1
|
Nitori N, Deguchi T, Kato A, Kato F, Shinoda M, Itano O. Ileal interposition reconstruction for ileo-rectal fistula following sex reassignment surgery: A case report. Int J Surg Case Rep 2023; 109:108523. [PMID: 37481975 PMCID: PMC10391648 DOI: 10.1016/j.ijscr.2023.108523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Ileorectal fistulas following sigmoid colon vaginoplasty are rare. Reports on the management of the surgical complications of sex reassignment operations among transgender patients are few. PRESENTATION OF CASE A 40-year-old patient with a male-to-female sex identity disorder underwent sigmoid vaginoplasty for sex reassignment 4 months prior to presentation. The patient was referred for persistent diarrhea and postoperative lower abdominal pain. Proctoscopy, gastrografin enema, and small bowel enterography revealed rectal anastomotic stenosis and an ileorectal fistula. The prior anastomotic site and ileal rectal fistula were resected, and ileal interposition reconstruction was performed to avoid damaging the blood supply to the artificial vagina. Routine follow-up after the closure of the diverting ileostomy showed no new pathologies. DISCUSSION This case highlighted the management of surgical complications after sex reassignment surgery. CONCLUSION Ileal interposition was a useful reconstruction method after resecting the colonic anastomotic site to preserve the artificial vagina.
Collapse
Affiliation(s)
- Nobuhiro Nitori
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan.
| | - Tomoaki Deguchi
- Department of Surgery, Machida Hospital, Kiso-higasi 4-21-43, Machida-shi, Tokyo 194-0036, Japan
| | - Ayu Kato
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan
| | - Fumihiko Kato
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan
| | - Masahiro Shinoda
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852 Hatakeda Narita, Chiba 286-0124, Japan
| |
Collapse
|
2
|
Abstract
Johns Hopkins Hospital established the first gender-affirming surgery (GAS) clinic in the United States in 1966. Operating for more than 13 years, the clinic was abruptly closed in 1979. According to the hospital, the decision was made in response to objective evidence claiming that GAS was ineffective. However, this evidence directly contradicted many contemporaneous studies and faced immediate criticism from the scientific community. Despite this resistance, it took the hospital nearly 40 years to resume performing GAS. Scientific evidence-imbued in scandal, bias, and moralism-was instrumentalized to serve broader institutional interests. The burgeoning field of plastic surgery tethered and then untethered GAS from its auspices in response to poor technical outcomes and transphobia. No longer serving surgeons' interests, the clinic was marginalized to "barely minimal facilities" in 1974, five years before GAS was formally banned. Over the next 5 years, the clinic co-inhabited space with the Department of Obstetrics and Gynecology. Simultaneously, the Department of Obstetrics and Gynecology navigated scandals related to reproductive technology (namely, the Dalkon Shield [A.H. Robins] controversy) until the clinic space was demolished in 1979. The study that informed the GAS ban was preferentially funded in keeping with the political economy of biomedical research. This article presents a spatial argument for how the closure of the nation's first GAS clinic was not based in empirical data alone but was manipulated to fuel political and institutional agendas.
Collapse
Affiliation(s)
- Walker J Magrath
- The Johns Hopkins University School of Medicine, Baltimore, Maryland (W.J.M.)
| |
Collapse
|
3
|
Kloer C, Parker A, Blasdel G, Kaplan S, Zhao L, Bluebond-Langner R. Sexual health after vaginoplasty: A systematic review. Andrology 2021; 9:1744-1764. [PMID: 33882193 DOI: 10.1111/andr.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Vaginoplasty is a gender-affirming procedure for transgender and gender diverse (TGD) patients who experience gender incongruence. This procedure reduces mental health concerns and enhances patients' quality of life. A systematic review investigating the sexual health outcomes of vaginoplasty has not been performed. OBJECTIVES To investigate sexual health after gender-affirming vaginoplasty for TGD patients. DATA SOURCES MEDLINE/PubMed, Embase, Scopus, and PsycINFO databases were searched, unrestricted by dates or study design. METHODS We included primary literature that incorporated TGD patients, reported sexual health outcomes after vaginoplasty intervention and were available in English. Outcomes included at least one of these sexual health parameters: sexual desire, arousal, sensation, activity, secretions, satisfaction, pleasure, orgasm, interferences, or aids. RESULTS Our search yielded 140 studies with 12 different vaginoplasty surgical techniques and 6,953 patients. The majority of these studies were cross-section or retrospective cohort observational studies (66%). 17.4%-100% (median 79.7%) of patients (n = 2,384) were able to orgasm postoperatively regardless of revision or primary vaginoplasty techniques. Female Sexual Function Index was the most used standardized questionnaire (17 studies, ranging from 16.9 to 28.6). 64%-98% (median 81%) of patients were satisfied with their general sexual satisfaction. The most common interference of sexual activity was dyspareunia. CONCLUSIONS The heterogenous methods of measuring sexual outcomes reflect the difficulty in comparing single-center surgical outcomes, encouraging the need for a standardized and validated metric for reporting sexual health after vaginoplasty for TGD patients. The most common sexual health parameter reported is sexual activity while therapeutic aids and pleasure were the least reported parameters. Future studies are needed to improve and expand methods of measuring sexual health, including prospective studies, validated questionnaires, and inclusive metrics. Systematic review registration number: PROSPERO 01/01/2021: CRD42021224014.
Collapse
Affiliation(s)
- Carmen Kloer
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA.,Duke University School of Medicine, Duke Health Systems, Durham, NC, USA
| | - Augustus Parker
- NYU Grossman School of Medicine, New York University Langone Health, New York, NY, USA
| | - Gaines Blasdel
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Samantha Kaplan
- Duke University School of Medicine, Duke Health Systems, Durham, NC, USA
| | - Lee Zhao
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| |
Collapse
|
4
|
Monstrey S, Hoebeke P, Dhont M, Cuypere GD, Rubens R, Moerman M, Hamdi M, Landuyt KV, Blondeel P. Surgical Therapy in Transsexual Patients: a Multi-Disciplinary Approach. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098617] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Monstrey
- Department of Plastic Surgery, University Hospital, Gent, Belgium
| | - P. Hoebeke
- Department of Urology, University Hospital, Gent, Belgium
| | - M. Dhont
- Department of Gynecology, University Hospital, Gent, Belgium
| | - G. De Cuypere
- Department of Psychiatry, University Hospital, Gent, Belgium
| | - R. Rubens
- Department of Endocrinology, University Hospital, Gent, Belgium
| | - M. Moerman
- Department of Otorhinolaryngology, University Hospital, Gent, Belgium
| | - M. Hamdi
- Department of Plastic Surgery, University Hospital, Gent, Belgium
| | - K. Van Landuyt
- Department of Plastic Surgery, University Hospital, Gent, Belgium
| | - Ph. Blondeel
- Department of Plastic Surgery, University Hospital, Gent, Belgium
| |
Collapse
|
5
|
Dunford C, Bell K, Rashid T. Genital Reconstructive Surgery in Male to Female Transgender Patients: A Systematic Review of Primary Surgical Techniques, Complication Profiles, and Functional Outcomes from 1950 to Present Day. Eur Urol Focus 2020; 7:464-471. [PMID: 32061539 DOI: 10.1016/j.euf.2020.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/08/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT Genital reconstructive surgery (GRS) is a necessary part of transitioning for many transwomen, and there is evidence of positive effects on a person's well-being and sexual function. Surgical techniques have evolved, from pursuing aesthetic outcome to now functional outcome with natal females as the standard. OBJECTIVE To systematically review the evidence, identifying the surgical techniques used in primary GRS, their complications, functional outcomes, and the tools used to assess them. EVIDENCE ACQUISITION The clinical question was designed using the standard PICOS format. The search complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 statement and was performed by two independent reviewers. EVIDENCE SYNTHESIS Europe, USA, and Thailand favour the penoscrotal technique for vaginoplasty, whereas in the UK, the penile inversion (PI) technique predominates. Primary vaginoplasty using a segment of bowel is less common, and all three techniques have comparable rates of intraoperative rectal injury. The incidence of rectovaginal fistula is reportedly higher in the PI technique. Wound haematoma and vaginal prolapse rates are comparable. Higher rates of clitoral necrosis, urethral meatal stenosis, and wound infection are reported in PI. However, the ability to orgasm, ability to have penetrative sexual intercourse, and satisfaction with aesthetic result are better with PI. CONCLUSIONS The evidence for GRS complications and functional outcomes is of low level. Standardised nomenclature reporting of adverse events and robust patient-reported outcome measures (PROMs) are lacking. PROMs are a powerful assessment tool, and standardised definitions of adverse events and functional outcomes should be a priority of future research. PATIENT SUMMARY We looked at all studies published on genital reconstructive surgery from 1950 to the present day. We assessed each surgical technique and their associated complication rates, sexual and urinary function outcomes, and how they were reported. We found the evidence to be low and weak. We suggest more robust ways of reporting complications, and the impact on patients' quality of life should be investigated.
Collapse
Affiliation(s)
- Charlotte Dunford
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, University College London Hospitals, London, UK.
| | - Kathryn Bell
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK; Newcastle University, Newcastle upon Tyne, UK
| | - Tina Rashid
- Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
6
|
Rossi Neto R, Hintz F, Krege S, Rübben H, vom Dorp F. Gender reassignment surgery - a 13 year review of surgical outcomes. Int Braz J Urol 2012; 38:97-107. [DOI: 10.1590/s1677-55382012000100014] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2011] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - F. Hintz
- University of Essen Medical School, Germany
| | - S. Krege
- University of Essen Medical School, Germany
| | - H. Rübben
- University of Essen Medical School, Germany
| | | |
Collapse
|
7
|
Do Histologic Changes in the Skin-Lined Neovagina of Male-to-Female Transsexuals Really Occur? Ann Plast Surg 2007; 59:546-9. [DOI: 10.1097/01.sap.0000258953.00234.50] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Goddard JC, Vickery RM, Qureshi A, Summerton DJ, Khoosal D, Terry TR. Feminizing genitoplasty in adult transsexuals: early and long-term surgical results. BJU Int 2007; 100:607-13. [PMID: 17669144 DOI: 10.1111/j.1464-410x.2007.07017.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the early and late surgical outcomes of feminizing genitoplasty (FG) in adult transsexuals in a UK single surgeon practice over a 10-year period. PATIENTS AND METHODS Computerized and manual databases were searched over the period 1994-2004 to identify patients who had undergone male to female FG. Case-notes were retrieved and analysed to identify epidemiological data, the number and type of perioperative problems, early results at outpatient review, late occurring problems and patient satisfaction. A telephone questionnaire was then conducted targeting all FG patients in our series. The questions were directed at identifying surgical complications, outcome and patient satisfaction. RESULTS In all, 233 case-notes were identified and 222 (95%) were retrieved. All patients had penectomy, urethroplasty and labiaplasty, 207 (93%) had formation of a neoclitoris, and 202 (91%) had a skin-lined neovagina. The median (range) age was 41 (19-76) years. The median hospital stay was 10 (6-21) days. A record of the first outpatient visit was available in 197 (84.5%) cases. The median time to follow up was 56 (8-351) days. Over all, 82.2% had an adequate vaginal depth, with a median depth of 13 (5-15) cm and 6.1% had developed vaginal stenosis. Three (1.7%) patients had had a vaginal prolapse, two (1.1%) had a degree of vaginal skin flap necrosis and one (0.6%) was troubled with vaginal hair growth. In 86.3% of the patients the neoclitorizes were sensitive. There was urethral stenosis in 18.3% of the patients and 5.6% complained of spraying of urine. Minor corrective urethral surgery was undertaken in 36 patients including 42 urethral dilatations, and eight meatotomies were performed. At the first clinic visit 174 (88.3%) patients were 'happy', 13 (6.6%) were 'unhappy' and 10 (5.1%) made no comment. Of the 233 patients, we successfully contacted 70 (30%). All had had penectomy and labioplasty, 64 (91%) had a clitoroplasty and 62 (89%) a neovagina. The median age was 43 (19-76) years and the median follow up was 36 (9-96) months. Overall, 63 (98%) had a sensate neoclitoris, with 31 (48%) able to achieve orgasm; nine (14%) were hypersensitive. Vaginal depth was considered adequate by 38 (61%) and 14 (23%) had or were having regular intercourse. Vaginal hair growth troubled 18 (29%), four (6%) had a vaginal prolapse and two (3%) had vaginal necrosis. Urinary problems were reported by 19 (27%) patients, of these 18 (26%) required revision surgery, 14 (20%) complained of urinary spraying, 18 (26%) had an upward directed stream and 16 (23%) had urethral stenosis. The patients deemed the cosmetic result acceptable in 53 (76%) cases and 56 (80%) said the surgery met with their expectations. CONCLUSION This is largest series of early results after male to female FG. Complications are common after this complex surgery and long-term follow-up is difficult, as patients tend to re-locate at the start of their 'new life' after FG. There were good overall cosmetic and functional results, with a sustained high patient satisfaction.
Collapse
Affiliation(s)
- Jonathan C Goddard
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
INTRODUCTION Determining the history and development of feminizing genitoplasty is fascinating and instructive but fraught with difficulty. Earliest examples relate to practices carried out in ancient cultures. Gender reassignment surgery (GRS) developed from reconstructive procedures for congenital abnormalities. Some surgery was disguised, techniques were not recorded, and operations were carried out in secret. AIM The aim of this article is to review the historical development of male-to-female GRS. METHODS Information was gleaned from Medline and general Internet searches. Further evidence was found by reviewing the references of early articles. A fascinating insight was also found in the autobiographies of GRS patients. RESULTS The first recorded case was by Abrahams in 1931. Techniques evolved from the early vaginal absence work of Beck and Graves. Pioneers of GRS were Sir Harold Gillies in England and Georges Burou of Casablanca. In the 1950s, they both used invagination of the penile skin sheath to form a vagina. Howard Jones, of Johns Hopkins, published the second classic technique using penile and scrotal skin flaps. These two methods form the basis of male-to-female GRS today. The history of GRS reveals a struggle to improve functionality as well as cosmesis. In particular, the neovagina but also a functioning neoclitoris, which has developed from a cosmetic swelling into an innovated organ, derived from the glans penis and harvested penile neurovascular bundle. CONCLUSIONS Improved function and cosmesis continue to be the aim of the gender dysphoria surgeon. However, this review suggests the future management of transwomen should address not only refinements of surgical techniques but also prospective collection of posttreatment quality-of-life issues.
Collapse
Affiliation(s)
- Jonathan Charles Goddard
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, UK.
| | | | | |
Collapse
|
10
|
Selvaggi G, Ceulemans P, De Cuypere G, VanLanduyt K, Blondeel P, Hamdi M, Bowman C, Monstrey S. Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals. Plast Reconstr Surg 2005; 116:135e-145e. [PMID: 16267416 DOI: 10.1097/01.prs.0000185999.71439.06] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism. BACKGROUND Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major role in the research and treatment of gender identity disorder, publishing the Standards of Care for Gender Dysphoric Persons. METHODS The authors performed an overview of the terminology related to male-to-female gender identity disorder; the different theories regarding cause, epidemiology, and treatment; the goals expected; and the surgical technique available for sex reassignment surgery in male-to-female transsexualism. RESULTS Surgical techniques available for sex reassignment surgery in male-to-female transsexualism, with advantages and disadvantages offered by each technique, are reviewed. Other feminizing nongenital operative interventions are also examined. CONCLUSIONS This review describes recent etiopathogenetic theories and actual guidelines on the treatment of the gender identity disorder in male-to-female transsexuals; the penile-scrotal skin flap technique is considered the state of the art for vaginoplasty in male-to-female transsexuals, whereas other techniques (rectosigmoid flap, local flaps, and isolated skin grafts) should be considered only in secondary cases. As techniques in vaginoplasty become more refined, more emphasis is being placed on aesthetic outcomes by both surgeons and patients.
Collapse
Affiliation(s)
- Gennaro Selvaggi
- Department of Plastic Surgery, University Hospital of Ghent, Ghent, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Brame R. Notable presentations in the history of the South Atlantic Association of Obstetricians and Gynecologists. Am J Obstet Gynecol 2005; 193:519-24. [PMID: 16098882 DOI: 10.1016/j.ajog.2005.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 03/19/2005] [Indexed: 11/26/2022]
|
12
|
Fugate SR, Apodaca CC, Hibbert ML. Gender reassignment surgery and the gynecological patient(1). PRIMARY CARE UPDATE FOR OB/GYNS 2001; 8:22-24. [PMID: 11164348 DOI: 10.1016/s1068-607x(00)00065-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
With the increasing number of open transsexuals in the population and the advances in reconstructive surgical techniques, gender reassignment surgery has been increasing since the 1960s. Secondary to the increase in patients undergoing gender reassignment surgery, the practicing gynecologist is more likely to encounter a transsexual patient. A 49-year-old, nulligravid, white female presented to the gynecology clinic for her annual gynecological exam. Her past surgical history was significant for male to female gender reassignment surgery in 1991. Her hormonal medications included levothyroxine and estrogen. She described a strong family history of breast cancer for which she was being followed in our institutional Breast Watch Clinic. On physical examination, findings were notable for surgically constructed female external genitalia and a neovagina. The rectal exam was normal and failed to demonstrate any prostate pathology. It is important for the experienced gynecologist to be familiar with transsexualism, the reconstructive surgery involved, the surgical complications, and gender identity support groups and clinics available to these patients. Transsexuals should be treated to the extent possible like other female gynecological patients, while care is taken not to overlook underlying or preexisting medical conditions, including conditions unique to the prior and new genders.
Collapse
Affiliation(s)
- S R. Fugate
- Madigan Army Medical Center, Tacoma, Washington, USA
| | | | | |
Collapse
|
13
|
van Kesteren P, Meinhardt W, van der Valk P, Geldof A, Megens J, Gooren L. Effects of Estrogens Only on the Prostates of Aging Men. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65584-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P. van Kesteren
- Departments of Andrology, Urology and Pathology, and Laboratory of Experimental Endocrinology, Free University Hospital, Amsterdam, The Netherlands
| | - W. Meinhardt
- Departments of Andrology, Urology and Pathology, and Laboratory of Experimental Endocrinology, Free University Hospital, Amsterdam, The Netherlands
| | - P. van der Valk
- Departments of Andrology, Urology and Pathology, and Laboratory of Experimental Endocrinology, Free University Hospital, Amsterdam, The Netherlands
| | - A. Geldof
- Departments of Andrology, Urology and Pathology, and Laboratory of Experimental Endocrinology, Free University Hospital, Amsterdam, The Netherlands
| | - J. Megens
- Departments of Andrology, Urology and Pathology, and Laboratory of Experimental Endocrinology, Free University Hospital, Amsterdam, The Netherlands
| | - L. Gooren
- Departments of Andrology, Urology and Pathology, and Laboratory of Experimental Endocrinology, Free University Hospital, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Hage JJ, Karim RB, Bloemena E. Labial masses following vaginoplasty in male transsexuals: the differential diagnosis. Plast Reconstr Surg 1996; 97:1226-32. [PMID: 8628805 DOI: 10.1097/00006534-199605000-00018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Following vaginoplasty and vulvoplasty for male-to-female transsexualism, a mass may evolve in one of the major labia in a minority of patients. From April of 1989 to April of 1994, we treated seven patients with such masses. The case reports presented illustrate some of the differential diagnoses of this long-term complication. More often than not, the swelling was caused by infection. The funiculus or even testicular rest in itself also may represent the mass. Intralabial urethral fistula appears to be the second cause of swelling, either with or without inflammation. As an exceptional cause we observed a swelling representing a cyst of prostatic origin. In all, the mass could be excised completely.
Collapse
Affiliation(s)
- J J Hage
- Department of Plastic and Reconstructive Surgery, Academic Hospital, Free University, Amsterdam, The Netherlands
| | | | | |
Collapse
|
15
|
Kruk-Jeromin J, Jeromin L, Dec W, Zieliński A, Sosnowski M. Two-stage surgical treatment for male transsexuals. Int Urol Nephrol 1992; 24:75-81. [PMID: 1624247 DOI: 10.1007/bf02552121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A plan for complex treatment of male-to-female transsexuals is presented. On the basis of our experience in the management of 15 patients, two-stage surgical treatment aiming at the change of external genitals, as well as the obtained cosmetic and functional results are described.
Collapse
Affiliation(s)
- J Kruk-Jeromin
- Department of Plastic Surgery, Medical Academy, Lódź, Poland
| | | | | | | | | |
Collapse
|
16
|
Wolfe VI, Ratusnik DL, Smith FH, Northrop G. Intonation and fundamental frequency in male-to-female transsexuals. THE JOURNAL OF SPEECH AND HEARING DISORDERS 1990; 55:43-50. [PMID: 2299839 DOI: 10.1044/jshd.5501.43] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twenty speakers, diagnosed as male-to-female transsexuals, produced conversational recordings of speech and voice. The samples were submitted to perceptual evaluations and to acoustic analysis by means of a Visi-Pitch, Apple IIe microcomputer system. Transsexuals categorized as having female voices had higher fundamental frequencies (fo), less extensive downward intonations, a higher percentage of upward intonations and downward shifts, and a smaller percentage of level intonations and level shifts than transsexuals categorized as having male voices. The lowest average fo identified as belonging to a female speaker was 155 Hz. Higher (more feminine) ratings on the masculinity-femininity dimension correlated with fo (r = .89), percentage of level shifts (r = -.67), percentage of downward shifts (r = .50), percentage of level intonations (r = -.43), and percentage of upward intonations (r = .40). Findings are discussed in terms of the relative perceptual salience of average fundamental frequency and patterns of intonation for female voice quality.
Collapse
Affiliation(s)
- V I Wolfe
- Speech and Hearing Clinic, Auburn University Montgomery, AL 36193
| | | | | | | |
Collapse
|