Robotic Single-Site Surgery for Female-to-Male Transsexuals: Preliminary Experience

Abstract (free full text available):

Hysterectomy with bilateral salpingo-oophorectomy is a part of gender reassignment surgery for the treatment of female-to-male transsexualism. Over the last years many efforts were made in order to reduce invasiveness of laparoscopic and robotic surgery such as the introduction of single-site approach. We report our preliminary experience on single-site robotic hysterectomy for cross-sex reassignment surgery. Our data suggest that single-site robotic hysterectomy is feasible and safe in female-to-male transsexualism with some benefits in terms of postoperative pain and aesthetic results.

Suicidal ideation among patients with gender identity disorder.


In this study, we tried to clarify the prevalence of suicidal ideation and self-mutilation including suicide attempts among patients with gender identity disorder (GID) and the relationship of those behaviors to demographic characteristics. A total of 500 consecutive Japanese GID patients without any other psychiatric comorbidity were evaluated at the outpatient GID Clinic of Okayama University Hospital. The lifetime rate of suicidal ideation was 72.0% of the total sample. There were no significant differences in the prevalence of suicidal ideation among groups divided by sex, age, age at onset or education. The lifetime prevalence of self-mutilation including suicide attempts was 31.8% of the total sample. Low level of education was significantly related to self-mutilation among both male-to-female and female-to-male GID patients. Younger age at onset was a significant factor affecting self-mutilation only among MTF GID patients. A lack of strategies to cope with severe distress among persons with lower education might induce a high frequency of self-mutilation including suicidal attempt. GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation.

Gonorrhoea of the sigmoid neovagina in a male-to-female transgender.


A 33-year-old male-to-female transgender consulted our outpatient clinic with perneovaginal bleeding during and following coitus. Four years before, she underwent a total laparoscopic sigmoid neovaginoplasty. Physical, histological and endoscopic examination revealed neither focus of active bleeding nor signs of active inflammation. A polymerase chain reaction test performed on a neovaginal swab showed gonococcal infection. Treatment consisted of 500 mg intramuscular ceftriaxone. Three weeks later, our patient reported resolution of symptoms, consistent with eradication of Gonococcus Neisseria demonstrated by a follow-up neovaginal swab polymerase chain reaction. To our knowledge, this is the first case report of gonococcal infection of the sigmoid neovagina.

Contouring the forehead and rhinoplasty in the feminization of the face in male-to-female transsexuals.


Transsexualism is a gender identity disorder in which there is a strong and ongoing desire to live and be accepted as a member of the opposite sex. In male-to-female transsexuals with strong masculine facial features facial feminization surgery can be performed as part of gender reassignment. The male forehead has extensive supraorbital bossing, and above this there is often a flat area before the convex curvature of the upper forehead begins. In the female, the supraorbital bossing is considerably less, often nonexistent, and above this the flattening is usually less marked and more of a continuous mild curvature. The female nose is relatively smaller than the male nose. The glabellar and the nasolabial angle are less acute. The female nose is regarded as attractive if it shows a straight or mildly concave dorsum and an accented tip. We present a case of treatment of a 26-year-old male-to-female transsexual to demonstrate that contouring the forehead combined with a rhinoplasty can lead to significant feminization of the face. The procedures described seem to be safe and reliable.

Vaginal Hysterectomy as a Viable Option for Female-to-Male Transgender Men.



According to the 2011 Institute of Medicine Report and emphasized by the American College of Obstetricians and Gynecologists Committee Opinion, transgender individuals encounter significant healthcare barriers. The American College of Obstetricians and Gynecologists charges obstetrician-gynecologists to help eliminate these barriers to care by creating nondiscriminatory practices and assisting with transitioning. This includes supporting social, medical, and surgical aspects of the gender affirmation process. Obstetrician-gynecologists are able, without additional training, to perform hysterectomies for transgender men, and total vaginal hysterectomies are the least morbid and most cost-effective form of hysterectomy.


We present data from a retrospective chart review of all hysterectomies performed for benign indications at a single urban county hospital from 2000 to 2012. Primary area of interest is a case series of hysterectomies performed on female-to-male transgender men.


A total of 948 hysterectomies were performed for benign indications. Of those, 34 were for female-to-male transgender men. Compared with women with carcinoma in situ (CIS), female-to-male transgender men were younger, had fewer pregnancies and deliveries, had smaller uteri, had lower body mass index, were usually on testosterone before surgery, and were more likely to have concurrent oophorectomies. The primary indication for hysterectomy for female-to-male transgender men was pain (53%) compared with bleeding (46%) for women with CIS. Total vaginal hysterectomies were performed in 24% of female-to-male transgender men compared with 39% of women with CIS. There was no difference in complication or conversation rates between the two groups.


Total vaginal hysterectomy is a safe, viable, and cost-effective option to consider for female-to-male transgender men and gender affirmation surgery and encourage obstetrician-gynecologists to consider total vaginal hysterectomy as a minimally invasive option in serving female-to-male transgender men to encourage nondiscrimination and augment access to care.