Gender Confirmation Surgery: Principles and Techniques for an Emerging Field

✍ Scribed by Loren S. Schechter (editor)

• Publisher: Springer
• Year: 2020
• Tongue: English
• Leaves: 275
• Category: Library

✦ Synopsis

Gender confirming surgery represents one of many therapies for individuals with gender dysphoria and can be pivotal in allowing individuals to become their true selves. An emerging field, this text represents a continuing evolution of surgical techniques, as well as a framework around which surgical therapies are based. Providing a fundamental understanding of the surgical principles while also recognizing the fast-paced nature of the advances in technique, Gender Confirmation Surgery touches upon the challenges and complexities in the surgical care of transgender individuals, featuring detailed sections for transwomen and transmen surgeries, non-surgical options, and establishing educational programs.
Written as a guide primarily for surgeons in plastics, urology, and gynecology, this book can also appeal to primary care practitioners, mental health professionals, and endocrinologists. By representing an evolution of technique and advances in the field, Gender Confirmation Surgery offers a framework around which practitioners can familiarize themselves with gender surgery.

✦ Table of Contents

Preface
Contents
Contributors
1: History, Societal Attitudes, and Contexts
The Concept of Transsexualism
Incidence and Prevalence of Transsexualism
Cultural Extent of Transsexualism
The Benjamin View
The Gender Clinics of the 1960s and 1970s: John Money’s Paradigm
Hegemony of the Mental Health Model and Demise of the Clinics
Reassignment, Change, or Affirmation?
References
2: Etiology of Gender Dysphoria
Introduction
Historical Background
Early Theories
Environmental Theories
Anatomical Postmortem Studies
Prenatal Hormonal Influences
Genetic Influences
Neurodevelopmental Cortical Hypothesis
References
3: History of Gender Identity and Surgical Alteration of the Genitalia
Introduction
Ancient History
Modern Era (Nineteenth Century to Today)
Gender Surgery in Popular Culture
References
4: Language and Terminology in Transgender Health
Diagnostic Codes in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)
Diagnostic Codes in the World Health Organization’s International Classification of Diseases (ICD)
WPATH and the Standards of Care
Terminology from a Western Perspective
Cisgender Person
Gender
Gender Affirming
Gender Identity
Gender Expression
Genderqueer
Gender Stereotypes
Gender Incongruence
Gender Dysphoria
Gender Transition
Intersex
Sex
Sex Assigned at Birth
Sexual Orientation
Transcultural Competence
Transgender Person
Transgender Man
Transgender Woman
Terminology from a Non-Western Perspective
Gender Affirming Medical Interventions
References
5: The Mental Health Assessment for Surgery
WPATH Standards of Care and the Mental Health Assessments for Surgery
The Initial Interview
The Second Assessment
References
6: Primary Care for the Transgender and Gender Nonconforming Patient
Introduction
Hormonal Therapy
Care of the Adolescent
Prevention and Care
Surgery
Conclusion
References
7: Hormone Therapy for Transgender Women
Introduction
Principles of Hormone Therapy
Treatment Regimens
Long-Term Monitoring and Potential Adverse Events
Surgical Considerations
Conclusions
References
8: Hormone Therapy for Transgender Men
Introduction
Principles of Hormone Therapy
Treatment Regimens
Long-Term Monitoring and Potential Adverse Events
Surgical Considerations
Conclusions
References
9: Medical Management of the Adolescent Individual with Gender Dysphoria
Introduction
Puberty
GnRH Agonists
Gonadotropin-Releasing Hormone Agonist Treatment
Gender-Affirming Hormone Treatment
Conclusion
References
10: Male-to-Female Breast Augmentation and Body Contouring
Introduction
Preoperative Care and Medications
Breast Augmentation
Breast Augmentation Background
Differences in Male and Female Chests
Breast Augmentation Preoperative Assessment
Breast Augmentation Surgical Approach
Breast Augmentation Postoperative Care
Breast Augmentation Complications
Breast Augmentation Postoperative Considerations
Breast Augmentation Additional Approaches
Body Contouring
Body Contouring Background
Differences in Male and Female Body Habitus
Body Contouring Preoperative Assessment
Body Contouring Surgical Approach
Body Contouring Postoperative Care
Body Contouring Complications
Body Contouring Special Considerations
Conclusions
References
11: The Importance of Facial Gender Confirmation Surgery
Secondary Sex Characteristics and Their Role in Gender Dysphoria
Impact of Facial Gender Confirmation Surgery
Historical Aspects of Facial Gender Confirmation Surgery
Patient Perspective
Current Evidence and Controversies
Conclusion
References
12: Facial Gender Affirmation Surgery: Facial Feminization Surgery and Facial Masculinization Surgery
Background
Feminization of the Hairline
The Forehead
Forehead Type I
Forehead Type II
Forehead Type III
Forehead Type IV
Rhinoplasty
Upper Lip
The Jaw
The Thyroid Cartilage
Other Procedures
Conclusion
References
13: Fertility Preservation Options for Transgender and Trans Masculine Patients Planning Hysterectomy
References
14: Penile Inversion Vaginoplasty
Introduction
History
Embryology
Overview of Surgical Technique
Geometric Limitations of Penile Inversion Vaginoplasty
Goals
Indications
Preparation for Surgery: Medical Clearance
Preparation for Surgery: Social Assessment
Age at Time of Surgery
Other Considerations
Preoperative Hair Removal
Preoperative Physical Exam
Urethral Injury
Rectal Injury and Fistula
Surgical Technique
Postoperative Considerations
Complications
15: Intestinal Vaginoplasty
Introduction
Techniques
General Approach
Harvesting of Intestinal Segment and Re-Establishing Bowel Continuity
Creating Vaginal Pouch
Creating Neo-Introitus Between Anorectum and Urethra, Securing the Pouch to the Neo-Introitus, and Fixing the Neovaginal Pouch to Prevent Prolapse
Techniques for Sigmoid Vaginoplasty
Simple Sigmoid Harvest
Simple Sigmoid Harvest with Rotation (Distal Sigmoid Retro-Folding)
Proximal Sigmoid Advancement with Distal Bowel Resection and Preservation of Mesenteric Continuity
Sigmoid Advancement with Distal Mesenteric Transection
Techniques for Cecal Vaginoplasty
Repairs After Failed Penile/Scrotal Vaginoplasty
Resection of Failed Skin Vaginoplasty with Creation of Intestinal Neovagina
Repairs of Fistula Between Rectum and Skin Neovagina
Discussion
References
16: Chest Masculinization Surgery
Introduction
Criteria for Surgery
Preoperative Considerations
Selection of Surgical Technique
Surgical Preparation
Periareolar Technique
Concentric Circular Technique
Double Incision Free Nipple Graft Technique
Free Nipple Grafting
Liposuction
Nipple Reduction
Complications and Revisions
References
17: Urethral Anatomy and Urethral Reconstruction in Phalloplasty and Metoidioplasty
Anatomy of the Urethra
Male Urethra [1–5]
Macroscopic and Microscopic
Vascular Anatomy
Lymphatics
Innervation
Female Urethra [1–3, 5, 6]
Macroscopic and Microscopic
Vascular Anatomy
Lymphatics
Innervation
Contiguous Structures
Urethral Construction in Metoidioplasty and Phalloplasty
Metoidioplasty [9]
Phalloplasty
Prelamination and Prefabrication [16]
Local Tissue Flaps [16]
Complications and Urethral Problems in Transmen
References
18: MLD (Musculocutaneous Latissimus Dorsi) Phalloplasty
Introduction
Patients and Methods
Surgical Anatomy
Surgical Technique
Results
Discussion
Conclusions
References
19: Radial Forearm (RF) and Anterolateral Thigh (ALT) Phalloplasty Reconstruction
Introduction
Reconstructive Options
Indications/Criteria
Mental Health
Hormone Therapy
Surgical Reconstruction of the Pars Fixa
Surgical Reconstruction Using Radial Forearm Phalloplasty
Preoperative Evaluation
Surgical Markings
Flap Harvest
Tubing
Glansplasty
Groin Preparation
Forearm Donor Site Closure
Pars Fixa and Pendulans Anastomosis: RFFF
Surgical Reconstruction Using Pedicled Anterolateral Thigh (ALT) Phalloplasty
Preoperative Evaluation
Surgical Markings
Flap Harvest
Tubing
Glansplasty
Groin Preparation and Flap Transfer
Donor Site Closure
Urethral Anastomosis and Closure: ALT
Postoperative Management
Hospitalization
Postoperative Revision
Glansplasty and Coronaplasty
Debulking
Urethral Tube Formation
Phallopexy
Erectile Implant Placement
Fat Grafting
Other Forearm and Thigh Donor Site Revisions
Tattooing
Potential Complications
Conclusion
References
20: Management of Urethral Complications Following Metoidioplasty and Phalloplasty
Introduction
Gender Affirmation Surgery
Metoidioplasty
Phalloplasty
Urologic Complications
Urethrocutaneous Fistulas
Persistent Vaginal Cavity
Urethral Strictures
Consequences of Urologic Complications
Patient Presentation
Initial Evaluation
Preoperative Planning and Surgical Preparation
Unique Surgical Considerations
Additional Surgical Considerations
Fistula Repair Techniques
Techniques for Obliteration of a Persistent Vaginal Cavity
Endoscopic Stricture Repair Techniques
Urethroplasty Techniques
Single-Stage Anastomotic Techniques
Single-Stage Substitution Techniques
Staged Techniques
Perineal Urethrostomy
Challenges of Reconstructive Surgery
References
21: Strategies to Optimize Sexual Function with Feminizing and Masculinizing Genital Gender-Affirming Surgery
Introduction
Predicting Sexual Function After Genital GAS
Pre-surgery Domains that Affect Sexual Health
Medical History
How Being Sexually Functional Can Impact Quality of Life
Cedars-Sinai Pre- and Post-genital Gender-Affirming Surgery Sexual Function Rehabilitation Protocol
Before Surgery
Early After Surgery
Sexual Function After Feminizing Genital GAS
Surgical Considerations to Maximize Genital-Erogenous Sensation
Preservation of the Ilioinguinal Nerve and Genital Branch of the Genitofemoral Nerve
Construction of the Neoclitoris
Maximal Preservation of the Neurovascular Bundle
Erogenous Sensation of the Vulva
We Hypothesize that Erogenous Sensation of the Vulva Arises from Three Factors
Erogenous Sensation Related to the Prostate and Vaginal Canal
Practical Considerations for Patients Regarding Sexual Function After Vaginoplasty
Location of Erogenous Sensation
Vaginal Lubrication and Hygiene
Risk of Injury: Vaginal Depth, Male Partner Penile Length, and Sexual Positions
Sexual Function After Masculinizing Genital GAS
Surgical Considerations to Maximize Genital-Erogenous Sensation
Inflatable Penile Prosthesis Type and Size
Practical Considerations for Patients Regarding Sexual Function After Phalloplasty
References
22: Postoperative Care from the Primary Care Perspective
Introduction
Masculinizing Chest Surgery
Masculinizing Genital Surgery
Feminizing Breast Surgery
Feminizing Genital Surgery
Sexual Health
Behavioral Health
Conclusion
References
23: Religious Attitudes Toward Gender-Confirming Surgery
Protestant and Other Christian Responses to Gender Transition
Mainline Protestants and Resources for Affirmation
Non-affirming Perspectives: Three Theological Problems
Other Christian Traditions
Impacts on Patients and Families
Recommendations for Surgeons
Neo-Pagan, New Age, and Eclectic Spirituality: A Rising Trend
Catholic Positions Regarding Gender-Confirming Surgery
A Diversity of Christian Views
Gender Identity and Homosexuality
Catholic Moral Theology and the Ethics of Sterilization
Official Catholic Teaching
Medical and Theological Discussion
Jewish Teaching Regarding Gender-Confirming Surgery
Introduction
Sex and Gender in Jewish Thought
Non-genital GCS
Genital GCS
Conclusion
Islamic Theology and Gender-Confirming Surgery
Introduction
Intersex, Transsexual, and Transgender Individuals
GCS and Islamic Theology of Opponents and Defenders
Khomeini and Shiʿa Theology of GCS
Al-Τ̣anṭāwī and His Cautionary Position Toward GCS
Muslim World League’s Fatwa
The Approach of Malaysia’s Council of Islamic Religious Affairs to GCS
Conclusion
Buddhist Attitudes Toward Gender-Confirming Surgery
References
24: Establishment of a Gender Confirmation Program
Multidisciplinary Treatment Model
Educational Philosophy
Education Model
Quality Parameters
Overview of Surgical Procedures
Vaginoplasty
Phalloplasty
Genital Surgery: Metoidioplasty and Phalloplasty
Conclusion
References
Correction to: Male-to-Female Breast Augmentation and Body Contouring
Correction to:
Index