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On June 28 is celebrated, a date marked worldwide for the fight against prejudice and the conquest of rights. Among the most significant advances, the recognition of gender identity as a fundamental human right stands out. In the health area, this is reflected in procedures such as gender affirmative surgery, also known as sexual reassignment, which allows align genitals with the gender identity of the trans person-contributing to well-being, self-esteem and the right to self-determination.
“Gender affirmative surgery is a surgical procedure performed to adapt the genitals of the individual’s biological sex to the genre by which the patient identifies,” explained the urologist specializing in genital reconstruction and head of the Department of Gender Affirmative Surgery, Dr. Ubirajara Barroso Jr.
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In trans men, this surgery is indicated for the construction of a penis, being a personalized process, where the doctor needs to evaluate each case individually. According to the urologist, about 35% of trans men and 70% of trans women choose to do the procedure. Ubirajara Barroso Jr. was the doctor who led Bahia’s first gender affirmative surgery by SUS in August 2023 and is the author of the total mobilization technique of cavernous bodies (TCM), a type of metoidioplasty that gives a larger penis.
How gender affirmative surgery is performed in trans men
“In trans men, surgery can involve techniques such as metoidioplasty, which consists of detaching clitoris and correction of genital curvature to create a larger phallus, or neophaloplasty, a more complex procedure that uses fabric from other parts of the body to create a penis,” explained Dr. Barroso.
When using metoidioplasty it is possible to apply the total mobilization technique of cavernous bodies (TCM) to build an organ that allows penetration. TCM was developed by Dr. Ubirajara Barroso Jr. in partnership with the Urology Division of the Federal University of Bahia (UFBA) and the Bahian School of Medicine and Public Health. The technique was published in 2022 at the International Brazilian Journal of Urology (IBJU), the official scientific journal of the Brazilian Society of Urology.
In classical metoidioplasty, erection is possible, but often the phallus is small, making it impossible to penetrate.
“With the TCM technique this picture is reversed because the phallus size gets larger, enabling penetration,” described Dr. Barroso. “Neophaloplasty is a more complex procedure performed with forearm tissue, abdominal skin, leg, or other tissues. The advantage is that this procedure enables good size. However, the disadvantage is that for penetration it will be necessary to use penile prosthesis and may have reduced sensitivity in some cases,” he said.
Gender Affirmative Surgery in trans women
In trans women, gender affirmative surgery is a surgical procedure that consists of the removal of the penis and the construction of a neovagina, with the preparation of the clitoris, the urethra and the vaginal canal. According to Dr. Ubirajara Barroso Jr., the procedure called clitoroplasty is performed by reducing the glans, preserving its innervation and vascularization and, consequently, maintaining sensitivity.
“In this procedure are removed part of the penis, preserving the urethra, skin and nerves that give sensitivity to the region and is built a neovagina and a neoclitoris,” he explained. The doctor added that when there is not enough genital skin, such as in cases of phimosis surgery, or in cases of vaginal canal loss in the first surgery, the best option is to use peritoneum, fabric that covers organs and abdominal wall. Another option is the use of the intestinal handle. In both there are good results, maintaining erogenous sensitivity to the patient.
“About 60% to 70% of trans women reach orgasm with affirmative gender surgery. The difference is that sensitivity and way of pleasure will become different from that before affirmative surgery,” he said. The doctor reported that after surgery on trans women transforming daily vaginal dilation, for at least 30 minutes, probably all life. Especially if there is no sexual activity with frequent penetration.
Postoperative of gender affirmative surgery
The recovery time for gender affirmative surgery is brief and hospitalization is about 2 to 3 days for trans women. In the case of trans homes, after gender affirmative surgery it is normal for some patients to feel some discomfort, swelling and sensitivity in the operated area, requiring the use of medications to relieve pain and reduce swelling in the region.
“The patient does not need to stay in the ICU and the hospitalization lasts about 5 days. After the discharge, the patient walks and can go up and down stairs normally,” explained the doctor remembering that it is important to follow some recommendations of postoperative restrictions to avoid complications:
– The patient cannot exercise for a period of 1 month;
– sex after two months of intervention;
– It is essential to maintain a good local hygiene;
– The patient should attend follow -up consultations to ensure that recovery is occurring as expected.
Understand the requirements for gender affirmation surgery
Because it is irreversible, Dr. Barroso pointed out that before gender affirmative surgery, patients undergo strict multidisciplinary follow -up including psychological assessment, being considered factors such as minimum age, emotional stability and participation in hormone therapy.
“To start the therapeutic process and perform hormonization it is necessary to be over 18 years, and already have experience with the genre that is identified to perform gender affirmation surgeries,” explained the urologist.
