Male to Female (MTF) Gender Reassignment Surgery (GRS) - Sex Change Surgery
The goal of transsexual surgery (sex change surgery) is to provide an aesthetically attractive and functional result which permits both effortless intromission and full orgasmic potential. Creation of an adequate vaginal pouch, a sensate and hooded clitoris, and a feminine vulva with delicate labia are paramount. Ultimate conjugation of the labial axis to the anterior midline (fourchette or commissure) requires a second stage procedure called a labiaplasty. To maintain and extend vaginal depth, medical grade dildos will be worn for a portion of each day. After suitable wound healing, sexual activity is a natural way to establish the permanency of the result.

Orchiectomy Procedure
The Orchiectomy Procedure is an independent procedure that can be performed for those who wish to eliminate testosterone surge and achieve some degree of secondary feminization without complete penectomy and vaginoplasty.

As this is an irreversible procedure, 2 letters of therapy clearance are required. One therapist (psychologist, psychiatrist, social worker, sexologist) must have a doctoral degree, and one of the two therapists must know the patient for an extended period of time. Conceivably one of the two therapists can satisfy the requirements for a doctoral degree and knowing the patient for an extended period of time. Consideration may be given to sperm banking prior to orchiectomy.

Pre-op lab is also required. Fee to include orchiectomy, local anesthesia with IV sedation, and followup care as provided by the Reed Centre.

Female to Male (FTM) Gender Reassignment Surgery (GRS) - Sex Change Surgery
- Metoidioplasty
- Penile Implantation for the Neo-Phallus patient
- Insertion of Testicular Implants into Labia

A. Metoidioplasty or Metaidoioplasty (phallic clitoral enlargement, stand to void) - Sex Change Surgery
The procedure confers the advantage of minimal surgery with preservation of natural sensation and erectile function. Donor site forearm scars avoided. Overweight patients may achieve greater length with pubic lipectomy which will recess the body surface line.

In this sex change procedure the clitoral hood is lifted and the suspensory ligament of the clitoris is detached from the pubic bone, allowing the clitoris to extend out further. When the female tissues have been primed with testosterone, the clitoral head may resemble an adolescent glans penis. An embryonic urethral plate must be teased away from the underside of the clitoris to permit outward extension and a visible erection.

For those patients who desire to void standing after this sex change proceedure, the urethra is extended into the neo-penis. This may be accomplished simultaneously or performed secondarily using either a vaginal flap or buccal mucosal graft.

Please understand in that metoidioplasty (sex change surgery) involves a fair amount of tissue transfer, some degree of post-operative swelling is expected. Complications may include but are not limited to less than anticipated length, torquing of the clitoris (usually amenable to release), loss of sensation, tissue necrosis, localized infection, persistent tenderness or hypersensitivity, transient or permanent narrowing of the vaginal opening which may render the vagina incapable of penile penetration, urethral narrowing, urethral obstruction, and urethral fistula (leakage of urine anywhere along the pathway of urethral extension). Between the first and second stages leading to urethral extension, voiding patterns and trajectory may be forwards or backwards and may splash wetting perineal, labial and vaginal skin.

B. Penile Implantation for the Neo-Phallus patient.
A penile prosthesis confers the wherewithal to penetrate which may be the defining moment for a successful conclusion to gender reassignment surgery. Clearly the intimacy of complete sexual contact is sought equally by patients and their partners.

C. Insertion of Testicular Implants into Labia.
This should be performed as a procedure unto itself or with urethral extension to minimize complications. To prepare the labia majora for implantation, a tissue expander may be employed for a few months. This also creates a more pleasing scrotal appearance.