Sex reassignment surgery

Case contributed by Assis Prof Faeze Salahshour


The patient was a transgender person who underwent sex reassignment surgery (male to a female); now, she complaints from bloody vaginal discharge.

Patient Data

Age: 50 years
Gender: Female

Breast augmentation is visible as bilateral breast implants; The collapsed left implant is likely due to rupture. The surgeon used an ileal pouch for vaginal deepening. The ileal pouch is too long, and its blind end adheres to the proximal sigmoid, still, without any wall thickening. The interface fat plane between the pouch and the lower rectum is lost. Several reactive lymph nodes are visible adjacent to the lower pouch. Multiple small cysts scattered in all liver segments, small gallstone, and calcified granuloma in the left lung base are other findings.

Annotated image

The orange arrows depict the ileal pouch used for vaginoplasty. The red and white arrows show the breast implants, which collapsed on the left side(white arrow).

Case Discussion

Bloody vaginal discharge raises the possibility of fistula formation, but discrete fistula was not visible. CT with rectal or vaginal contrast injection or MRI is more helpful in this regard. Transgender people are those that their sex that assigns at birth is not congruent with their sexual identity. Some of them underwent sex reassignment surgery to alter the physical, sexual characteristics to resemble that of the other gender. Feminization surgeries include orchiectomy, augmentation mammoplasty, vaginoplasty, voice, and facial feminization surgery.

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Case information

rID: 83354
Published: 30th Oct 2020
Last edited: 1st Nov 2020
System: Urogenital
Inclusion in quiz mode: Included
Institution: Tehran University of Medical Sciences (TUMS)

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