In this video, William Kuzon, MD, demonstrates a genital sex reassignment procedure in a 41-year-old transwoman. Dr. Kuzon discusses the importance of ensuring that patients for this procedure have met the criteria set forth by the World Professional Association for Transgendered Health (WPATH) including adaption to hormonal therapy and living full-time in the female gender for more than one year. Preoperatively, he also discusses the importance of confirming normal male anatomy with no testicular mass or in-groinal hernias, which would complicate the planned procedure.
In collaboration with a urologist, Dr. Kuzon demonstrates the procedure for designing the flap which will become the back wall of the new vagina, prior to dissecting the bulbocavernosus and identifying the juncture of the anal sphincter. He performs an orchiectomy and then the penis is degloved and the penile skin tube separated from the penile corporal bodies. The dorsal neurovascular bundle is isolated and a portion of the glans harvested to form the neo clitoris. The corpus spongiosum is then separated from the corpora cavernosa and a catheter inserted into the urethra. Dr. Kuzon demonstrates the blunt dissection of the new vagina and discusses the risks of rectal tear and rectal vaginal fistula. Finally, he demonstrates the placement of the neo clitoris on the midline, the anchoring of the penile urethra, the inversion of the penile tissue and the trimming and position of the remaining scrotal skin to form the new labia.