How does a transgender man come to orgasm

THE OP course : This is how the sex is changed

People who cannot identify with their innate gender are called transsexuals or transgender. Science assumes that their orientation is innate and cannot be changed with psychotherapy or medication. Transsexuality is recognized as a disease; if there are several psychological confirmations, the health insurers pay at least some of the operations that adjust the body to the opposite sex.

Men who want to live as women (“trans women”) require at least three operations, namely “genital adjustment, a breast and a larynx operation to reduce the size of the Adam’s apple”, as Dirk Elling, chief physician at the women's clinic at Sana-Klinikum in Lichtenberg, explains. The genital adjustment procedure is the most complex and risky one. It takes at least four hours. The patient is under general anesthesia. The skills and experience of the surgeons are crucial for a good result. Before the operation can take place, the man must have had female hormones for at least a year. They stop beard growth and make the entire body look more feminine.

Bleeding and infection can result

In men and women, doctors try to use the existing sexual organs (which also contain the nerves that are important for sexuality) to shape those of the opposite sex. In “trans men” the uterus and ovaries are removed, the large labia become a scrotum, the clitoris and skin from other parts of the body become a penis. In the case of "trans women", the operation takes place in the opposite direction. "First you create a tunnel between the rectum and urethra and remove muscles, fat and connective tissue," explains Dirk Elling, who regularly performs the operations. The resulting cavity extends to the peritoneum wall. The prostate has become very small due to the female hormones, it no longer plays a role and can remain in the body.

Now the penis follows. Its erectile tissue - vascular plexuses that fill with blood during an erection - are completely removed like the testicles. The penis seam, the skin on the underside of the penis, is turned inside out and used to line the previously created tunnel. The labia are formed from the skin of the scrotum, and the clitoris is formed from the glans, which is one of the strongest erogenous zones and is of great importance for orgasm. The aim is to enable patients to have sex even after the operation. The urethra can remain; it is shortened and implanted into the skin of the "turned-in" penis.

Possible complications are bleeding and infection. After the operation, the patients have to stay in the hospital for about two weeks and then wear a silicone phallus in the "tunnel" for at least three months, otherwise the cavity will close again with new tissue.

The "OP course" ends with this episode. In the next week our new column "The culprits" starts, in which we introduce pathogens.

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