An Overview of FTM Bottom Surgery
For many patients who identify as FTM bottom surgery only consists of a hysterectomy. In other cases, patients also desire genital reconstructive procedures that either turn the clitoris or an erectile prosthetic and tissue grafts from elsewhere in the body to build a phallus. The choice depends on the needs of each individual patient with regard to the way they envision their genitals looking and functioning when they take on their male sexual identity.
In general terms, hysterectomy refers to removing the uterus. Sometimes this takes place with bilateral salpingo-oophorectomy, or BSO, which refers to removing the fallopian tubes and both ovaries. Some trans men want to have the BSO procedure at the same time as their hysterectomy, while others do not. Two factors generally determine whether BSO is also included. First is the trans man’s discomfort with the idea of retaining female reproductive organs after FTM bottom surgery, as the ovaries keep them from feeling that they are fully living as the men they have identified themselves to be. Second is a desire to cut down on the danger of ovarian, endometrial and cervical cancers after transitioning to life as a man. The risk of these cancers remains even after the surgery, but it is significantly smaller.
One reason why trans men want to emerge from FTM bottom surgery with a minimal danger of these types of cancer is that they feel a high level of discomfort seeking gyneological care after they have completed their transition. However, it is important for trans men to seek a checkup from a gynecologist at least once every three years after their transition because of the risk of those cancers developing. Trans men who keep their vagina (either after or before other genital reconstruction), who have family members with uterine, ovarian or breast cancers or who have had any gynecological cancers in the past themselves are particularly in need of periodic checkups to ensure that they do not develop the disease later in life. No matter how long it has been since the last checkup, it’s important to seek screening if vaginal bleeding takes place after testosterone has stopped menses from occurring.
Genital reconstruction is another form of FTM bottom surgery. Metoidioplasty involves making the clitoris larger with hormones until it becomes the phallus. Over time, it develops an average length of 1 1/2 to 2 inches. After the clitoris has reached its full size, the surgeon separates it from the patient’s labia minora. Then, he cuts the suspensory ligament so that it drops to the approximate location of a penis on a biological male anatomy. Patients choose metoidioplasty if they are concerned about the cost of genital reconstruction and are not particularly interested in achieving sexual penetration after the surgery. The procedure generally takes a couple of hours, and the erectile tissue in the clitoris continues to function normally, making prosthetics unnecessary. Metoidioplasty permits patients to keep having clitoral orgasms even after the procedure.
Phalloplasty is the other FTM bottom surgery for those who want genital reconstruction. This involves building a penis and begins with the lengthening of the urethra, which in a trans man ends near the opening to the vagina. In many cases, a scrotoplasty happens next, as the vulva can be used to build a scrotum before the doctor inserts prosthetic testicles. In a separate procedure, the doctor inserts an erectile prosthetic and uses a skin graft (typically from the arm) to put skin around the new penis. To remove hair from around the new penis, laser hair reduction and/or electrolysis are the most common techniques.
In some cases, the surgeon performs a metoidioplasty a couple of months before the phalloplasty to ensure that the patient retains sensation through the whole procedure. If the nerves connect correctly, as they do in many cases, genital orgasm is possible after the transition has taken place.
For those considering FTM bottom surgery, sexchangeoperation.net is a valuable resource for finding local practitioners, support groups and other information about the process. This sort of procedure involves a great deal of preparation, but for those who have spent their entire lives in a woman’s body but identifying as a man, this can result in a feeling of liberation and an entirely new life.