Gender dysphoria: 34-year-old woman undergoes phalloplasty to become a man

New Delhi, Nov 21 (PTI) A 34-year-old woman from Uttar Pradesh, who was suffering from gender dysphoria, has got herself clinically transformed into a man after undergoing a surgery at a leading private hospital in Delhi, doctors said on Monday.

Gender dysphoria is a term that describes a sense of unease or psychological discomfort that a person may have because of a mismatch between their biological sex and their gender identity.

The department of plastic and cosmetic surgery at the Sir Ganga Ram Hospital (SGRH) had received a 34-year-old female, two months ago from Uttar Pradesh who wanted to get completely transformed into a male person.

"By all proportions and psychiatric evaluations, it was found that although the patient was female, but mentally she was a male, a condition which is called gender dysphoria.

"In last six years, she had already undergone bilateral breast removal in 2017 and uterus, ovary and vaginal removal in 2019. She was on male hormone replacement therapy since 2016," the hospital said in statement.

At the time of arrival at SGRH, the patient had "all male characteristics" including beard, hairs on chest, male voice and male behaviours, doctors said, adding that only requirement was "penile reconstruction (phalloplasty) and implant to transform her into a male.

"We decided to perform penile reconstruction (phalloplasty) for complete male transformation by state-of-the-art micro-surgical technique of tissue transfer. Our aim was to give good shape, length, urethra (to pass urine) and erotic sensation to the patient," said Dr Bheem Singh Nanda, senior consultant, department of plastic and cosmetic surgery at the hospital.

Of all the techniques, doctors chose forearm as donor for penile reconstruction. This was a "challenging surgery as the penis was fabricated on the forearm with preservation of vessels and all the important nerves," the hospital said.

The next step was to implant the reconstructed penis from the forearm to the genital area of the patient, doctor said.

The second challenge was to join the urethra (urine tube) and then connect the vessels to establish the blood circulation again in the reconstructed penis, Nanda was quoted as saying in the statement.

"The last and the most important step was to join the nerves of the reconstructed penis with the erotic nerves (pudendal nerve and nerve to clitoris) which is the most important pre-requisite for penile implant and sexual satisfaction later," he added.

It was a successful surgery which took about eight hours with minimal blood loss. Six weeks post-surgery, the patient is completely male with five inches of male sexual organ (penis), the hospital claimed, adding, she has changed her female name into a male name, and "passes urine in standing position and uses male urinal".

The person is "now married to the woman", who was the "love of his life" since student days, the hospital claimed.

"Phalloplasty has matured considerably over the last decades in reconstructive options and technical refinements, thanks to increasing recognition of gender dysphoria. The primary goals of performing a phalloplasty are to facilitate sexual penetration, protective sensation, orgasm, standing micturition, and natural aesthetic, ideally in few stages and with minimal morbidity," Nanda said.

Radial forearm free flap and anterolateral flap are the most common options, each with a unique profile of complications, aesthetic, and functional outcomes, the doctor said.

"Choices for reconstruction must be tailored to the individual patient's goals and available tissue characteristics. In her case, we chose radial forearm flap technique because it gives better shape, urethra quality and good sensation as compared to other techniques," he said.

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