Page 56 - Hospital Authority Convention 2017

Corporate Scholarship Presentations
HOSPITAL AUTHORITY CONVENTION 2017

C1.3 Medical 10:45 Room 428

“Sex Reassignment Surgery” – to Falsify or to Rectify the Body
Chan CK
Department of Surgery, Prince of Wales Hospital, Hong Kong
Transsexualism was first coined in 1970s, it was renamed gender identity disorder (GID) later in 1990, which is defined as a
strong and persistent cross-gender identification with the patient’s persistent discomfort with his or her own sex and a sense
of inappropriateness in the gender role of that sex (Diagnostic and Statistical Manual of Mental Disorders, fourth revision,
text revision [DSM-IV-TR]). Currently it is named gender dysphoria (GD) (DSM V) to emphasise the fact that individuals being
bothered by this condition are not having genuine mental disorder.
The disturbance (not disorder) is not concurrent with a physical intersex condition and causes clinical distress or impairment
in social, occupational, or other important areas of functioning. Besides, it affects all adaptive physical and psychosocial
aspects of a person. Its diagnosis, however, is based solely on the history and personal perceptions.
The medical professional/clinician is obliged to find out if the individual meets the criteria of an irreversible gender
transposition, and if he or she will benefit from medical (hormonal and surgical) sex-reassignment treatment. If a patient
has absolved 12 months of real-life experience and at least 12 months of continuous hormonal treatment, the indication for
surgical sex reassignment may be offered.

Treatment for GD individuals includes social and psychological support, cross-hormone treatment, and sex reassignment
surgeries (SRS), which is considered to be the most effective treatment to date that can significantly relieve the psychological
stress imposed on those individuals.

Genital SRS in male-to-female (MtF) transsexuals includes vaginoplasty (for the vaginal lining and inversion of the penile-
scrotal skin flaps remain the technique of choice), clitoroplasty and vulvoplasty. The operation may be performed in one or
two stages.

In contrast to genital reassignment in MtF patients, no operative standards are available in female-to-male (FtM) subjects.
Recently, neophallus creation from sensate free forearm flaps (the radial forearm flap) has emerged as the most promising
approach for those patients who want to have a neophallus. Other alternatives such as metoidoioplasty or neophallus
reconstruction from regional flaps (e.g. abdominopubic flap, anterolateral thigh flap) exist, but are also accompanied by
multiple possible complications and re-interventions.

The SRS is complex and requires not only coordination of multiple procedures, but also lifetime follow-up of transsexual
individuals. Best results are to be expected when using multidisciplinary teams of urologists, plastic surgeons,
gynaecologists, and experts in sexual medicine in large-volume centres.

Wednesday, 17 May

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