Pelvic floor prolapse after sex reassignment surgery


Since gender reassignment surgery is to transform a normal person into the opposite gender, not to "fix" a disease, it seems to me that some of the problems experienced by post hysterectomized women might be the same whether your uterus was removed for disease reasons (fibroids) or for sex reassingment. Here is an interesting article where at least someone in authority is asking the question:

I would like to see a study where they had three groups: Normal people, women with prolapse problems due to childbirth, etc., and the trasgender group. To give stats for the third group without comparing information for the other two just doesn't seem to have much meaning. A quarter of post - op trasgenderized patients end up disatisfied with their sexual function. I would like to know what the percent of nomal men and women would self-assess their sex lives the same way. We may be giving transgender disodered individuals a better result, a worse result, or an equivalent result.

With what I have learned from Christina and the Whole Woman books makes me think that if I were a transgender person wanting to go from female to male, I would leave the uterus IN, as that is the "keystone" support structure for the whole pelvic floor. In the reverse, changing a man into a woman, they leave the prostate and the buried extension of the penis. These items provide the internal sexual feeling comparable to a womans. So why wouldn't a women becoming a man want to keep her uterus for the same reason incidentally (it moves during orgasm and provide "deep" orgasmic sensations) but also performs the important function of holding the other organs in place so that a prolapse is less likely to occur. She could have the ovaries removed for the hormone change. Just leave the uterus like a brick holding things in place.

You raise interesting points, AnneH. I have wondered similar thoughts. the uterus still had to be able to drain, as it is technically a 'pouchlike' organ. That shouldn't be a major problem, or anything like the problem of turning female genitals into male genitals.

I guess they remove the uterus because everyone knows that there is no point in having a uterus if you are not going to use it for growing any more babies! (not)

I would imagine that a woman-turned-man would probably want to be rid of their uterus and ovaries, and I have a feeling that the tissue of the vagina and cervix are actually recycled into the new penis, so there would be limited opportunity for conserving them. Likewise a man-turned-woman would probably want to be rid of their testes.

Gender reassignment is complicated, drawn out and serious surgery. Perhaps the difficulties faced by these people post gender reassignment surgery are nothing compared to being born in a body which has the wrong sexual organs? It is something that they have chosen to do after a lot of thinking and counselling. Women who suffer prolapse didn't choose it at all. Does putting up with prolapse if you chose to have your body altered for gender reasons make it any easier to deal with? I think not, far from it!

Yes, I think it would be very like having an hysterectomy, in the sense that the hub is missing. It is interesting that there is not more prolapse in these people. On the other hand there are plenty of women who do not seem to have prolapse problems after hysterectomy. At least somebody is asking the question of whether these people should be assessed for suitability for surgery in the same way as natural women. Why not? (That question is kind of irrelevant if you think that there are very limited situations where pelvic repair surgery is the best option, so I am probably talking through the top of my head!)


...coz I gotta write my Post articles, but *of course* outcomes would be the same. I have to believe that far more than 1/4 of patients are unsatisfied by such mutilating surgery. I have heard that more and more transgendered folks are making the change without surgical alterations.

We interviewed a professional "sex nerd" (her words) for WWY2 as well, who said the most frequent hate crimes are directed against male-to-female transgender people. There is something in the lizard-brain of some "normal" males that cannot make sense of these people so they become overwhelmed with fear, which transforms into violence.

The transgender population has become another significant market for gynecology and urology. Pediatric gynecology is a specialty that reassigns intersex babies at the beginning of life. Yet, data suggests these people have lived happy, productive lives throughout history as "in-betweens".

It is a complicated world!


just wondering....once the external genitals are reconfigured from female to resemble male, wouldnt a prolapse be more difficult to diagnose? most of us came to diagnosis by noticing a bulge. you wouldnt see a bulge if everything was closed up.
another common symptom is feeling 'heaviness', but (again, just imagining here) if you were new to your genitals, you'd have no benchmark for what is normal, what is due to the surgery, and what might be due to your hidden cystocele.
what is the rate of male cystocele anyway? is it zero? is it possible, but just not on anybody's radar? does the prostate help keep the male bladder in place?
I wonder how many urogyn's would suggest slicing open a man's pelvis to tack up his bladder to his spine (my guess = 0).

now I have all sorts of thoughts to ponder while I play angrybirds

Gmom, if you are really curious there are some really graphic sites that document the progress of sex reassignment from before to after. It is really amazing what they can achieve, if you keep your mind away from the morals of it, or what is happening on the inside of the person's body. Just google "gender reassignment surgery" .

One thing I do find a little disturbing is that these previously male people are referred to after surgery as 'women' . I have a bit of a problem with that, but I guess I don't have to think about it a lot, and I think womankind can be generous enough to take these poor creatures who have suffered so much, into our fold, which seems to be the natural home of any human who is not a blemish-free heterosexual adult male human, and probably includes women who have reassigned as men.

I can only wish them peace.


...when Nature has always put these people on the planet in the first place? In olden times they were seers and shaman who lived at the edge of the village, but who people trusted and were not afraid of. It is our fear of not being able to put things in neat little boxes that causes our discomfort. I know one transsexual who is a very wonderful human being and someone people really like to be around. I have made the mindless mistake of referring to her as him sometimes, but that just comes with the territory and I imagine for the most part these people don't pay much attention to our foibles.

I don't think I am judging them, any more than I would judge a woman who had an hysterectomy. I can hardly imagine the degree of suffering that would make a person go out of their way to change such a fundamental part of themselves as their outer gender with the hope that it would make them happy. It is not always a smoother path after the reassignment, in ways that they cannot imagine before the big, irreversible surgery. Where have we heard that concept before?

I really feel for them, for the difficulty they live with every day of their lives, living in a body that is outwardly irreconcilable with their identity.

I worked once with a young man who was in the process of hormone treatment that was progressively changing his body in preparation for the reassignment surgery. He was essentially very feminine, and struggling in the job he was doing, which was essentially a 'man's job'. We got on very well together as a couple of misfits in our common workplace, and I learned a great deal from him. I have never met up with him since the operation. I think about him quite often and hope he is happy and well.

It is just a big head jump for me to think that a person born 'male', who has been known as a boy, all his life, can have some surgery to make him look different, pee differently and have penetrative sex the other way around, and call herself a woman thereafter. It raises so many issues and questions about the range of differences between individuals and genders, and the range of similarities between individuals and genders. What is a woman? What is a man?

I think the Indians and other peoples who have historically had emasculated males as an integral part of their culture, have the right idea of giving them the respectability of their own name for their own gender, rather than pretending that they are 'real' women.

It is kind of like artificial banana flavoured milk, which has never been anywhere near a banana. I don't mean that in a disrespectful way. It tastes kind of like banana, but it isn't banana. It is the difference between authentic and manufactured. One is not necessarily better than the other. They are just different. Let's not pretend that they are the same. Why do these people have to give their gender a name which clearly is not entirely true?

Why not validate them by giving them their own gender altogether, along with a third person singular pronoun which is neither he nor she, neither her nor him, nor a term for both. It is a different gender or pair of genders all together, or is it?

It is not a personal issue, but a language issue. These people will always be on the outer unless we 'in' them by altering the language we use to describe them, and to validate their identity as part of the human race, in the same way as gender inclusive language was developed to clear up ambiguity about the use of masculine pronouns, and the word 'man', when 'man or woman' is the intended meaning. Why use one word when you mean another word?

Some people still don't like inclusive language thirty years later, refusing to believe that it is inappropriate to use an exclusive word (man) when they mean 'human of either gender'. Go figure. I don't worry about them too much.

It's the same thing as calling women a minority group (as in equity group). Since when were there less women than men on the planet? How can there be a larger number of minority members than majority members of any population? It is an oxymoron. I think it might have been thought up by a man who just assumed that women are outside the door along with disabled people, coloured people, gays, and everybody except white, adult males. Rant over.

This has always made me wonder - If they left the uterus IN the body and then closed up the introitis - Then they would not be able to do smears etc to check the health of the person, which would not be good.

If they remove the uterus - Then the person could get vault prolapse etc as the hub of the wheel is now gone.

I feel terribly sorry for people facing this kind of a problem, feeling they are born in the wrong body to start with - going through all that surgery, and hopefully feeling great after it - Then being faced with prolapse, that they probably never envisaged.

Very sad really. It would be very interesting for studies to be done to tell us how many post op transgender people face prolapse issues though.