Feminizing Genitoplasty
Overview
What is feminizing genitoplasty?
Feminizing genitoplasty is a type of surgery that can change the genitals to correct any irregularities at birth or to alter the genitals in sexual reassignment procedures. Feminizing genitoplasty may require a series of surgeries.
Who might need feminizing genitoplasty?
In some cases, girls are born with genitals that look unusual or that do not work right. About 1 of every 1,500 to 2,000 babies has some genital irregularity. Babies with irregular genital tissue should be examined by a doctor. However, any problems related to the genitals may be very slight or may not even become apparent until later in life. Problems may start to appear during puberty, such as when menstrual periods should begin but do not. Issues also can occur when females begin to be sexually active and find it to be painful. Some females will not learn they have a problem until they try to get pregnant but fail. Surgery is often the only way to fix these problems.
At what age should feminizing genitoplasty be done?
There is some debate about the right age to perform surgery. Some experts recommend doing it at an early age (under 2 years) so that the child develops as “normally” as possible. Others favor waiting until the person is older and can express personal preferences. This is because some people with an irregular genital issue may also have questions about gender-identity related to having genes that are not typically male or typically female.
The cause of the defect and the problems it may be causing are large factors in deciding what to do. Some problems may be minor and can wait to be treated, but others need to be addressed right away.
There is no one right answer. Every case should be reviewed by a team of doctors that includes pediatricians, gynecologists, endocrinologists, urologists, plastic surgeons, mental health experts, and geneticists. If the patient is a baby, doctors who specialize in treating newborns should be involved, as well. All of these professionals should work with the parents and the patient (if she is old enough) to make the best decisions possible.
What are the types of feminizing genitoplasty?
The most common types of feminizing genitoplasty are clitoroplasty, vaginoplasty, and labiaplasty.
Clitoroplasty: In this procedure, an overly large clitoris (so large that it is uncomfortable) is made smaller as a result of surgical trimming by the doctor. Clitoroplasty also can repair some damage caused by genital mutilation (called “female circumcision” done in some parts of the world). After a clitoroplasty, most patients who have lost sensation in this part of the body may get some of it back.
In gender reassignment surgeries, transgender women have a clitoris created from their existing genital tissue.
Vaginoplasty: In this procedure, the vagina is reshaped, either because of a birth defect or to repair damage that has been done during childbirth or from diseases such as cancer. Some women choose to have this done to “tighten” the vagina, in hopes it will improve sexual satisfaction. Some women who get vaginoplasty may want to change their anatomy after childbirth or because of aging. Risks can include scarring and loss of sensation.
For transgender women who are having gender reassignment surgery, the bulk of the penis tissue is removed. The outer skin is reshaped, turned “inside out,” and inserted into the body to form a vagina.
Labiaplasty: In this procedure, the labia minora (inner labia) and/or the labia majora (outer labia) are reshaped or created. This is done for women who are born with misshaped tissue or no tissue in this area. Some women choose to have it done because they feel discomfort in this part of their body or wish to change the appearance of their genitals. Some want to alter the effects of childbirth or aging. Others feel that their labia are visible as a bulge when they wear tight clothing, such as exercise pants or swim suits.
Labiaplasty also is done as part of gender-reassignment surgery.
Risks / Benefits
What kinds of problems can feminizing genitoplasty correct?
Some of the most frequently seen problems include:
- A very large clitoris (the most sensitive part of the female genitals).
- Labia (the folds of skin on either side of the vagina) that are joined together (no opening).
- Labia that have only one opening for the both the vagina and the urethra (tube through which urine leaves the body).
- An abnormal vagina.
Some patients with non-typical genitals have congenital adrenal hyperplasia. Congenital means a condition is present at birth and the adrenal glands are glands located near the kidneys. In this type of hyperplasia, one or both of a person’s adrenal glands do not produce the enzyme needed for hormones to develop. This problem is seen in both male and female babies, but females are more likely to have unusually shaped genitals as a result. Diagnosing this condition is an important part of deciding what to do. The condition can affect the child’s overall growth and development, not just the genitals. Congenital adrenal hyperplasia is diagnosed by a doctor’s exam as well as blood and urine tests. In some cases, the condition is diagnosed before birth, usually in a family in which older children have the condition.
Congenital adrenal hyperplasia can be treated with hormone therapy, but any misshaped genitals will probably require surgery.
Recovery and Outlook
What happens after feminizing genitoplasty?
While most of these surgeries are performed on an outpatient basis, some require a few nights in the hospital. Some patients are sent home with a small tube coming out of the bladder to help them urinate for a few days while they heal. Many patients will need to take antibiotics for a while to help keep the surgical area from becoming infected.
The success of a feminizing genitoplasty is based on function and appearance. Most people will think that the area looks better and they have greater self-confidence. Many also will find that they have better sexual function and overall better health.
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