CLITORO-LABIAPLASTY | Instituto Musolas de Disforia de Género

This team adheres to the criteria of the Harry Benjamin International Gender Dysphoria Association regarding the requirements for a patient to be a candidate for sex reassignment surgery. It is necessary that you understand as a patient that you must meet certain criteria since the changes the patient will experience are irreversible:

Referral letter and diagnosis by an experienced psychologist or psychiatrist.
Be of legal consenting age (18 y.o.).
12 months of hormonal treatment.
12 months of continuous and satisfactory real-life test.
Progress in the consolidation of interpersonal relationships in the new role.
Informed consent including complete information about the procedure.
Have had previously done (4-6 months) the Histerectomy-Bilateral Salpingo-oophorectomy.

It is also essential to have followed a correct assessment by specialists accredited in the field of Endocrinology and Psychology, as well as having the relevant reports to be able to proceed to the surgical reassignment of sex.

What is it?

Clitoro-labiaplasty is a procedure by which male genitalia is reconstructed from female ones. It can be completed in two stages. The clitoris, previously enlarged by the hormone therapy, together with the minor and major labia are reconstructed, the penis is lengthened and testes (with implants) are reconstructed. The urethra is lengthened to the gland in a second stage.

This neo-penis provides many of the functional requirements, but the result may not permit sexual penetration because its size.

Who is a good candidate for this procedure?

Good candidates are, obviously, all those who completely fulfil the above mentioned criteria.

Even if you fulfil all criteria, you have to be into acceptable healthy weight. To be eligible for vaginoplasty you better be between 18 and 30 of BMI (Body mass Index). BMI represents the relationship between the height and weight of your body. Patients under 18 or over 30 BMI have an increased risk of thrombosis, delayed wound healing and wound infection. Obesity or overweight can partially or completely hide the new penis, making it to look smaller.

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How I do prepare for surgery?

You have to be into acceptable healthy weight. To be eligible for vaginoplasty you better be between 18 and 30 of BMI (Body mass Index).
It is essential that you quit smoking at least 6 weeks before surgery. Smoking is directly related to wound healing delay and skin flaps necrosis. It is on your own risk if you do not stop smoking.
It is very important to stop female hormone therapy 4 weeks before your surgery, and this should be done gradually, though antiandrogen treatment can be continued. Hormone therapy increases the risk of venous thrombosis.
It is convenient to wear during the surgery and the days after, compression stockings as they help minimizing the risk of venous thrombosis
If previous urinary tract problems have been detected it has to be studied and diagnosed by an urologist.

Hospital admission and anaesthesia.

Admission is usually done one day before. When admitted to the hospital you should deliver the next documents:
- Pre-operatory tests: Blood test, thorax X-Ray, and ECG.
- Surgical informed consent read and signed 1 week before surgery.
- Anesthesia informed consent read and signed 1 week before surgery.
- Copy of the referral letter and diagnosis.
Perineal and genital hair shaving.
Fraxiparine shot the afternoon before and antibiotic prophylaxis.
You are not allowed to eat or drink anything 8 hrs before your surgery.
This surgery is performed under general anaesthesia.

Post-operative cares.

Immediate post-operative care is specially addressed to isolate the penis incisions from the rest and keeping it clean. To allow appropriate local wound healing, the urinary catheter will remain during 6 to 8 days and you will be instructed about how to clean and care the area.

At discharge you will be given a prescription for painkillers and instructions about the physical activities you are allowed to do or not to do. During this period heavy lifting or sports is not recommended. You will receive an appointment for after 5 to 7 days to have

You may resume the hormone treatment 2 weeks after surgery.

Possible complications.

Like all surgical acts, it involves a certain degree of risk for both the anesthetic and the surgical part. Being an elective surgery one of the alternatives is not to undergo surgery. Within the surgical risks are the complications derived from all interventions in general such as

Continuous bleeding. Slight bleeding may be present during the first days. If major bleeding or big hematomas are present, a second operation may be needed to stop bleeding and remove clots.
Infection: is another complication that may occur. Antibiotics, extra dressings and cares and even a new intervention may be needed. If the infection affects the testicular implants they should be removed and wait (4-6 months) for complete healing and put them in place again.
Wound dehiscence: It means opening of a sutured wound that can delay a successful outcome, though it usually heals by itself. It is more frequently seen in smokers.
Vaginal secretions. It is not necessary for that technique to completely remove the vagina, which is an extra and very aggressive surgery with real risks for the urinary bladder and rectus. The vagina is left intact as it has become athropic because the hormone therapy and a small aperture is left to drain any secretion. It can be the cause of little occasional spots on your underwear.
Loss of feeling/orgasm. Nerves and vessel to the clitoris are not manipulated as they are out from the surgical area. It is extremely rare but local tissues can become swollen and partially or totally compressed. In this rare situation, that we have never seen, feeling can be diminished and take weeks or months to recover.
Hypertrophic scars or keloids. Skin healing differs from one person to another, and excessive scarring can appear. Usually it only takes time to see them improving so much. But it is really rare to see that type of scars at the genital area.
Necrosis of one or several flaps that have been left for the urethra lengthening at the second stage can partially or totally necrotized. This is extremely rare and that is why it is so important to quit smoking 4 weeks before surgery, as smoking increase the risk of wound healing.

The surgery.

The new penis will be reconstructed with the clitoris, which has previously being enlarged by the hormone therapy, undermining and lengthening the clitoris from its base to create the new penis.

The urologist team will perform then a penis lengthening by liberating of both corpora cavernosa from their pelvic attachments. At this stage it will reach its final size.

Minor labia are used to give coverage for the ventral aspect of the new penis and prepare the area for the urethral lengthening that, optionally, can be done in a second stage.

Major labia, will be partially modified and once the scrotal sac has been created, silicon testicular implants are put in place. Finally the major labia filled with implants are joined together in the middle to make a new scrotum.

After the first stage the aspect of the genitalia is that of the male, though still voiding from its original urethral opening, sitting not standing up. Penis can sustain physiological (natural) erections and is able to reach orgasms.

During the procedure, a urinary catheter is inserted into the bladder and 1 drainage catheter is placed in the area of the perinea, and is generally removed after 24 hours.

Two days after the operation, you will be allow to move and sit and if everything is right you will be discharged at third day. The patient must wear the urinary catheter for at least 1 week, to allow wounds heal properly.

The final result, regarding the size, will be at the best case that of a small or micropenis running to something similar to half the 5th finger to the thumb size.

What is it?

Who is a good candidate for this procedure?

How I do prepare for surgery?

Hospital admission and anaesthesia.

Post-operative cares.

Possible complications.

The surgery.

Informed consent and instructions for Sexual reassignment surgery.

CI Esp Clítoro-labioplastia

Instituto Musolas de Disforia de Género

Via Augusta 134 - 136 | 08006 Barcelona | T.: +34 93 200 46 45 | info@musolasdisforiadegenero.com

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