To be able to undergo an orchiectomy or a vaginoplasty, you must be of legal age . Preperation Hormonal therapy (both estrogen and antiandrogen) is stopped two to three weeks before vaginoplasty. This has no immediate psychological effects: the patient’s own / endogenous hormones are indeed contained in the long term thanks to the treatment. It takes almost 6 weeks for the pituitary to wake up. However, this time is not long enough to, for example, freeze sperm just before the operation: spermatogenesis (the process of development of male germ cells (spermatogonia) into adult sperm) requires at least 3 months of normal testosterone. According to research, it is possible to freeze a testicle, but this technique does not provide a guaranteed result. If you do not yet have the desire for children, talk to your caregiver, your endocrinologist and the surgeon. Intervention During vaginal reconstruction, the contents of the penis, namely the corpora cavernosa, are almost completely removed. The skin of the penis is welded at the end and turned inward to create the walls of the vagina (which retains sensation). This means that the skin on the outside of the penis now covers the inside of the vagina. Sometimes the vagina is deepened with a skin graft. The testicles are also naturally removed, and the posterior part of the scrotum is used as a separate pad of skin to widen the entrance to the vagina. The tip of the glans, which is very sensitive, is completely dissociated from the corpora cavernosa and is used to reconstruct the clitoris, together with a certain amount of foreskin, with the help of which the labia minora can be reconstructed. The two outer parts of the scrotum help rebuild the labia majora. Urological aspects The outlet of the urethra is shortened to allow urination directly downwards, as is the case in a biological woman. The procedure also involves working anatomically between the rectum and the bladder to create a cavity that will accommodate the new vagina. The space between the rectum and the bladder is lined with nerves and muscles important for normal urinary function. Surgical treatment in this area can lead to impaired urinary function. This is why, immediately after surgery, it can sometimes be a bit painful to urinate at first. Most women can urinate again immediately after removing the urinary catheter. Some people have to wait a little longer for urinary function to normalize. The only urological complications are abnormalities in the direction of the urine stream. This normalizes most of the time over time. In very rare cases, a small surgical correction may still be necessary. A small number of patients may also have temporary mild incontinence problems after the operation., Follow-up: prosthesis and dilation During the period immediately following the operation and in a subsequent postoperative stage, a silicone prosthesis specially designed to obtain the maximum depth and width of the vagina and to maintain these dimensions is used. Subsequently, regular dilation of the vagina should also be carried out using this prosthesis or during coitus to ensure that the depth of the vagina is maintained. Risks and complications Possible complications during this procedure are hemorrhage and somewhat difficult healing at the entrance to the vagina. Fortunately, an extremely rare, but nonetheless serious complication is a perforation of the rectum causing a junction between the vagina and the rectum (rectovaginal fistula) and the elimination of stool through the vagina. In the presence of such a complication, the patient should temporarily pass stool using an artificial anus placed at the height of her abdomen. It is only after healing that the continuity of the digestive tract can be restored. Duration of hospitalization and convalescence Patients should always be hospitalized the day before the genital reassignment operation in order to undergo preoperative colonic preparation (intestinal purge). It is also indicated to undergo prior laser or electric hair removal of the genital area. On average, this gender reassignment operation requires hospitalization of 8 to 9 days. It is necessary to take into account an incapacity for work of six to eight weeks. In one in five patients, a slight cosmetic correction is still necessary afterwards, at the front of the vagina.

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Remember every patient's situation is unique and a personalized approach is crucial when considering testicular implantation or any medical procedure. ⁠Patients should feel comfortable discussing their concerns and asking questions during the consultation to make an informed decision about their health and well-being.
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