Endocrine Abstracts

The final stage of gender reassignment in female-to-male gender reassignment is phalloplasty of which there are various types. All patients should be fully counselled, shown photographs of the techniques and, if possible, discuss with patients who have had the various operations.

The main objectives are to stand and void, have penetrative sexual intercourse and to have a good cosmetically acceptable phallus.

The various types include a metatoidioplasty which involes bringing the urethral meatus forwards to the tip of the clitoris, extending the clitoris to allow patients to stand to void only. Approximately 50% of patients can manage this. A total phalloplasty can be either raised from the abdominal skin (pubic) or from the arm (forearm free flap). The superior phalloplasty with regards to urinary function is the forearm free flap phalloplasty, which has a better cosmetic appearance and is sensate. The urethral complications with this procedure is far less than with the pubic variety, although scars with the latter are hidden below the belt. Both types of phalloplasty will allow the insertion of a penile prosthesis for penetrative sexual intercourse and it is important that an inflatable variety is used, as this will reduce post-operative complications such as erosion. Testicular implants improve the cosmetic appearance as does sculpture of the glans penis to give a reliable looking phallus.

Over 200 pubic phalloplasties and 50 forearm free flap procedures have now been performed and the results and complications will be discussed.