Genital Reconstruction Surgery

Overview

Genital Reconstruction Surgery (GRS) corrects the most drastic physical symptom of Benjamin's Syndrome by removing the testicles and constructing a vagina and vulva from the existing genital tissue. The techniques are very sophisticated (though not perfect and not without risk) and a good surgeon can create a result virtually indistinguishable from the natural version. It does not create a uterus or ovaries, so HRT is still desirable after surgery, and there is of course no menstrual cycle. The outcome is essentially equivalent to that for women who have undergone total hysterectomies. GRS is often referred to as Sex Reassignment Surgery (SRS), or sometimes Gender Reassignment Surgery (inappropriately since the surgery doesn't change gender at all) or other variations.

Penile Inversion

The most common form of GRS is penile inversion. This involves removing the spongy tissue from inside the penis, and inverting the skin. An opening is made between the rectum and the urethra, and lined with the penile skin. Skin grafts can be used to provide additional depth; in recent years, the scrotum has become the preferred source. This requires scrotal electrolysis beforehand to avoid hair inside the vagina - electrolysis around the base of the penis is also highly recommended. Some hair can be removed at the time of surgery, but it helps to get rid of as much as possible beforehand. The remainder of the scrotum is reshaped to form the labia. The urethra is trimmed to the appropriate length, and a clitoris is usually created from the glans of the penis or other sensitive tissue.

After the operation, it is neccessary to dilate regularly to prevent the new vagina from shrinking. That means inserting a dilator or dildo into the vagina, and holding it in place with steady pressue for an extended period. For the first few weeks several dilations a day are required, but the need diminishes over time to once every few days, or potentially less if sexually active. The vagina does not produce a significant amount of natural lubrication, though fluid may be produced from the urethra during arousal, and some form of lubricant is usually essential for sexual intercourse. The surgery usually costs between US$6,000 and US$20,000.

Colon Surgery

An alternative form of GRS uses a segment of the colon to form the vagina, which had both advantages and disadvantages. The colon segment provides an odorless (if properly cared for), self-lubricating vagina of appropriate dimensions, with little need for dilation to maintain it. The colon segment is rotated within the body, but retains its original blood supply. More external tissue is left from which to form the vulva, requiring less stretching and compromisation of nerves and blood supply. Construction of the clitoris is the same as with the penile inversion technique.

The main downside is that the surgery is much more invasive than penile inversion. Chopping a piece out of the colon and stiching the loose ends together to close the gap is a bigger shock to the system than surgery restricted to the genital region. Some surgeons use laparoscopic instruments to carry out the operation without having to cut open the abdomen to access the colon, which eliminates scarring but does not greatly reduce the risks. Also, the colon segment produces lubrication constantly, not in response to arousal, and excessive mucus production may be a problem in some cases. Some dilation may be needed to prevent the entrance of the vagina from shrinking. Colon GRS is generally more expensive than penile inversion.

Labiaplasty

Some surgeons carry out GRS in two stages, a vaginoplasty and a labiaplasty. Patients of other surgeons may also request a labiaplasty later to improve the cosmetic or functional result. At the time of the vaginoplasty, the whole genital area becomes very swollen and generally messy. This, along with individual variations in healing, makes it virtually impossible for the surgeon to accurately predict the appearance of the eventual outcome. A more aesthetically pleasing result can be obtained by leaving the finer detailing of the vulva to a later date, after it has healed and the swelling gone down. The two-stage procedure also helps to preserve blood supply and nerve connections, by allowing some to heal before messing around with others. The labiaplasty typically involves bringing the tops of the labia together and providing hooding to the clitoris, along with refinement of the labia minora. Other problems, most commonly involving the urethra, can also be resolved at the same time. Depending on the surgeon, a labiaplasty may cost between US$2,000 and US$3,500.

Surgeons

The majority of experienced GRS surgeons are based in North America. Probably the two most highly regarded are Toby Meltzer and Eugene Schrang. Both charge around US$14,000 for the surgery, plus a few thousand for a technically optional but strongly recommended secondary operation (labiaplasty) to improve the cosmetic result a few months later. Mernard and Brassard in Canada also have a good reputation, and perform a single stage procedure that costs significantly less. Dr Biber has a great deal of experience, but in my opinion is probably a bit too old to be doing such delicate surgery (I believe he is in his eighties). Other popular surgeons include Suporn, Preecha and Kunaporn in Thailand, Seghers in Brussels, Royle in Britain, and Haertsch in Australia.

External Links

Surgeon's Sites

• Toby Meltzer - a GRS surgeon in Portland, Oregon, USA.
• Eugene A. Schrang, M.D. - a GRS surgeon in Neenah, Wisconsin, USA.
• Gender Reassignment Surgery in Montreal - Drs Mernard and Brassard, Quebec, Canada.
• Dr Gary Alter - a GRS surgeon in Los Angeles, California, USA.
• Mr E Peter Walker - a GRS Surgeon in Christchurch, New Zealand.
• Phuket Plastic Surgery - Dr Sanguan Kunaporn, Thailand.
• Zundara.com - Dr Preecha Tiewtranon, Thailand.
• Dr Suporn Watanyusakul - a GRS Surgeon in Chonburi, Thailand.
• Dr Michael L. Brownstein - a GRS Surgeon in San Francisco, USA.
• Green Mountain Gender Clinic - Dr Donald. R. Laub Jr, Vermont, USA.

Personal Accounts

• Raspy's Ranch - an account of GRS with Dr Meltzer, with long-term updates.
• My Sex Reassignment Surgery Journal - another Meltzer report.
• Our Trip to Bangkok for SRS - a report on GRS with Dr. Preecha Tiewtranon.
• Gender Reassignment in Brighton - a report on GRS with Mr Michale Royle.
• Dr Becky Allison's GRS - surgery with Dr Schrang.
• Paula's GRS - a report on surgery in Montreal.
• Amandaja's Web Page - An Australian's site on Benjamin's Syndrome, including a report on surgery with the team in Christchurch, NZ.

Information About Portland, Oregon

• Tri-Met - public transport.
• Motel 6 - cheap accomodation.
• Powell's Books - the largest used and new bookstore in the world.
• Yahoo - Portland directory.
• POVA - Portland Oregon Visitors Association.

Other

• The New Sex Change Indigo Pages - a comprehensive listing of surgeons with contact details and other info.
• Zen And The Art Of Post-Operative Maintenance - advice for women recovering from GRS.
• Stentsitive - dilators from Intelligence Engineering, LLC.