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Female to male gender reassignment surgery. Hysterectomy with bilateral salpingo-oophorectomy and vaginectomy are usually performed prior to external genitalia reconstruction. The key component of FTM genital reconstructive surgeries includes the creation of a neophallus which can be achieved by metoidioplasty or phalloplasty. In metoidioplasty, hypertrophied clitoris is mobilized with extension of the urethra to the tip using a flap of vaginal epithelium with resultant microphallus. Modern free flap (most commonly radial free forearm flap) phalloplasty results in much better cosmetic results. Urethroplasty (allowing for standing urination) and placement of testicular prosthesis with scrotoplasty (from labia majora) are the other components which complete the female to male genital reconstruction (b). a Represents anatomy prior to surgery for comparison
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Objectives
Gender dysphoria is defined as a conflict between the biological gender and the gender with which the person identifies. Gender reassignment therapy can alter external sexual features to resemble those of the desired gender and are broadly classified into two types, female to male (FTM) and male to female (MTF). In this paper we describe...
Citations
... Além disso, até mesmo o presente trabalho durante sua elaboração, mesmo buscando pontuar as inadequações observadas na revisão dos artigos selecionados, falhou ao usar como descritor e como parte do título o termo "cirurgia de redesignação sexual", uma vez que, como diz Shergill et al. (2019), a substituição dessa expressão pelo uso de "cirurgia de afirmação de gênero" carrega mais empatia e compaixão pelas pessoas que optam por passar por essa cirurgia. ...
Historicamente considerada como distúrbio mental, sendo desclassificada pela OMS em 2019, a transexualidade abrange 2% dos adultos brasileiros. A mudança de sexo envolve terapia hormonal e cirurgia, essa última podendo resultar em complicações impactadoras na qualidade de vida. Suporte e empatia dos profissionais de saúde influenciam a satisfação do paciente. Em relação à revisão sistemática da literatura, foi estudado sobre a satisfação e as expectativas da cirurgia de redesignação sexual em pacientes transexuais, comparando pré e pós-operados. A pesquisa envolveu 52 artigos nas bases de dados MEDLINE, LILACS e CAPES, com 17 estudos dos últimos cinco anos selecionados, excluindo revisões sistemáticas, integrativas e metanálises. Constatou-se que a patologização da transexualidade limita o acesso à saúde aos transexuais. A literatura sobre expectativas pós-cirúrgicas é escassa, principalmente para mulheres trans. A busca por redesignação sexual relaciona-se à humanização do corpo e ao reconhecimento social de gênero. Termos inadequados, como "transsexualismo", prejudicam a discussão temática, sendo crucial uma abordagem acolhedora dessa população nos serviços de saúde. Dessa forma, reconhece-se a importância da cirurgia para o bem-estar de transexuais que a desejam, apesar das divergências sobre sua necessidade na melhoria da qualidade de vida. Destaca-se o foco do acompanhamento pós-operatório em questões sociais, emocionais e familiares, além de aspectos técnicos ou estéticos. Palavras-chave: Cirurgia; Paciente; Sexo; Qualidade de Vida.
... In the immediate postoperative period, the neovagina is routinely dilated and supported by surgical packing (Fig.21) [36]. A Foley catheter is kept in until vaginal packing has been removed; vaginal packing is removed after about 5-7 postoperative days [35]. ...
Gender-affirming surgery (GAS) is increasingly being performed. GAS is tailored to the patient leading to a diverse spectrum of radiologic post-operative findings. Radiologists who are unfamiliar with expected anatomic alterations after GAS may misdiagnose important complications leading to adverse patient outcomes. This collaborative multi-institutional review aims to:Describe relevant embryology and native anatomy.
Describe relevant Gender-Affirming Surgery (GAS) techniques and expected neo-anatomy with associated complications, including common terminology.
Review expected imaging appearance of neo-anatomy/postoperative findings.
Review multi-modality [ultrasound, plain film, retrograde urethrogram, computed tomography] emergent imaging findings.
Understand unique patient evaluation and imaging protocol considerations in the GAS population.
Discuss pearls and pitfalls of imaging in the acute post-GAS setting.
... The legislature under the state is bound, among other things, to provide for all citizens within its available resources, facilities for work, and adequate livelihood with all proper rest and leisure (Farhat et al., 2020). The policy for self-perception of the transgender community is considered in this research as the ultimate reflection of continuous marginalization systematically and constitutionally (Shergill et al., 2019). It provides a lack of rights and access to social services (Ismail & Shah, 2018). ...
... Historically, there has been little published within the radiology literature on topics of transgender health [8,33]. More recently, the number of transgender health-related publications within the radiology literature has increased, many of which focus on breast imaging or imaging in the postoperative setting after genderaffirming surgery or relate to retrospective analyses or small case studies [34][35][36][37][38][39][40][41]. The National Institutes of Health Sexual & Gender Minority Research Office was established in 2015 with a mission outlined in the fiscal year 2021-2025 strategic plan to "ensure sexual and gender minority populations are considered and represented in research activities across the agency" [42]. ...
Transgender people have a gender identity that differs from their natal sex and experience many forms of discrimination, including within the health care field. Although transgender patients only comprise 0.6% of the adult US population, they frequently require imaging evaluation. Few published articles provide data-driven research on optimizing education of the radiology care team and delivery of inclusive and respectful imaging care to this vulnerable population; existing data suggest prior areas of success and prior areas of failure. Here, we offer specific recommendations on how radiology care team members can better serve transgender patients and begin generating much needed evidence-based best practices to improve their imaging health and care.
... The most common complications are given in Table 2 [17][18][19]. Routine post-operative evaluation is not typically recommended for the genital surgeries [7]. ...
Gender-affirming surgery is becoming more accessible, and radiologists must be familiar with both terminology and anatomy following gender-affirming surgical procedures. This essay will review the most common gender-affirming genital surgeries, their post-operative anatomy, and common complications by providing intraoperative photographs, illustrations, and cross-sectional images. Routine radiologic imaging recommendations for transgender patients will also be reviewed.
... Complications of vaginoplasty may occur in the immediate, early (days to weeks), or late (months to years) postoperative periods [8,9,20]. Wound complications include dehiscence, necrosis, cellulitis, bleeding, fistula, and perioperative fluid collections such as hematoma and abscess (Fig. 5) [35]. Perioperative fluid collections are readily assessed with crosssectional imaging and may be treated with image-guided drainage. ...
... Late complications of vaginoplasty include neovaginal stenosis (Fig. 6) and neovaginal prolapse, usually diagnosed by patient report or on clinical exam [35]. Correction usually requires revision surgery, highlighting the importance of preventative measures of neovaginal dilation and sacrospinous ligament fixation [17,39,40]. ...
Gender-affirming surgery is a group of surgical procedures that alters the physical appearance of a transgender person to resemble that socially associated with their identified gender. Masculinization and feminization surgeries include chest and breast surgery as well as genital reconstruction. The genital reconstruction surgeries have unique anatomic imaging features and are associated with complications that may require radiologic evaluation. This review provides a review of the imaging anatomy, expected findings, and complications associated with gender-affirming surgeries.
Rationale and objectives:
Over 20% of the Lesbian, Gay, Bisexual, Queer or Questioning, Intersex, Asexual or Ally, and more (LGBTQIA+) community reports experiencing discrimination upon accessing health care, causing many to defer access to care and resulting in poorer outcomes. While members of this community routinely undergo imaging studies, little formal education exists within the field of radiology to review the unique health care needs of this population and the specific relevance to imaging, in addition to actionable methods to promote inclusion.
Materials and methods:
A 1-hour educational conference was held for a cohort of radiology resident physicians at our institution, in which topics including LGBTQIA+ health care disparities, clinical nuances relevant to the field of radiology, and actionable suggestions that both academic and private-practice centers can adopt to foster inclusion were presented. All attendees were required to complete a 12-question, multiple-choice preconference and postconference examination.
Results:
Median prelecture and postlecture quiz scores for four first-year radiology residents were 29% and 75%, for two second-year radiology residents were 29% and 63%, for two third-year radiology residents were 17% and 71%, and for three fourth-year radiology residents were 42% and 80%.
Conclusion:
Multiple areas of opportunity to foster LGBTQIA+ inclusion at the provider and administration levels currently exist throughout the field of radiology. A radiology-focused education module regarding clinical nuances, health care inequities, and ways to foster an inclusive environment with the LGBTQIA+ community is an effective way to promote learner knowledge.
Transgender and gender diverse (TGD) people experience health disparities, and many avoid necessary medical care because of fears of discrimination or mistreatment. Disparate care is further compounded by limited understanding of gender-affirming hormone therapy (GAHT) and gender-affirming surgery among the medical community. Specific to radiology, TGD patients report more negative imaging experiences than negative general health encounters, highlighting the need for guidance and best practices for inclusive imaging care. A patient's imaging journey provides numerous opportunities for improvement. Inclusive practice in a radiology department starts with ordering and scheduling the examination, facilitated by staff education on appropriate use of a patient's chosen name, gender identity, and pronouns. Contemporary electronic health record systems have the capacity for recording detailed sexual orientation and gender identity data, but staff must be trained to solicit and use this information. A welcoming environment can help TGD patients to feel safe during the imaging experience and may include institutional nondiscrimination policies, gender-neutral signage, and all-gender single-user dressing rooms and bathrooms. Image acquisition should be performed using trauma-informed and patient-centered care. Finally, radiologists should be aware of reporting considerations for TGD patients, such as avoiding the use of gender in reports when it is not medically relevant and using precise, respectful language for findings related to GAHT and gender-affirming surgical procedures. As a field, radiology has a range of opportunities for improving care delivery for TGD patients, and the authors summarize recommended best practices. See the invited commentary by Stowell in this issue. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
Partial or complete scrotal loss had a great impaction not only in man’s sexual performance, but also on the whole quality of his life. Understanding the pivotal role the scrotum plays in life is obviously revealed during evaluation of improper scrotal repair, which may end with infertility and psychic mishaps. Scrotal loss, necessitating scrotoplasty is commonly encountered in avulsion trauma along motor car accidents and after surgical removal. Also rare cases of congenital scrotal agenesis is another indication. Simply a superficial small defect can be closed by primary closure or skin grafting, but local flaps are indicated in cases of extensive scrotal loss. The all-encompassing term “scrotoplasty” generalises multiple interventions aiming to recreate a normal looking scrotum. Reconstruction of the scrotum after complete loss of the overlying skin is a challenging problem. Adequate counselling with patients and a multidisciplinary team are critical to set realistic expectations of scrotal reconstruction outcome with a native dynamic scrotum and to optimise immediate reconstruction outcome. Numerous techniques that have been described for scrotoplasty reflecting the challenge and complexity of this technique. The loose hanging nature of the scrotal skin, along with the rugae and unique surface characteristics, are difficult to replicate with any other method. Also the difficulty in reconstruction of scrotum lies in the fact that the blood supply to the scrotal skin is usually destroyed when the skin and dartos muscle are avulsed or involved in infective process. Bacterial flora of the perineum, difficulty of immobilization and contour of testes makes the task of testicular coverage more difficult. Although the regional flaps or skin grafts may indeed provide the semblance of a scrotal sac, but the flaps are frequently too thick and have altered texture and color characteristics. Furthermore, the skin grafts frequently allow for wound bed contraction and subsequent distorting contracture and deformity. The one reconstructive option that has allowed use of an identical substitute of the limited surface area of scrotum is tissue expansion. Common as well rare indications of scrotoplasty will be highlighted, and different modalities of reconstructions and their outcome will be discussed.
