Gender identity disorders: diagnostic and surgical aspects

Area of Science:

• Medical Science
• Surgical Procedures
• Gender Studies

Background:

• Transsexualism involves persistent cross-gender identification and discomfort with one's assigned sex.
• Diagnosis requires clinical distress and exclusion of intersex conditions, as per DSM-IV-TR criteria.
• Medical professionals assess eligibility for sex-reassignment treatment, including hormonal and surgical interventions.

Purpose of the Study:

• To outline the criteria and procedures for medical and surgical sex reassignment.
• To describe current surgical techniques for male-to-female and female-to-male genital reconstruction.
• To emphasize the importance of multidisciplinary teams for optimal outcomes.

Main Methods:

• Review of diagnostic criteria for gender dysphoria (transsexualism).
• Description of surgical techniques for male-to-female genital reassignment (vaginoplasty, clitoroplasty, vulvoplasty).
• Overview of emerging and alternative surgical methods for female-to-male genital reconstruction (neophallus creation, metoidoioplasty).

Main Results:

• Male-to-female genital surgery typically involves vaginoplasty using penoscrotal skin flaps.
• Standardized operative procedures for female-to-male genital reassignment are less established.
• Neophallus creation from free forearm flaps shows promise for female-to-male patients, alongside other reconstructive options.

Conclusions:

• Successful sex reassignment requires meeting specific diagnostic and treatment timelines (real-life experience, hormonal therapy).
• Surgical approaches for male-to-female transition are relatively standardized.
• Advancements in female-to-male reconstructive surgery, particularly neophallus creation, offer new possibilities.
• Optimal results in gender reassignment surgery are achieved through collaboration within multidisciplinary teams at high-volume centers.