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Amputation

Sex Reassignment Surgery Question

11/18/2009

Question:

I am a transsexual female-to-male person who plans on undergoing sex reassignment surgery in the future. I happen to know a male-to-female who will get the surgery in the near future. I was wondering if it would be possible to surgically switch our genitalia if we got our surgeries at the same time. Would the parts still work as if we were born with them? Would there still be reasonable feeling if the nerves were cut and somehow reattached? Is reattaching nerves even possible? Would cost become an issue? Would it increase or decrease from standard practices? Both of us would much rather have real organs than manmade ones, but I`m not sure if it`s a reasonable option or if it`s even possible. More information on this matter would be greatly appreciated.

Answer:

Dear Reader,

Thank you for your question.

Surgical techniques do exist for reconstructive surgery for traumatic penile amputations including microreimplantation techniques.  These techniques are usually reserved for those individuals who sustained a genital injury and do not involve genital organ donation or exchange.  The severed penis is reimplanted to the host using micro-surgical techniques (1).

To my knowledge, there have been no genital transplant procedures documented in the medical literature.  In part, the surgeries would be technically different and difficult and the risks related to organ rejection great.  Current surgical techniques for creation of a phallus or neovagina use various autologous (same-donor) techniques to avoid issues of tissue rejection.  These techniques also involve nerve-sparing procedures to maintain and maximize sensation for the genitals of the desired gender.

According the the World Professional Association for Transgender Health Inc. (WPATH), sex reassignment plays an undisputed role in contributing toward favorable outcomes, and comprises Real Life Experience, legal name and sex change on legal documents, as well as medically necessary hormone treatment, counseling, psychopherapy, and other medical procedures.  Genital reconstruction is not required for social gender recognition, and such surgery should not be a prerequisite for document or record changes; the Real Life Experience component of the transition process is crucial to psychological adjustment, and is usually completed prior to any genital reconstruction, when appropriate for the patient, according to the WPATH Standards of Care. Changes to documentation are important aids to social functioning, and are a necessary component of the pre-surgical process; delay of document changes may have a deleterious impact on a patient's social integration and personal safety. . . . Medically necessary sex reassignment procedures also include hysterectomy, bilateral mastectomy, chest reconstruction or augmentation as appropriate to each patient (including breast prostheses if necessary), genital reconstruction (by various techniques which must be appropriate to each patient, including, for example, skin flap hair removal, penile and testicular prostheses, as necessary), facial hair removal, and certain facial plastic reconstruction as appropriate to the patient (2).  To my knowledge, genital transplantation surgeries and procedures are not an available treatment option.

References:

1.  Jordan GH, Gilbert DA. Management of amputation injuries of the male genitalia. Urol Clin North Am. 1989 May;16(2):359-67.

2.  WPATH Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A.  Available at: http://www.wpath.org/publications_standards.cfm

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Response by:

Henry H Ng, MD, FAAP FACP Henry H Ng, MD, FAAP FACP
Senior Instructor of Medicine
School of Medicine
Case Western Reserve University