[Vaginal hysterectomy and bilateral adnexectomy for female to male transsexuals in an interdisciplinary concept].

BACKGROUND: FtM reassignment surgeries are rare and require interdisciplinary cooperation of plastic surgeons and gynaecologists. There are only few homogeneous data and standardised recommendations about the operative access to hysterectomy and bilateral adnexectomy of FtM transsexual patients.

PATIENTS AND METHODS: Between 2006 and 2009 106 FtM transsexuals were hysterectomised in an interdisciplinary concept of plastic surgeons and gynaecologists in the Frauenklinik des Rotkreuzklinikums München. Firstly plastic surgeons performed a complete colpectomy, after that a vaginal hysterectomy with bilateral adnexectomy was carried out by gynaecologists. Simultaneously plastic surgeons performed a bilateral subcutaneous adenomammectomy on the FtM patients, and the removed vaginal tissue was prepared for preforming a new urethra. In the next step the vagina was closed by plastic surgeons and the urethra preformed.

RESULTS: In 103 of 106 cases (97.2%) hysterectomy and bilateral adnexectomy were performed through the vagina. The complication rate was 5.4%. The vaginal hysterectomy and the bilateral adnexectomy lasted 52 min on average.

DISCUSSION: Vaginal, abdominal or laparoscopic approaches provide possible operative access for hysterectomy and bilateral adnexectomy in FtM transsexuals. A data comparison shows that the rate of complications with our FtM transsexuals operated through the vagina was not higher than that with non-transsexual patients operated through the vagina for benign illnesses of the uterus. There are advantages of the vaginal hysterectomy for patients concerning a reduced occurrence of scars and avoiding injuries of the rectus muscle as an important precondition for phalloplasty. The bilaterally performed subcutaneous adenomammectomy and the preparation of the removed vaginal tissue for the preformation of the urethra can be carried out simultaneously, meaning that the time for operation and the stay in hospital will be shortened and costs will be reduced as well. The problem of a relatively narrow field for the operation will be minimised or even solved by the preceding colpectomy.

CONCLUSION: Realising the vaginal hysterectomy with bilateral vaginal adnexectomy after performing a total colpectomy from our point of view is the optimal choice concerning operative methods for reassignment surgeries.