Surgery in transsexuals.

A review was made of transsexual patients who presented at a clinic for treatment. A total of 154 patients were seen over 6 years. There were 16 female to male transsexuals and 138 male to female transsexuals. Psychiatric screening was a mandatory prerequisite. Hormonal treatment for the transsexual had been started with no exception, prior to consultation. The scope of surgery and its limitations were described to the patient. The female to male transsexual had to undergo a multistaged procedure that included mastectomy, hysterectomy, raising of the penile pedicle, mobilising of the pedicle, insertion of silicone stiffener, and use of testicular prosthesis. Urethral diversion was not attempted. The surgical technique for the male transsexual utilised an inverted U flap on the perineum. Bilateral orchidectomy was performed. The penile skin flap was filletted. The vaginal tunnel was created by sharp and blunt dissection. The urethra was mobilised and translocated. The excess scrotal skin formed the labia. The most serious complication that occurred was that of rectovaginal fistula. Other complications included vaginal stenosis, urethral stenosis and labial abscess.