You may also pursue a Centurion procedure, wherein the ligaments underneath the major labia are repositioned to add girth to the neopenis. This method uses donor tissue from the cheek or from the vagina to connect the urethra to the new neopenis, allowing you to urinate while standing.
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You may also choose to do a urethral lengthening with your metoidioplasty, also known as a full metoidioplasty. In this procedure, the clitoris, already elongated to 3-8 centimeters by HRT, is released from the surrounding tissue, and repositioned to match the positioning of a penis. Metoidioplasty is a much simpler and quicker procedure than phalloplasty. Testicular implants usually require waiting for a follow-up surgery. Scrotoplasty may be performed with either surgery, which modifies the major labia into a scrotum. Phalloplasty and metoidioplasty are two methods that involve the construction of a neopenis. Surgeons who use this technique purport greater vaginal depth, more sensate inner labia, and improved cosmetic appearance. The penile tissue is used for the labia minora and clitoral hood. This method uses perforated scrotal tissue graft for the vaginal lining, and intact scrotal tissue for the labia majora (same as a penile inversion). Suporn who invented it) or the Chonburi Flap. Non-penile inversion is also known as the Suporn technique (after Dr. This technique is also used to reconstruct vaginas for cisgender women who developed atypically short vaginal canals. Intestinal tissue has the added benefit of being mucosal, and therefore self-lubricating. This method is often used for transgender women who began hormone therapy at puberty and were never exposed to testosterone. Intestinal tissue helps when penile and scrotal tissue is scarce. This technique is sometimes used in conjunction with penile inversion. Rectosigmoid vaginoplasty involves the use of intestinal tissue to form the vaginal wall. Common variations include using the remaining scrotal tissue as a graft for additional vaginal depth, and using the intact mucosal urethra recovered from the penis to line part of the vagina, creating some self-lubrication. One main drawback is the lack of self-lubrication by the vaginal wall. This results in a sensate vagina and labia. The labia major and minora are primarily made from scrotal tissue.
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Penile inversion involves using the penile skin to form the neovagina. In all three surgery methods, the clitoris is sculpted from the head of the penis. There are three main methods of vaginoplasty performed today: This poses a significant challenge to transgender people with same-sex attractions or gender expressions outside a stereotypical norm (dresses and makeup for women, hyper-masculine presentation for men), and essentially erases the experience of nonbinary trans people. The gatekeeper model also tends to use heteronormative, cisnormative criteria for qualifying the real-life experience. They also believe that RLE is a mentally traumatic, socially impractical, and physically dangerous period of time in which a transgender person must out themselves to their community - without the benefit of the physical transformations that hormones or surgeries bring. Some argued that this presumes transgender identity to be inferior or less legitimate than cisgender identity. This model required months or years of “ real-life experience” (RLE) in their gender identity before they could have HRT or more routine surgeries. Requiring letters from therapists and physicians appeals to some hospitals, surgeons, and care providers, who may look at this system as legally defensible if necessary.īoth of these methods are considered by some in the transgender community to be an improvement of the previous and widespread gatekeeper model. However, some care providers argue that ethical standards don’t contradict informed consent. They believe it takes control out of the hands of the person and implies that the transgender person deserves less personal authority than a cisgender person. The WPATH method draws criticism from some people in the transgender community.
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The WPATH standards of care requires a letter of support from a therapist to begin HRT, and multiple letters to undergo bottom surgery.
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Then, you decide for yourself whether to proceed without any input from any other healthcare professional.
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The informed consent model allows the physician to inform you of the risks of a certain decision. Leading transgender healthcare providers will either follow an informed consent model or the WPATH standards of care.