Reversal Surgery in Regretful Male to Female Transsexuals After Sex Reassignment Surgery.
INTRODUCTION Sex reassignment surgery (SRS) has proved an effective intervention for patients with gender identity disorder. However, misdiagnosed patients sometimes regret their decision and request reversal surgery. This review is based on our experience with seven patients who regretted their decision to undergo male to female SRS. AIMS To analyze retrospectively seven patients who underwent reversal surgery after regretting their decision to undergo male to female SRS elsewhere. METHODS From November 2010 through November 2014, seven men 33 to 53 years old with previous male to female SRS underwent reversal phalloplasty. Preoperatively, they were examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia with scrotoplasty and urethral lengthening, total phalloplasty with microvascular transfer of a musculocutaneous latissimus dorsi flap, and neophallus urethroplasty with penile prosthesis implantation. MAIN OUTCOME MEASURES Self reported esthetic and psychosexual status after reversion surgery and International Index of Erectile Function scores for sexual health after phalloplasty and penile prosthesis implantation. RESULTS Follow up was 13 to 61 months (mean 31 months) Good postoperative results were achieved in all patients. In four patients, all surgical steps were completed; two patients are currently waiting for penile implants; and one patient decided against the penile prosthesis. Complications were related to urethral lengthening: two fistulas and one stricture were observed. All complications were repaired by minor revision. According to patients' self reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status. CONCLUSION Reversal surgery in regretful male to female transsexuals after SRS represents a complex, multistage procedure with satisfactory outcomes. Further insight into the characteristics of persons who regret their decision postoperatively would facilitate better future selection of applicants eligible for SRS.
The journal of sexual medicine