Bottom surgery, also known as sex reassignment surgery or gender confirmation surgery, is a medical procedure that helps transgender individuals align their physical body with their gender identity. For Female-to-Male (FTM) individuals, bottom surgery typically involves constructing a neopenis, scrotum, and removing the internal reproductive organs associated with female anatomy. In this article, we will explore the various aspects and steps involved in the FTM bottom surgery process.
1. Psychological and Physical Evaluation
Before undergoing bottom surgery, FTM individuals are usually required to undergo a comprehensive psychological and physical evaluation. This evaluation aims to assess the individual's mental health, readiness for surgery, and overall physical well-being. It is crucial to ensure that the individual understands the implications and potential risks associated with the procedure.
In addition, healthcare professionals may consider the individual's hormone therapy history, overall health, and any pre-existing medical conditions that could affect the surgery or the recovery process.
If deemed suitable for surgery, the individual will proceed to the next steps in the process.
2. Preparing for Surgery
Prior to the actual surgery, FTM individuals may undergo a process known as genital electrolysis. This involves removing the hair follicles from the genital region through electrolysis. Genital electrolysis helps to reduce the risk of hair regrowth inside the neopenis after surgery.
Additionally, patients may need to stop taking certain medications, such as blood thinners, in preparation for surgery. This ensures a safe and successful surgical experience.
The medical team will provide detailed instructions on pre-surgery care and any necessary lifestyle adjustments, such as quitting smoking or losing excess weight, to optimize surgical outcomes.
3. Neophallus Construction
The neophallus, or neopenis, is the main focus of FTM bottom surgery. The construction of a neophallus involves several different surgical techniques, including:
a) Metoidioplasty: This procedure is suitable for individuals who have undergone significant hormone therapy and have experienced natural enlargement of the clitoris. The surgeon releases the clitoral ligaments and repositions the clitoris to create a small neophallus. The urethra may be rerouted to allow for urination through the neopenis.
b) Phalloplasty: Phalloplasty involves the construction of a neophallus using tissue grafts from different parts of the body, such as the forearm, thigh, or abdominal area. This procedure is more complex and typically requires multiple surgical stages. The neophallus created through phalloplasty can provide greater options for aesthetic appearance and potential erectile function.
c) Radial Forearm Free Flap: This specific technique utilizes a graft of skin and tissue from the forearm to construct the neophallus. The vascular and nerve structures in the forearm are carefully connected to ensure blood flow and sensation in the new phallus.
4. Scrotoplasty
Scrotoplasty involves the creation of a scrotum, which provides a more masculine appearance to the genital region. The scrotum can be constructed using tissue grafts from the labia majora or other donor sites, depending on the individual's preferences and surgical plan.
The surgeon carefully positions and shapes the scrotum to achieve a natural-looking result. Testicular implants may also be inserted to provide a further masculine appearance.
5. Vaginectomy and Hysterectomy
In FTM bottom surgery, the removal of the internal reproductive organs associated with female anatomy is typically performed. This includes a vaginectomy, which involves closing off the vaginal canal, and a hysterectomy to remove the uterus and cervix.
These procedures help to align the physical body with the individual's gender identity and eliminate the need for ongoing reproductive health care that may cause distress or dysphoria.
6. Urethral Lengthening
Urethral lengthening is an optional procedure that allows FTM individuals to urinate through the neopenis. It involves extending the urethra from its original location to the neophallus. This can improve convenience and reduce urination-related dysphoria.
The technique used for urethral lengthening can vary depending on the surgeon's expertise and the individual's specific needs. Common methods include the use of tissue grafts or the tubularization of existing tissue.
7. Post-Surgery Recovery
After FTM bottom surgery, individuals typically require a significant recovery period. The length of the recovery period can vary depending on the specific procedures performed and the individual's healing process.
Pain management, wound care, and regular follow-up appointments with the surgical team are important aspects of the recovery process. It is crucial to follow all post-operative instructions provided by the healthcare professionals to promote optimal healing and minimize complications.
During the recovery period, individuals may experience swelling, bruising, discomfort, and temporary limitations in physical activities. Emotional support and counseling may also be beneficial during this time as individuals adjust to their new physical appearance and potential changes in sexual function.
8. Risks and Complications
As with any surgical procedure, FTM bottom surgery carries certain risks and potential complications. These can include infection, bleeding, scarring, wound complications, unsatisfactory aesthetic results, and potential loss of sensation in specific areas.
It is crucial to have open and honest discussions with the surgical team about the potential risks and complications associated with FTM bottom surgery. Understanding these risks can help individuals make informed decisions and prepare themselves mentally and physically for the procedure.
Frequently Asked Questions (FAQs)
Q1. What is the required age for FTM bottom surgery?
A1. The age requirements for FTM bottom surgery vary depending on the country and the specific surgical procedures. In many cases, individuals need to be at least 18 years old to undergo FTM bottom surgery. However, individual circumstances, such as parental consent, hormonal therapy history, and psychological readiness, may also be taken into consideration.
Q2. Are the results of FTM bottom surgery permanent?
A2. The results of FTM bottom surgery are intended to be permanent. However, as with any surgical procedure, complications or revision surgeries may be necessary in certain cases. It is essential to discuss the potential for additional procedures or touch-ups with the surgical team during the initial consultation.
Q3. Will I be able to experience sexual pleasure after FTM bottom surgery?
A3. The potential for sexual pleasure after FTM bottom surgery can vary among individuals. Some surgical techniques, such as phalloplasty, may offer the possibility of aesthetic appearance and potential erectile function. However, it is important to discuss the specific sexual function expectations and limitations with the surgical team before undergoing the procedure.
References:
1. Schechter, L. S., & D'Ancona, G. (2017). Sex Reassignment Surgery: Current Concepts. Transgender Surgery and Medicine, 1–15. DOI: 10.1007/978-3-319-42901-0_1
2. Rotem, O., Peleg, R., & Farkas, A. (2017). Gender identity and body satisfaction in transgender and cisgender individuals: Exploring the roles of self-esteem, general self-efficacy, and social support. Sexual and Relationship Therapy, 1–19. DOI: 10.1080/14681994.2017.1398652
3. Morrison, S. D., Son, J., & Thai, N. (2018). Plastic and Reconstructive Surgery for Transgender Patients. Plastic and Reconstructive Surgery, 141(5), 729e–737e. DOI: 10.1097/PRS.0000000000004338
