Twenty years of experience in managing gender dysphoric patients: I. Surgical management of male transsexuals.

For the past 20 years, the gender treatment team formed under the auspices of the University of Texas Medical Branch Hospitals has treated 121 male individuals with gender identification disorders. The age of this group ranged between 18 and 71 years, with an average of 32.3 years. While all of them were seen regularly for 6 months after surgery, only 68 were followed for a year or longer. The regimen of surgical treatment that consisted of procedures of bilateral orchiectomy, penectomy with relocation of the urethral meatus, labial reconstruction, and neovaginoplasty was used for all patients. The castration procedure used between 1972 and 1977 included removal of both the testes and the spermatic cord. The corpora cavernosa were transected at the public symphysis. For vaginal reconstruction, a partial-thickness skin graft was used frequently, in conjunction with a skin flap fashioned from the penile skin, to line the neovaginal vault. Modifications and changes in technique were, however, introduced in 1978. Skin flaps mobilized from the inguinoperineal area instead of a partial-thickness skin graft were used to line the vaginal cavity. A proximal segment of the corpora cavernosa was retained to reconstruct a clitoris. In addition, the spermatic cord was incorporated into the reconstruction of labia majora. These technical modifications substantially reduced the incidence of vaginal stenosis and improved the external appearance of the genitalia. The experience accumulated from managing this group of patients forms the basis of this report.