Reader’s question Helenn Ady Ianusz, Itajaí, SC
Illustrates Marcos de Lima
male surgery
The most common procedure is metoidoplasty.
Duration: 2-3h
Cost: BRL 45 thousand
1. Doctors make an incision in the skin around the clitoris so as to release the organ from the pubic bone
2. Then, if necessary, the urethra is extended and positioned along what will be the neopenis
3. This is made from the mucous tissues of the vagina. The labia minora protect the graft and thicken the penis.
4. The tissues of the labia minora also cover the neopenis. Doctors suture them together
5. In general, scrotoplasty (creation of the scrotum from the labia majora and silicone implants) takes place at the same time. Other procedures, such as removing the uterus, can also happen simultaneously.
6. The surgery is relatively quick, minimally invasive and preserves natural sensitivity and erection capacity. This is because, when we are in the womb, the clitoris and the penis are the same structure (what defines whether it will develop as one or as the other is exposure to testosterone). In any case, the resulting penis is small (from 7 to 8 cm)
Alternative
Another method is phalloplasty, which uses skin grafts, muscles, vessels and nerve endings from the patient’s forearm or thigh to create the neopenis. The procedure, however, is still expensive and complex and, therefore, rarely performed.
female surgery
The most common technique is modified penile inversion.
Duration: 7 am
Cost: BRL 35-37 thousand
1. Doctors remove the testicles and preserve the skin of the scrotum. They also remove much of the penis, keeping the nerve tissue that lines it.
2. This nerve tissue, including that of the glans, will help build the clitoris. The urinary canal is also maintained
3. Next, surgeons make an incision between the rectum and the bladder. This space will house the neovagina
4. In this cavity, they accommodate the skin of the penis and the scrotum, now with the appearance of a shirt sleeve
5. This will give a depth of about 15 cm and coat the neovagina. The hair follicles in all of this tissue are cauterized, which prevents hair from growing inside.
6. All other fabrics are repositioned and reshaped. What’s left of the scrotum redefines the labia. Doctors attach the clitoris from the glans and other sensitive and vascular tissues of the penis. The urinary tract is shortened and repositioned
brasuca scenario
The first surgery was in 1971, but the Federal Council of Medicine only made a statement about it in the 1990s. Since 2008, SUS has performed procedures such as readjustment sexual and hormone therapy. That year, there were 101 surgeries. In 2014, 3,157. It is estimated that, to perform the surgery at the Hospital das Clínicas, in São Paulo (one of the five centers that perform the procedure), the wait reaches 20 years. For this reason, many patients turn to private surgeons.
+ Read the testimony of a Brazilian who had the surgery in Thailand
Bureaucracy
The minimum age to have the surgery is 21 years old. In addition, the patient must have psychological, psychiatric and endocrinological follow-up and support from a social worker. A minimum social experience of two years as the gender with which the patient identifies is also required. This procedure seeks to identify whether the surgery is really adequate, since the operation is irreversible. In Thailand, there is much less bureaucracy, which is why the country is the world champion in this type of surgery.
right term
The name of the surgical procedure is the subject of debate. For transgender activists, it would be more correct to call it transgender surgery. readjustment genital, since the operation modifies the genital, and not the sex or gender of the patient. Another possible term is “transgender”, used by the National Association of Supplementary Health (ANS). There are even those who talk about “gender confirmation surgery”. “Sex change” is considered inappropriate by the medical community and transsexual activists.
Consultancy: Matheus Manica, surgeon, Marcio Littleton, surgeon, and Daniela Andrade, transsexual activist.
Sources: Surgery Encyclopedia, Nlucon, Conselho Federal de Medicina, SRSMiami, Metoidoplasty and Brownsteincrane.