Penile inversion

From Susan's Place Transgender Wiki

Penile inversion is a surgical technique for genital reassignment used to construct a neo-vagina from a penis for trans women, sometimes also for intersex people. It is one of two main sorts of vaginoplasty, along with colovaginoplasty.

[edit] The operation

The way the tissues are utilized varies by surgeon to surgeon as is the amount of tissue available. The description below is a general overview of the most common technique.

The procedure starts after initial prep, (most notable part being the use of a laxative to clean out the bowels a day or two beforehand) with an incision in the scrotum to harvest some of its skin, and the gonads are removed.

Now the penile skin is degloved (the outside skin cut and separated from the tissues underneath it) and both (skin) tissues are handed over to assistants for processing.

The way the vaginal lining is constructed, varies by surgeon, along with how much skin material he or she has to fashion with. If the patient lacks adequate skin tissue, the surgeon will often advise (before hand) for the taking of a skin graft using tissue from either the scrotum or thigh. If hair follicles are to be removed from the graft intraoperatively, it is done so at this time.

At this point, some surgeons will begin to create a vaginal cavity using blunt dissection to avoid damage to the intestine and bladder, while others will continue separating the tissues of the penis into the soon to be cut away corpora cavernosae, (erectile tissue) glans, (head of the penis) and urethra.

Usually now the clitoris is fabricated from the previously separated glans, being careful to preserve the blood supply and nervous tissues, and placed approximately where it will be permanently located.

The newly constructed vaginal lining should, at this point, be ready for insertion and is secured into the cavity created in the perineal body. (the space in between the urethra and bladder, and the colon)

The last steps in the operation include trimming the urethra and securing it in its final location, the final touches to the labia, and preparing the patient for recovery. (which includes packing the new vagina with gauze, and temporarily sewing the labia majora together to keep everything in place during the first 5 or so days of recovery)

In some cases, a later operation, labiaplasty, is advised to make more aesthetic and/or functional results; or if the surgeon believes it is better to wait until the body heals than complete it all in one go.

79 days post-op (Dr Brassard was the surgeon), photo of Steph.

This photo (to the right) was taken 79 days post op and depicts fairly typical results by Dr Brassard who uses the penile inversion technique. In this picture there is still some swelling in the tissue above the clitoral hood, and the scaring is fading as expected.

Dr. Suporn Watanyusakul differs from other surgeons in using scrotal skin as the vaginal lining.

[edit] Advantages

The advantages to this procedure include:

Less out of pocket costs
Less post surgical complications
Faster recovery
Aesthetic and functional results that are “good enough” for most people

[edit] Disadvantages

The disadvantages to this procedure include:

Patients without adequate skin tissue may require skin grafts to achieve desired depth
The aesthetic and functional results vary greatly between the best and worst surgeons
Best results may require a second stage labiaplasty
Requires life-long dilation
Self-lubricating properties vary from person to person

[edit] See also

[edit] References

Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients by S. Krege, A. Bex, G. Lümmen and H. Rübben (BJU International, Volume 88 Issue 4, Dec 2001)
Vaginoplasty in male transsexuals using penile skin and a urethral flap by S.V. Perovic, D.S. Stanojevic and M.L.J. Djordjevic (BJU International, Volume 86 Issue 7, Dec 2001)
Surgical conversion of genitalia in transsexual patients by L. Jarolím (BJU International, Volume 85 Issue 7, Dec 2001)

[edit] External links

Dr. Toby Meltzer Performs SRS (A graphic walkthrough of the procedure)

[edit] Discuss

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