We have tried to better understand how gender reassignment surgery works

In surgery, the suggested ways of changing sex are: male to female and female to male. In male-to-female surgery, the penis is removed, the testicles are removed and a new vagina is created with reconstruction of the vulva (external adnexa, clitoris, labia minora and labia majora). In female-to-male surgery, there are several surgical options for phalloplasty, from penile prosthesis to the use of skin flaps.

It is only in the last few years that we have also been reading in the literature about the importance of a rehabilitative approach that accompanies trans people on their surgical journey of gender reassignment. It has been shown that by caring for transgender persons before surgery, one is able to identify problems with the pelvic floor that could lead to major dysfunction after surgery. Awareness of the pelvic muscles and how they function are key concepts to acquire first in order to understand how the new organ will function, what the new dynamics and strategies are. The physiotherapist's role in this journey is to inform, educate and prepare for what comes next, especially the post-operative journey, to have a pre-determined timing for care and treatment. On this pathway, the physiotherapist is also involved in sexuality education and gives advice on the use of aids such as appropriate lubricants, treatment of scars, awareness exercises and strengthening of the pelvic muscles.

Consider, for example, the difficult procedure of post-operative dilation of the neo-vagina as part of the MtF sex change operation. This procedure must be performed perfectly, with knowledge of tools such as dilators, timing and application options. It is a basic procedure to achieve good sexual and functional function of the neo-organ. From the literature, this procedure is also the one with more difficulties and more dysfunction, such as pelvic pain or sexual pain. If you are already prepared before the operation and know what to expect, you can prepare yourself optimally for the operation and the time after the operation.

Together with Appi (Associazione Pavimento Pelvico Italia) and Dr Patrizio Vicini, a pre-operative admission programme and a post-operative education programme have been prepared; you can request these documents by emailing [email protected].