If you are a transgender woman in the Miami area who wishes to complete her transition, allow Dr. Christopher J. Salgado and his team of experts at the University of Miami to aid in your journey.
Gender Confirmation Surgery on the genitalia is often the last set of procedures that will allow a transgender woman’s body to truly align with her gender identity.
Types of Male to Female Genitalia Procedures
This combination of procedures creates a neo-vagina from the penile and scrotal tissue.
Also known as Bilateral Castration, this is often the first procedure that many transgender women will undergo. This outpatient procedure suspends the production of testosterone before Gender Confirmation Surgery, thus nullifying the dependency on testosterone blockers (anti-androgens). However, patients will need to continue Hormone Replacement Therapy (HRT) with a lower dosage of estrogen.
At the heart of Gender Confirmation Surgery is a Vaginoplasty. This surgical procedure uses a penile and scrotal tissue to create a ‘neo-vagina’. In addition, part of the glans penis will be used to construct a clitoris. To avoid complications such as urethral strictures and incontinence, the prostate is left in place. In the event that there is very little penile tissue to work with, a ‘sigmoid colon vaginoplasty’ is done instead. This alternative technique uses a piece of the colon to create the neo-vagina. While discharge and a faint odor can be expected up to six months, it is a very successful procedure that increases the vaginal depth and enables natural lubrication. Many transgender women who have undergone this procedure have reported sensations in the neo-vagina and clitoris. While it will take time to adjust to your new body, orgasm is achievable once your resume regular sexual activity.
In addition, a Labiaplasty can be performed to cosmetically enhance the results of your vaginoplasty. This procedure is performed by Dr. Salgado for transgender women at the time of vaginoplasty with the scrotal skin and inverted penile skin. At times following Gender Affirmation bottom surgery the labia majora has lost volume and a labiaplasty is performed by augmentation of the labia with autologous fat.
Using the existing tissue from the glans penis, a clitoris will be formed. A neurovascular bundle is raised so that all erogenous nerves are harvested and will provide sensation to the clitoris that will have a similar look and feel of a cisgender woman.
THE MTF SRS PROCEDURE
Before your surgery, Dr. Salgado will meet with you to discuss the procedure and what you can expect during the recovery phase. You will be instructed to provide a detailed medical history and your current health will be evaluated at this time. It is important that you maintain realistic expectations about the procedure.
In the month before your surgery, it is advised that you stop drinking and smoking and continue to do so for the first two weeks after surgery. The effects from these vices may interfere with anesthesia and delay recovery. In addition, medications such as aspirin and ibuprofen may cause complications as well. It is also important that you clear your digestive system. Dr. Salgado may prohibit the intake of solid food on the day before surgery. However, you are permitted to consume liquid. The consumption of a laxative and the use of an enema are also advised to ensure that any waste is cleared from the body once surgery begins.
Unlike other surgeries, your recovery from genitalia surgery will have serious long-term physical and psychological implications. It is important that you take the following steps during this period:
- Get plenty of rest, especially during the first two weeks after surgery.
- Restrict your movements. Avoid strenuous activity and heavy lifting.
- Avoid smoking and drinking to ensure your body heals properly.
- Regularly take medication as prescribed by Dr. Salgado.
- Avoid baths. Showers may resume after five days. Remember to gently pat the genital area dry with a clean towel. Prolonged exposure to water will affect the healing process.
- Dilate frequently.
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On average, it will take twelve weeks (three months) for your neo-vagina to settle. Swelling and bruising is normal and expected, so it is recommended to get plenty of rest as your body heals. You may return to work gradually in about four to six weeks and you may resume exercising after eight weeks.
In addition, it is best to avoid any activities that may tear the neo-vagina, or result in a wound. Activities include:
- Sexual intercourse
- Activities that can put pressure against the genitals
- Sports or exercise that may cause the stretching of the genitals
Swelling around the labia is normal and will gradually decrease in time. Standing and sitting for long periods of time may aggravate the area, so it is important to apply ice to the perineum for twenty minutes every hour.
You must wash your hands before and after you make any contact with the area. When washing and wiping, it is best to do so from front to back to avoid bacterial contamination from the anus.
Brownish/yellow vaginal discharge is expected in the first four to six weeks, including bleeding and spotting. The use of a douche can help control the discharge you experience.
Regular dilation allows the neo-vagina to maintain its shape. A conformer is placed inside your neo-vagina during surgery and will stay in place for one week. After the conformer is removed, regular dilation begins using Soul Source Silicone Smooth Dilators. Once you have become comfortable with its size, you must begin to use a bigger size in its place. In time, sexual intercourse can serve as a substitute to regular dilation.
Frequency of Dilation
MONTHS SINCE SURGERY COLOR OF DILATOR DIAMETER OF DILATOR FREQUENCY 0-3 Months Pink 7/8″ 4 Times Daily for 20 Minutes 3-6 Months AQUA 1 3 Minutes Daily for 20 Minutes 6-9 Months YELLOW 1 1/8″ 2 Times Daily for 20 Minutes 9-12 Months ORANGE 1 1/4″ 1-2 Times Daily for 20 Minutes
Like any form of surgery, scarring is expected and its effects are permanent. The incisions will heal after six months. They are barely visible after a year.
You will start to see results as your body begins to heal. Generally, it takes twelve weeks for your neo-vagina to settle. After this time, post-operative sexual intercourse is possible. Sensation in the neo-vagina and clitoris is generally successful.
GENITALIA GENDER CONFIRMATION SURGERY COSTS
Several factors may affect the total cost of your MTF bottom surgery. This will be discussed during your consultations with Dr. Salgado, including financial options. Factors include:
- The experience of your surgeon and his team
- Location and facilities
- Medications and anesthesia to be administered
- Post-operative consultation
FINANCING AND INSURANCE OPTIONS
Because Gender Confirmation Surgery is covered only by a handful of insurance companies, Salgado Plastics is committed to acquiring coverage for patients undergoing Gender and Sexual Health procedures.
THE BENEFITS OF GENITALIA GENDER CONFIRMATION SURGERY
Gender Confirmation Surgery of the genitalia is truly life-changing. For many transgender women, living with a set of male genitals can be a very emotional and stressful experience. Correcting this section of the body to align with your gender identity can have a profound effect on your life. It can boost your confidence and self-esteem while allowing you to simply enjoy the intimacies that go hand-in-hand with femininity.
THE RISKS OF GENITALIA GENDER CONFIRMATION SURGERY
The effects from Gender Confirmation Surgery are not reversible, so it is very important to discuss the risks with Dr. Salgado during your initial consultations. In the weeks after your surgery, you can expect bruising and swelling in the affected area, along with post-operative pain. This will subside as you continue to recover.
ARE YOU A CANDIDATE FOR GENITALIA GENDER CONFIRMATION SURGERY?
Transgender women seeking to undergo Gender Confirmation Surgery must be in good health and must have realistic expectations about the results of the surgery. You are a good candidate if you:
- Suffer from Gender Dysphoria (Gender Identity Disorder).
- Have spent one year undergoing Hormone Replacement Therapy (HRT).
- Have been cleared by a licensed therapist who specializes in gender transition.
HOW TO CHOOSE A GENDER CONFIRMATION SURGEON
It is recommended that you take the time to find a surgeon who:
- Is a certified surgeon under the American Board of Plastic Surgeons.
- Has spent years training and specializing in Gender Confirmation Surgery.
- Is comfortable to talk to and listens to any concern you have.
- Has facilities that are approved by the American Association for Accreditation of Ambulatory Centers.
- Has a strong reputation for success.