Prostate – the prostate in post-operative transsexuals

Prostate – the prostate in post-operative transsexuals

S Johnson
[Abstract] Full Text [PDF]

The prostate is one of three glands necessary for reproduction. The prostate produces a sticky, milky fluid of acids and enzymes. This fluid makes up about 15 percent of the total volume of the semen and helps to sustain the sperm cells that are created in the testicles. The prostate is surrounded by muscle, which contracts to ejaculate this fluid.

Confusion can occur in the case of male to female transsexuals during X-Ray examinations.  Often the prostate is not removed during gender reassignment surgery.  This can show as a shadow on an X-Ray.

This could cause concern and be confused with a tumour.  Family or friends should inform paramedics of the individual’s transsexual condition, as in the case of falls and emergencies there might not be time for A&E Departments to obtain medical records.  The same would apply on holidays to different parts of the world.

Strikingly affected are the sex life and the sex functions. Within a few weeks of treatment, some patients report they no longer feel like masturbating, their sex urge, including the desire to “dress,” being much reduced. There are no or fewer involuntary morning erections and after six months or so, voluntary erections also become difficult to elicit and about one out of ten patients describes them as distinctly painful. If orgasm can still be reached, there is in more than 50 per cent of the cases no ejaculation, which may to a large extent be due to prostatic shrinkage. (Benjamin)

The prostate is rarely removed during SRS surgery. The main reason for this is the difficulty and safety of the procedure. The prostate is (doughnut-like) near important nerves and blood vessels. Removing the prostate could risk damaging these nerves or bladder during what is already a complicated surgical procedure therefore the preferred option is to leave it in place.

Prostate cancer risk is significantly reduced in comparison to males not receiving estrogen therapy. Have the prostate examined once a year is recommended.

Surgical Removal of the Prostate

When the entire prostate gland is removed, the operation is called a radical prostatectomy. There are several ways in which this procedure is performed.

In a perineal prostatectomy, the prostate is removed through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.

In a suprapubic prostatectomy, the prostate (and sometimes nearby lymph nodes) is removed through an incision in the abdomen, just below the belly button. This method allows for the removal of more tissue and is used in cases of prostate cancer that may have spread.

Laparoscopic prostatectomy involves removing the prostate using a thin tube-like instrument called a laparoscope. The laparoscope is inserted through a small incision in the belly button and has a lighted camera on the end. Several more small incisions are made in the abdomen through which surgical instruments are passed.

Prostate Removal: Risks

Risks for any anesthesia are:
reactions to medications
problems breathing

Risks for any surgery are:

Additional risks include:
problems with urine control (incontinence)
difficulty achieving and maintaining an erection (impotence)
loss of sperm fertility (infertility)
passing the semen into the bladder instead of out through the urethra (retrograde ejaculation)
urethral stricture (tightening of the urinary outlet)