Less invasive hysterectomy okay for transsexuals

Total laparoscopic hysterectomy, a type of minimally invasive "key-hole" surgery, is suitable for removing the uterus in female-to-male transsexuals, according to a report in the journal Obstetrics and Gynecology.

Transsexuals are individuals with a gender identity that is opposite to their biological sex. Some transsexuals undergo sexual reassignment surgery in an effort to match their appearance to their gender identity.

Hysterectomies often involve an incision in the wall of the vagina. With female-to-male transsexuals, however, this is often not possible because many of the patients have taken testosterone, a hormone that thins the vaginal walls, making them unsuitable for these procedures.

With total laparoscopic hysterectomy, by contrast, incisions are made only in the abdominal wall, not inside the vagina.

In their study, Dr. Katherine A. O'Hanlan, from Gynecologic Oncology Associates in Portola Valley, California, and colleagues reviewed the outcomes of all patients who underwent total laparoscopic hysterectomy at one center since September 1996. Of the 593 patients studied, 41 were transsexuals.

The average ages in the transsexual and non-transsexual groups were 32 and 51 years, respectively.

The average operating time in the transsexual group was 74 minutes compared with 120 minutes in the non-transsexual group. Average blood loss in the transsexual group was also lower, as was the weight of the removed uterus.

The overall complication rate in the transsexual group was 12 percent, higher but was not significantly different from the 8 percent rate noted in the non-transsexual group. The rate of complications leading to repeat surgery was also comparable in each group, at about 5 percent.

The findings indicate that "total laparoscopic hysterectomy...has a role in the gynecologic care of female-to-male transsexuals, even those at a very young age," the authors conclude. "These procedures may facilitate their progress to a more satisfying and healthy life."

SOURCE: Obstetrics and Gynecology, November 2007.