The surgery of reconstruction of the penis would be more risky in patients transgender

Health 31 January, 2018


Published the 31.01.2018 at 14: 25


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The phalloplasty, or surgery of the penis, is the operation that allows transgender people to change sex. A person born a woman, wishing to become a man, has to resort to this type of surgery to have female genitalia.

But people say “cisgenres”, that is to say born male, may also have to resort to this type of surgery, after an accident, for example. An american study, published in Plastic and Reconstructive Surgery, official journal of the American Society of Plastic Surgeons (ASPS) and relayed on the site EurekAlert, shows how this operation is more risky for patients transgender.

Phalloplasty, how does it work ?

Sex change is not trivial. In France, it requires a psychological follow-up of approximately two years. A psychologist (or psychiatrist) is responsible for determining if the patient is sure of his choice and if the sex change will not have psychological consequences that are too heavy. This monitoring also enables the patient to obtain a refund of social Security.

Then, the operation consists in suturing the vagina. We take a part of the skin of the forearm and the rolls, to form a penis. The skin of the labia majora is used to form the scrotum, surrounding the testicles silicone. The labia minora to form the urethra, the tube that evacuates urine from the bladder. It is important to note that the patient, with his new penis, can’t get an erection “normal”. It either needs a penile implants, either install a system to pump in the scrotum. It is the person itself that activates the pump to have an erection.

What are the risks ?

An operation of reconstruction of the penis lasts for ten hours. It is a lot. And the risks of complications are many : necrosis of the penis (which then requires a removal), blood clots, infection, hematoma… sometimes these complications require re-operation. This has implications on the health of the patient, but also on his psychological well-being.

Why transgender people are most at risk ?

Jeffrey B. Friedrich, phd, University of Wasgington, in the United States and his colleagues analyzed the results of fifty studies related to phalloplasty. One part was about sex changes, one other male persons.

The main difference between the two groups regarding the complications associated with the urêtre. On 869 patients who are transgender, with 39.4% of them have suffered, compared to 24.8% for the patients “cisgenres” (482). According to Dr. Friedrich, the reconstruction would obviously be more difficult in patients who did not have a penis before. In addition, there would be less complications when the formation of the urêtre, or urétroplastie, is done once and not in several. For researchers, this should prompt health professionals to adapt their surgery depending on the patients.