Review
Evaluation of surgical procedures for sex reassignment: a systematic review

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Summary

Objectives

To evaluate earlier reviews and literature concerning five individual surgical procedures for male-to-female (MTF) transsexism: clitoroplasty, labiaplasty, orchidectomy, penectomy and vaginoplasty. Further evaluations were made of eight surgical procedures for female-to-male (FTM) transsexism: hysterectomy, mastectomy, metoidoplasty, phalloplasty, salpingo-oophorectomy, scrotoplasty/placement of testicular prostheses, urethroplasty and vaginectomy.

Background

Increased prevalence and advances in surgical options available to patients requesting gender reassignment surgery have made this an important consideration for research. There remains a lack of systematic reviewing of the evidence, in particular, of the individual surgical options available.

Methods

Searches were undertaken in six electronic databases (Applied Social Sciences Index and Abstracts [ASSIA], Cochrane Library [Wiley Online], Embase [Ovid Online], Medline [Ovid Online], Medline in Process [Ovid Online], Psycinfo) providing coverage of the biomedical, grey literature and current research.

Results

Eighty-two published papers (38 MTF; 44 FTM) met the inclusion criteria identified across the 13 surgical procedures. For MTF transsexism there was no evidence satisfying the inclusion criteria concerning labiaplasty, penectomy or orchidectomy procedures. A large amount of evidence was available concerning vaginoplasty and clitoroplasty procedures. For FTM transsexism satisfactory outcomes were reported. Outcomes related to the ability to perform sexual intercourse, achieve orgasm and void whilst standing. Some complications were reported for both MTF and FTM procedures.

Conclusions

The evidence concerning gender reassignment surgery in both MTF and FTM transsexism has several limitations in terms of: (a) lack of controlled studies, (b) evidence has not collected data prospectively, (c) high loss to follow up and (d) lack of validated assessment measures. Some satisfactory outcomes were reported, but the magnitude of benefit and harm for individual surgical procedures cannot be estimated accurately using the current available evidence.

Section snippets

Transsexism and GRS

The process by which a person comes to receive GRS is complex and occurs over a series of stages. The Harry Benjamin International Gender Dysphoria Association (HBIGDA)2 has provided a set of standards that have been widely adopted by service providers. In the UK, transsexuals typically receive a diagnosis of GID by a psychologist (e.g. mental health professional, clinical psychologist) or psychiatrist. A medical consultant may then prescribe the patient with hormones. In general, persons with

Sources searched

Searches were undertaken in six electronic databases (Applied Social Sciences Index and Abstracts [ASSIA], Cochrane Library [Wiley Online], Embase [Ovid Online], Medline [Ovid Online], Medline in Process [Ovid Online], Psycinfo) providing coverage of the biomedical, grey literature and current research. The publication lists, current research registers, and health services research related organizations were consulted via the world wide web (www). Keyword searching of the www was undertaken

Results

A total of 1170 references were screened which identified 117 published papers concerned with core surgical procedures.

Discussion

In the first section concerning MTF surgical procedures, 38 published papers met the inclusion criteria (23 case series and 15 case studies) with an additional 13 papers excluded (four case series, three case studies, four reviews, one prospective non-randomized controlled study, one expert opinion). The level of included evidence was of poor quality.9 There was a clear lack of randomized controlled evidence and only one excluded study included a control group comparison. No studies met the

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    Copyright © 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd All rights reserved.