Gender Reassignment Surgery Before And After Mtf Transition

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And Now You Must Adjust To Your Brand-New Genitalia

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When you get a new sex organ a couple decades into life, it takes some getting used to. "Just peeing was a whole new experience. I've always sat down to pee, but I still sometimes reach down to shake it off. It's the force of habit that's hard to, well, shake. A potentially embarrassing aspect is having to recalibrate your sense of bathroom timing; when I have to go now I'd better go! This has gotten a little better with time as my muscles get used to it, but I had some near-misses."

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And, of course, having a new fuck-zone makes that whole aspect of your life quite different. "But after being over the 'new' part of it, it feels natural in a way it never did before. I wasn't joking earlier about wanting to cry after sex; it never felt right, and it created a wall between me and anyone I was intimate with." And note that there are a few differences between a surgery-built vagina and one that just grows in the traditional way. Namely, lubrication. "What male bodies obviously don't grow are lubricating ducts for the vaginal wall. After surgery, you'll always need lube for sex, and with the aftercare being what it is I feel I should get a sponsorship from Durex."

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Or at least a "sixth one free" punch card.

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Nora didn't view her surgery as just transitioning from a penis to a vagina. "I went from nothing to something, from not having a vagina to having one. I never felt like I had genitalia of my own before; the thing was just there, it didn't belong to me. It was a cruel joke. I couldn't even talk about it in terms like 'my penis'; it was 'that thing.' Now I do have private parts, and it's liberating and empowering. It's not been all that long and already I can hardly remember what it felt like, physically, to have that other thing."

This actually hits on a major misconception people have about transgender people, viewing them as men who want to be women. Nora says, "I wasn't a boy who wanted to be a girl. I was an unhappy girl who wanted to be a happy one. Without understanding that, having an understanding of transsexuality is not possible. I have ambitions now, motivations; I enjoy life, and I enjoy people. The surgery didn't magically make me happy, but it took away a lot of barriers and allowed me to work towards the life I want for myself, just like anyone else."

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Surgery below the belt; results above the shoulders.

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Now, we're not trying to publish an advertisement for gender reassignment surgery here. There is very little long-term data on the effects. The best evidence we have suggests it does have a positive mental health impact on most patients (weirdly enough, results tend to be better for people who transition from female to male than male to female -- nobody knows why), but gender reassignment patients do still have an elevated suicide risk compared to the general population. Not just because patients still face a stigma (again, you're having to explain this to every single person in your life) but because gender identity issues have so dominated their lives that they're not sure how to move on.

"Many -- too many -- people get post-operative depression. Not because they regret it but because they've spent so much time and effort into working towards it that when it's over they have little left going on." That, by the way, was why the counselors kept prodding her about her career and life goals. "The clinic wants to know there is more to your life than transition, because when it's all your life is about it can be a red flag." You spend your youth wishing you could live your life as a woman, but once you accomplish that goal, you then have to actually go out and live your life as a woman. That's not the end of a story -- it's the beginning of one.

Knowledge is power, so get you some. Be sure to check out 5 Shocking Realities oF Being Transgender The Media Ignores and 6 Awful Lessons I Learned Transitioning From Female To Male.

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Gender-confirmation surgeries—the name given to procedures that change the physical appearance and function of sexual characteristics—increased by 20 percent from 2015 to 2016 in the U.S., with more than 3,000 such operations performed last year. Rates are also increasing worldwide. Now, at least one surgeon is reporting a trend of regret. 

Urologist Miroslav Djordjevic, who specializes in gender reassignment surgery, has seen an increase in “reversal” surgeries among transgender women who want their male genitalia back. In the past five years, Djordjevic performed seven reversals in his clinic in Belgrade, Serbia. The urologist explains to The Telegraph that those who want the reversal display high levels of depression, and in some instances, suicidal thoughts. Other researchers also report hearing about such regrets. 

Related: Transgender teen repeatedly stabbed in genitals; LGBT advocates battling for hate crime classification

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“It can be a real disaster to hear these stories,” Djordjevic told The Telegraph.

Charles Kane, who identified as Sam Hashimi after male-to-female reassignment surgery, opted to become a man again after experiencing “hormonal regret.” In the BBC documentary One Life: Make Me a Man Again, Kane explained he originally wanted to become a woman after a nervous breakdown.

“When I was in the psychiatric hospital, there was a man on one side of me who thought he was King George and another guy on the other side who thought he was Jesus Christ. I decided I was Sam,” Kane said.

Postsurgery, Kane believed his female identity would never be liked or accepted as a real woman. He also blamed the influence of female hormones as responsible for making him seek the surgery. “I don’t think there’s anyone born transsexual. Areas of their human brain get altered by female hormones,” Kane told Nightline.

Kane’s insight may not be applicable to all transgender patients seeking reversal surgery. Djordjevic expresses concern about the psychiatric evaluation and counseling that take place prior to the gender reassignment surgery. He recalls patients telling him that when they inquired about the procedure at other clinics, they receive minimal information before being asked for proof that they could pay for the operation.

In Djordjevic’s practice, patients undergo a minimum of one to two years of psychiatric evaluation, accompanied by hormonal evaluation and therapy. Prior to the surgery, he asks patients for two professional letters of recommendation. After the procedure, he strives to remain in contact—he talks with 80 percent of his former patients, The Telegraph reports.

Related: What’s the cultural impact of transgender characters on TV?

A 2011 study found that after sex reassignment surgery, more than 300 Swedish transsexuals faced a higher risk for mortality, suicide ideation, and psychiatric issues compared to the rest of the population. The researchers concluded, “Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.”

In male-to-female reassignment surgery, doctors will reshape the male genitals in the form of a vagina. The surgery also includes removing the testicles and an inversion of the penis. In female-to-male procedures, doctors remove the breasts, uterus and ovaries and extend the urethra so a transgender man can urinate standing up. Male-to-female reassignments are more common because they are considered less expensive and more successful.

Gender reassignment surgeries are expensive. Male-to-female procedures cost between $7,000 and $24,000, and the cost of female-to-male procedures can reach $50,000. The complications and the expense warrant extra care from doctors performing these reassignments. “Ethically, we have to help any person,” says Djordjevic, “in the best possible way.”

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