Sex Reassignment Surgery
Iran is one of the few countries that legally and medically performs gender reassignment surgery. It is also the only Islamic country in the world that legally and religiously allows this surgery for Muslim transgender individuals.
Despite its long history and a significant number of surgeries in this field, Iran has become one of the best medical destinations for gender reassignment surgery worldwide.
Gender reassignment encompasses surgical procedures used to treat transgender individuals. If you have an undefined gender identity, you have likely heard of this surgery. Gender reassignment surgeries aim to align individuals’ physical gender with their true gender identity. The most significant of these surgeries is vaginoplasty, a procedure in which the male genitalia is reconstructed into a vagina, referred to as a neovagina.
Who is suitable for gender reassignment surgery?
The decision to undergo gender reassignment surgery is entirely a personal choice. You should choose this method based on your own needs and circumstances, not to fulfill the expectations of others or conform to different societal norms. Gender reassignment surgery is applicable in the following cases:
In individuals with confirmed intersex conditions. This means that, for example, a person is born with a male body but genetically female. In such cases, gender reassignment surgery can be used to align their physical gender with their true gender identity.
Video on how to perform SRS.
Who is suitable for gender reassignment surgery?
Individuals who have undergone mental health care and specialists have diagnosed them as transgender.
They have the ability to live as their affirmed gender.
They are 18 years of age or older.
They have realistic expectations.
They have physical and mental well-being and stability.
The goal of male-to-female gender reassignment surgery is to change male genitalia into female genitalia.
Male-to-female gender reassignment surgery is usually done in a single stage.
There are various methods for this surgery, but the most common one involves vaginoplasty, where male genitalia are carefully preserved, and their blood vessels and nerves are used to create a sensitive, sexually functional neovagina. The scrotal tissue is often used to create a clitoris, and a cavity is constructed inside the lower abdomen to simulate the role of a vagina.
There are several steps that patients should take before undergoing vaginoplasty surgery:
- Trim or shave the pubic area: The first step is to trim or shave excess hair around the scrotum and the genital area. This is because during vaginoplasty surgery, the skin in this area is used to create the neovagina. Having hair inside the vagina can lead to hygiene issues.
- Quit smoking: If you are a smoker, it is essential to quit smoking at least two months before surgery. Smoking or using any form of tobacco products reduces blood flow to the genital area and can slow down the post-surgery recovery process.
- Manage your weight: Keep in mind that individuals with a body mass index (BMI) of over 35 are at higher risk during surgery, and their recovery may be slower. However, BMI is not the sole criterion for assessing individuals’ health status. Before surgery, the patient’s weight and overall health will be evaluated. If it is determined that weight loss is beneficial and can contribute to a faster recovery, the patient should lose weight before the surgery. In some cases, depending on an individual’s weight and body shape, vaginoplasty may not be feasible.
- Hormone therapy: Hormone therapy is typically a consistent part of the treatment process. In feminizing hormone therapy, testosterone is replaced with female hormones. Estrogen is used in this process, which reduces the level of testosterone in the body and promotes the development of secondary female sexual characteristics. Hormone therapy may be used alone or in conjunction with gender reassignment surgery.
It’s important to note that hormone therapy alone may not be suitable for everyone, as it may affect fertility and lead to sexual and general health issues.
The detailed procedure of vaginoplasty for gender reassignment varies based on the surgeon’s expertise and the patient’s individual circumstances. However, in general, male-to-female vaginoplasty involves the following steps:
- Anesthesia and Preparation: During vaginoplasty surgery, the patient is placed under general anesthesia and positioned with their legs raised. The surgery typically takes between three to five hours. The surgical team prepares the surgical site, ensuring it is clean and ready for the procedure.
- Incision: The surgery begins by making an incision along the midline of the genital area. This incision exposes the cavernous bodies, neural structures, and vascular structures of the penis. The precise location and length of the incision may vary depending on the surgical technique and the patient’s specific condition.
- Separation of Genitalia: The surgeon carefully opens the penile skin, separates the erectile tissue (corpora cavernosa), and preserves the neural and vascular structures. Part of the erectile tissue is used to create the clitoris, while the majority of the penile skin is used to construct the vaginal lining. The remaining male genitalia, such as the corpus spongiosum responsible for urethral function, are shortened, and the urethral opening is relocated to the top of the vaginal entrance. The surrounding tissues responsible for ejaculation are often retained, but minimized to prevent complications and preserve sexual function. In some cases, the remaining urethral tissue can be used to create the labia minora or be incorporated inside the vagina.
- Preparation of Scrotal Skin: The spermatic cords are cut, and the testes are removed. The remaining scrotal skin and the skin around the genital area are used to create the labia majora and labia minora. In some cases, the remaining scrotal skin can be used to form a vaginal canal extension added to the vaginal entrance to increase the depth of the neovagina.
- Vaginal Construction: The anatomical space where the neovagina will be located is between the bladder and rectum. Technically, this part of the surgery is the most complex. After creating the vaginal space, the penile skin is inverted into this space to form the vaginal lining. The depth of the neovagina that can be achieved varies based on individual factors such as the length of the genitalia, the amount of scrotal skin available, and the internal anatomy of the patient. Surgeons can typically create a depth of about 10 centimeters.
- Clitoral Hood: The next step involves creating the clitoral hood. The hood is typically made from a part of the genital tissue, and care is taken to preserve neural and vascular structures during this process. The clitoris is positioned at the top of the vaginal entrance, allowing for future sexual pleasure.
- Labiaplasty: Once the neovagina is constructed and other desired modifications are completed, the surgeon performs labiaplasty, which involves transforming the scrotal skin and any additional excess skin into the labia majora and labia minora for aesthetic purposes. Labiaplasty can be done either during the primary surgery or as a separate procedure at a later time.
- Closure of Incisions: After the neovagina is created and any desired enhancements are made, the surgeon carefully sutures the incisions to ensure proper wound closure and aesthetics. Post-surgery, pressure dressings are used, and the patient is usually required to use a urinary catheter for at least two weeks.
It’s important to note that the exact techniques and steps may vary depending on the surgical approach and the individual patient’s needs and anatomy. The procedure is highly specialized and should be performed by a qualified surgeon experienced in gender-affirming surgeries. After the surgery, patients typically undergo a period of recovery and follow-up care.
Recovery and Healing
After vaginoplasty by inversion of the genital organs, special sutures or bands are placed inside the vagina, which remain in place for 5 to 7 days. After removing these bands, the patient is taught how to use dilators to expand the vagina. From the second week onwards, the individual will begin to feel better, and complete recovery may take between 6 to 12 weeks.
Here are the guidelines to follow during the recovery period:
Avoid engaging in any strenuous activities for 6 weeks. Refrain from swimming and cycling for 3 months.
Sitting may be uncomfortable during the first month after surgery, but it is not dangerous. To reduce pain and discomfort, you can use donut-shaped cushions when sitting.
You can take a bath after the initial examination, but you should thoroughly dry the incision areas. Avoid taking baths for the first 8 weeks after surgery.
Swelling of the labia is natural for 6 to 8 weeks after surgery. Swelling can be intensified due to prolonged sitting or standing. During the first week after surgery, you can apply an ice pack to the perineal area for 20 minutes every hour to reduce swelling.
You can resume sexual intercourse about 3 months after surgery, unless your doctor recommends otherwise.
Before and after any sexual contact, make sure to clean the area. Take a shower every day. During washing, clean your body from front to back to prevent rectal bacteria from entering the vagina. Avoid wearing tight-fitting clothes, as they can lead to infection.
Expect yellowish to brownish vaginal discharge for 4 to 6 weeks after surgery. In the first 8 weeks after surgery, some bleeding and spotting are normal. Taking showers and washing the area with specific soaps can help reduce these issues. Using chamomile or witch hazel soap aids in cleansing the new vagina.
Smoking and Tobacco:
Avoid smoking and all forms of tobacco use for the first month after surgery as they can slow down the healing process.
After the operation, start with a liquid diet and gradually introduce solid foods. You may be prescribed anti-nausea medication. Pain medications can cause constipation, so you may also be given a laxative.
Pain after surgery is normal, and you will be prescribed pain medication. Take pain medications as instructed by your doctor.
Dilation is an essential part of the recovery process. After the operation, you will be taught how to use dilators to expand the vagina. Dilators help maintain the depth and width of the newly constructed vagina.
One crucial aspect of vaginoplasty recovery is vaginal dilation. Medical dilators are inserted into the vagina to maintain its size during the recovery period. The hospital may provide a set of dilators in various sizes for the patient. Your doctor will instruct you on how to use these dilators. It may be challenging at first, but healthcare professionals will help you navigate this phase of your treatment. You should start with the smallest dilator and gradually progress to larger sizes. You need to use the dilator until you become accustomed to its size and then change to a larger one.
During the first week after surgery, you should use the dilator twice a day, each time for 15 minutes. It’s essential to start dilation immediately after surgery to prevent changes in the depth and width of the vagina. Patients should continue dilation as long as the doctor recommends. Some patients may need to use dilators for the rest of their lives.
Different surgical techniques come with various complications. For example, individuals undergoing surgery may experience changes in their sexual sensations or encounter difficulties in bladder emptying. Generally, if an experienced surgeon performs the surgery, the risk of side effects is significantly reduced.
The side effects and risks of gender confirmation surgery include, but are not limited to, the following:
- Poor wound healing
- Hematoma or bruising
- Nerve damage
- Vaginal stenosis (narrowing)
- Vaginal depth reduction
- Injury to the urethra
- Adhesions between the urethra and skin or the formation of fistulas
- Painful intercourse
Gender Confirmation Surgery Procedures:
There are several secondary surgical procedures that transgender individuals can undergo to achieve a more suitable appearance. These surgeries include:
Top Surgery: In top surgery, the individual undergoes breast augmentation to change the appearance of the chest to appear more feminine. This is typically achieved with breast implants.
Facial Surgeries: Hormone therapy can help change the face after gender transition, but surgery can be a more effective way to make fundamental changes. Facial gender confirmation surgery can include various procedures to create more feminine features, such as changing the shape of the nose, brow lift (or forehead lift), chin reshaping, jaw and chin contouring, reducing the Adam’s apple, lip augmentation, hairline advancement, and earlobe reduction.
Research conducted in 2021 showed that 99% of individuals who underwent gender confirmation surgery did not regret their decision. This study, along with 27 other studies involving 8,000 transgender individuals, indicates that gender transition significantly reduces sexual dissatisfaction, depression, and suicidal tendencies in transgender individuals. Almost all of those who chose surgery were satisfied with their decision. Studies conducted in 2021 also showed that gender confirmation surgery is relatively low-risk. In general, the risks associated with gender confirmation surgery and mastectomy (breast removal) and breast augmentation are relatively low. The study confirmed that gender confirmation surgery reduces gender dysphoria, depression, and suicide to a significant degree and improves the quality of life significantly.
Gender confirmation surgeries can come with substantial costs, including surgical, anesthesia, hospitalization, and post-operative care expenses. The exact cost varies based on the surgical technique, the surgeon’s skill level, and the patient’s condition.
In the United States, the cost of surgery is around $45,000, and in Thailand, it’s approximately $30,000.
However, the cost of gender confirmation surgery in Iran is lower, with prices less than $12,000.
Iran is among the limited countries where gender confirmation surgery is performed and has experienced physicians in this field.
Gender Confirmation Surgery Approval in Iran:
Iran is known as the only Islamic country in the world that allows and considers gender confirmation surgeries legal and in accordance with Islamic law. Iran Medtour assists with obtaining gender confirmation surgery approval in Iran, as part of its services.
Here are some things to know before gender confirmation surgery:
Be prepared to lose or gain friends.
People may be surprised by your decision.
Be prepared for minor intrusions.
Prepare yourself for the culture of women’s beauty.
Seek guidance from a counselor.
Don’t expect gender confirmation surgery to solve all your problems.
If you want the best gender confirmation surgeons to perform your surgery in top-tier Iranian hospitals, all while experiencing a comfortable and stress-free treatment and staying in Iran at a reasonable cost, similar to your own home, take a look at the IranMedTour Sex Reassignment Surgery package. 😊