Orchiectomy

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Castration, gelding, neutering, orchiectomy, or orchidectomy is any action, surgical, chemical, or otherwise, by which a biological male loses use of the testes. This causes sterilization, i.e. prevents him from reproducing; it also greatly reduces the production of certain hormones, such as testosterone. It should not be confused with penectomy, which is the whole or partial removal of the penis, nor with vasectomy, which is a procedure to sterilize a male by blocking the vasa deferentia, the tubes which connect the testicles to the prostate.

The term "castration" is sometimes also used to refer to the removal of the ovaries in the female, otherwise known as an oophorectomy.

[edit] Reasons

The primary reason for an orchiectomy is as a treatment for testicular cancer. If only one testicle is found to be cancerous then only that one is removed. Even if both testicles are removed, male sexual function can be restored and maintained through the use of testosterone injections or patches.

Some men seek this procedure in order to remove what they consider uncomfortable, uncontrollable or dysfunctional sexual urges. Others may seek it in order to fulfill a fetish or fantasy.

Male-to-female transsexuals, as well as some otherwise transgendered people, sometimes undergo orchiectomy. Orchiectomy can be done before or in place of sex reassignment surgery. It is often indicated when antiandrogenic drugs such as spironolactone or cyproterone acetate cause unwanted or even dangerous side effects (such as kidney damage in the case of spironolactone or liver damage in the case of cyproterone acetate) and immediate sex reassignment surgery is unobtainable. An orchiectomy may also be indicated in MTF transsexuals who have had trouble with DVTs since the dosage of estrogen required after an orchiectomy can be lowered to what a natal female would be given to relieve symptoms of menopause.

[edit] Simple Orchiectomy

Typically done under local anesthesia, the scrotum is cut along the raphe to minimize the appearance of scars. The various layers of muscle and fasciae are incised and the testis is extracted. The spermatic cord is tied off with two triple square knots using non-dissolving sutures and cut. Operating time is generally 30 minutes in an outpatient setting with a stay overnight and checkup the next morning. Recovery time is typically a week or less.

This procedure cannot and should not be done outside of a doctor's care. Those who have done self-cutting of this extreme nature have generally regretted the outcomes or have had a difficult SRS due to scar tissue. Choosing to have this done by non-medially trained persons can also result in major health problems due to blood loss, excessive scar tissue formation or life threatening infections.

[edit] Radical, or Inguinal Orchiectomy

An inguinal orchiectomy may be either unilateral, involving only one testicle, or bilateral, involving both. This procedure is called an inguinal orchiectomy because the surgeon makes the incision, which is about 3 inches (7.6 cm) long, in the patient's groin area rather than directly into the scrotum. It is called a radical orchiectomy because the surgeon removes the entire spermatic cord as well as the testicle itself. The reason for this complete removal, in the cases of cancer treatment, is that testicular cancers frequently spread from the spermatic cord into the lymph nodes near the kidneys. For MTF trans women inguinal orchiectomy is often chosen to prevent scrotal scar tissue which may interfere with future sex reassignment surgery. A long non-absorbable suture is left in the stump of the spermatic cord in case later surgery is necessary.

After the cord and testicle have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged. The procedure is usually finished in less than an hour, an hour to an hour and a half for a bilateral procedure.

Full recovery time after a bilateral inguinal orchiectomy is usually less than two weeks. Light activity may be resumed in about 3 to 4 days after the procedure.

[edit] Medical consequences

A subject of castration who is castrated before the onset of puberty will retain their high voice, slight build and small genitals, will not develop pubic hair, and will have a small sex drive or none at all. This practice was used to maintain angel-like voices for choir boys in service of the Catholic Church during the Baroque Period and earlier, even though Church doctrine nominally forbade it as a form of mutilation.

Castrations after the onset of puberty will typically reduce the sex drive considerably or eliminate it altogether. Male castrates can, however, still have erections, orgasms and ejaculations. The voice will normally not change. Some castrates report mood changes, such as depression or a more serene outlook on life. Body strength and muscle mass can decrease somewhat. Body hair may or may not decrease. Castration prevents male pattern baldness.

[edit] SRS consequences

Marci Bowers has calculated the equivalence point of anti-androgen drugs with castration to be about three years.[1]. Additionally those who are planning SRS should consult with the surgeon before proceeding with castration as some may not perform SRS if the patient was surgically castrated. Dr. Suporn [2] prefers patients not be castrated.

[edit] See also

[edit] External links

Eunuch Archive - Stories about eunuchs, and a message board
Questions often asked about castration by Sherry
http://www.surgeryencyclopedia.com/La-Pa/Orchiectomy.html - A good description of the surgery and its aftercare

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