Male-to-female surgery

• Feminising genitoplasty (vaginoplasty)

Intended to achieve harmony between gender and sex, adapting the genitalia from birth to the desired gender, both from an aesthetic and functional point of view. 

Two main surgical techniques are used to perform feminising genitoplasty: penile inversion or pedicled rectosigmoid flap. The aim of both is to create a neovagina according to the chosen technique, as well as the construction of a vulva (female external genitalia). The latter consists of the design and construction of the labia minora, labia majora, clitoris and clitoral hood. 

• Penile inversion 

The standard feminising genitoplasty or vaginoplasty procedure is penile inversion. This type of gender affirming surgery involves making a neovagina that is covered with the inverted skin of the penis and scrotum. The purpose of vaginoplasty is to create genitalia that is as similar to female genitalia as possible, in terms of anatomy, aesthetics and function. 

• Pedicled rectosigmoid flap 

Feminising genitoplasty, pedicled rectosigmoid flap vaginoplasty or colon-vaginoplasty is a surgical procedure that involves using a section of the terminal large bowel (sigmoid colon) to produce a neovagina. This technique is only performed in cases where penile inversion vaginoplasty is not possible. This may be because the penis does not have enough skin, because it is circumcised, or for other reasons. In such cases penile inversion vaginoplasty would not allow sufficient vaginal depth and therefore the pedicled rectosigmoid flap technique is used. 

• Voice feminisation surgery 

Voice feminisation is a process designed to achieve a voice with female characteristics. The female voice has several specific qualities in terms of pitch, timbre, modulation, intensity, gesture, and even vocabulary, which make us quickly associate it with the female gender. All aspects must therefore be worked on in a coordinated manner with the help of an expert team including speech and language therapists.  

There are several procedures that can be performed to feminise the voice, either externally or through the mouth (transoral).

• Wendler glottoplasty 

A Wendler glottoplasty involves suturing the front of the vocal cords to reduce the size of the glottis (upper part of the larynx). This shortens the vocal folds and increases their vibratory tension, which ultimately results in a higher pitched voice.     

The surgery is performed under general anaesthetic with the aid of a microscope and requires 7-10 days of post-operative vocal rest.  

• Laser Assisted Voice Adjustment (LAVA) 

Wendler glottoplasty can be performed alone or in combination with another procedure called LAVA (Laser Assisted Voice Adjustment). The LAVA technique involves ablating (removing) the upper portion of the vocal cords with a carbonic laser to reduce their mass. Subsequent lateral scarring provides increased tension on the free edge of the cord, further raising the pitch of the voice.