|Year : 2004 | Volume
| Issue : 2 | Page : 185-186
Trans-sexualism and sex reassignment surgery: Case report of two patients
Manohar Shetty1, RB Nerli1, Rajesh Powar2, Shailesh Kamat1
1 Department of Urology, KLE Society's Hospital and Medical Research Centre, Belgaum, India
2 Department of Plastic Surgery, KLE Society's Hospital and Medical Research Centre, Belgaum, India
Department of Urology, KLES Hospital and MRC, Nehrunagar, Belgaum - 590 010
Source of Support: None, Conflict of Interest: None
Keywords: Trans-sexualism, sex reassignment surgery, sex-change surgery.
|How to cite this article:|
Shetty M, Nerli R B, Powar R, Kamat S. Trans-sexualism and sex reassignment surgery: Case report of two patients. Indian J Urol 2004;20:185-6
| Case Report - 1|| |
A 31-year-old, European male patient who had divorced his earlier wife and was living with another female in a lesbian relationship was diagnosed as a trans-sexual by a team of psychiatrists and clinical psychologists. He was on hormonal therapy for last two years and approached our center for sex reassignment surgery (SRS) from maleto-female [Figure - 1],[Figure - 2].
| Case Report - 2|| |
A 28-year-old, Indian male patient having a homosexual relationship with another male as a passive partner attended our clinic for SRS. He was evaluated by the psychiatrists and prepared for SRS. After six months of hormonal treatment he was taken up for SRS.
The patient was placed in lithotomy position. A vertical perineal incision was made from mid-scrotum to a point 1 cm short of the anal margin. Both the spermatic cords with testicles were divided at the external ring and removed. The penis was then degloved. The glans penis with neurovascular bundle was separated. Both the corporal bodies were resected completely and also the corpus spongiosum. The central tendon was divided and space was created for the neovagina between the urethra and bladder on one side and the rectum on the other side. The penile skin cylinder was inverted and closed at its prepucial end which then was placed into the space created for the neovagina. The position for the urethra and clitoris were marked and button holes were created for the same. The quarter of the glans penis was left uncovered to form the clitoris and rest of it was de-epithelialized and buried below the skin. The urethra was shortened and anastomosed to the skin opening with a catheter in it. The labia majora were created from the scrotum folds. A soft mould was placed within the vaginal tube. Postoperative dressing was changed on alternate days with subsequent vaginal dilatation. Both the patients were happy with the overall outcome of surgery at 12 and 16 months of follow-up.
| Comments|| |
Sexually deviant humans have been mentioned since antiquity and presumably have existed at all times. There are historical instances of autocastration and genital mutilation as a result of an individual's intense desire to change sex. There are many terms to describe the various states and degrees of intensity of cross gender identities. The term trans-sexual is attributed to Cauldwell, and is defined as a permanent and extreme sense of dissatisfaction because of a sense of gender that is opposite to external anatomical presentation.  The etiology of trans-sexualism is unknown and is proposed from psychological conditioning in childhood to an unusual paranoiac state to genetic disturbances.  The exact prevalence of this condition is not known and it varies in different societies and cultures. The trans-sexuals have a strong desire to resemble physically the opposite sex and they seek treatment including surgery towards this. The SRS, popularly known as sexchange surgery, is the administration of surgery to change the sex appearance according to one's sex identity. Once the diagnosis of trans-sexualism is made, recommendation for SRS should be based on strict criteria as laid down by the "The Harry Benjamin International Gender Dysphoria Association" which includes the patient should show the evidence of stable trans-sexual orientation; show insight into his/her condition and should not suffer from any serious psychiatric disorder; be able to pass successfully as a member of the opposite sex, and there should be clear evidence of cross-gender functioning; improvement in personal and social function should be predicted for the individual prior to and after the surgery.
There are several studies , on male-to-female SRS for trans-sexuals giving encouraging results and patients were found satisfied with end results and quality of life. The success of SRS depends on careful psychological evaluation and support for transforming surgery and the technique of surgery.  However, post-SRS period is not without complications. There are instances of suicidal tendency, severe psychological depression, reactive psychosis, sexual maladjustment and regret for undergoing SRS in post-SRS period.  Therefore, SRS is a treatment for carefully selected genuine primary trans-sexuals only.
| References|| |
|1.||Rehman J, Melman A. Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: functional and cosmetic out come. J Urol 1999: 161: 200-6. |
|2.||Krege S, Bex A, Lummen G, Rubben H. Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients. Br J Urol 2001: 88: 396-402. |
|3.||Sturup GK. Male trans-sexuals: a long-term follow-up after sex reassignment operations. Acta Psychiatr Scand 1976: 53: 51-63. |
[Figure - 1], [Figure - 2]