassion

Question 3

What is the history of female to male reconstruction?

Answer 3

Techniques developed for treatment of war injuries
Phallic reconstruction with groin free flap
Ulnar forearm flap, modify glans for sensation

Question 4

What is the significant innervation of the penis?

Answer 4

1. Pudendal nerve
   
   • somatic motor and sensory
2. Cavernosal nerves
   
   • parasympathetic and visceral afferent (autonomic innervation)

Question 5

What can happen to the nerves in prostatectomy?

Answer 5

Cavernosal nerves can be damaged in dissection of prostate apex and capsule

Question 6

What are the homologous structures in male and female genitalia?

Answer 6

Scrotum = labia majora
Body of the penis = labia minora
Glans of penis = clitoris
Bulbourethral glands = vestibular glands

Question 7

What are stages of reassignment?

Answer 7

1. Diagnostic phase (psychiatric)…identify gender dysphoria and gender identity
2. Hormone therapy
3. Real-world experience
4. gender reassignment surgery

Question 8

What is cloacal exstrophy?

Answer 8

Severe birth defect
Bladder and intestines are exposed
Causes splitting of male and female genitalia (penis and clit)
Anus is occasionally sealed?

Question 9

What are the surgical steps of MtF reconstruction?

Answer 9

1. usually single surgery
2. orchiectomy
3. removal of corpora cavernosa, preservation of glans penis
4. Preserve penile skin for neovagina (superior to skin grafts and colovaginoplasty)
5. penile skin better than hair-bearing scrotal skin
   Male to female

Question 10

What are late term concerns of MtF?

Answer 10

1. urethral stenosis
2. vaginal dilation required
3. Prostate issues

Question 11

What are surgical steps of FtM reconstruction?

Answer 11

Stage 1: subcutaneous mastectomy, hysterectomy, oophorectomy
Stage 2: vaginectomy and urethral reconstruction and lengthening
Stage 3: Scrotoplasty and neophallus construction (radial forearm flap)
-preservation of clit for senstation
Stage 4: penile and testicular prostehesis placement (6-12 months)

Question 12

What is orchiectomy?

Answer 12

Removal of the testicles