We have such a fabulous surgeon on the blog today. And this post is very special & something that needs to be talked about more.
Dr. Michael Safir is here to talk to us all about the surgical process of turning a penis into a vagina, and a vagina into a penis. Not only that, he’s letting us in on how he got into transgender surgeries & why he loves it so much.
After Dr. Safir’s podcast episode, Lauryn knew he had to come on the blog asap, too.
Be sure to listen to the full podcast epsiode where Dr. Safir discusses gender dysphoria, misconceptions about transitioning, the importance of pronouns, & how to be more understanding of others & their choices.
Let’s welcome Dr. Michael Safir to the blog.
Dr. Michael Safir on The Transgender Surgery Process
OK – basically, I turn vaginas into penises and turn penises into vaginas.
I didn’t always perform surgery for the transgender and non-binary community. But my life and education put me on a path to discovering what was important to me and how I could best help people as a surgeon.
I grew up in a conservative household and was taught to follow religious teachings tenaciously. This included learning that only being heterosexual and pursuing heterosexual relationships were OK.
College and medical school were eye-opening for me, as I met colleagues and patients who didn’t adhere to traditional sexuality or gender roles.
I decided in my final year of residency to pursue advanced surgical training in female and male reconstructive genital surgery at the best centers in the country (UCLA and UCSF).
At the time, I was the only urological surgeon in the US to have performed separate year-long fellowships in these fields. I visited Serbia, a major transgender center in Eastern Europe, to visit with a preeminent surgeon who performed surgery for the trans community.
For the last five years, I performed exclusively reconstructive bottom (below the waist) surgery for the trans community in San Francisco, earned the designation of Surgeon of Excellence, and set my career path in an ultra-specialized direction. I recently relocated to Los Angeles, California and joined a terrific multi-specialty transgender surgery group.
It is really easy for me to speak with the trans and non-binary community and medical practitioners who serve the community. It is sometimes hard to speak with the cis-gender community because I have to overcome, in many cases, childhood indoctrination that prevents much of the population from maintaining an open mind about a community that strives for simple understanding. I have to expect that many people won’t “get it” and understand that it may take some individuals more time to develop an understanding about the trans community.
The Transgender Surgery Journey:
It is the parent of a child exploring gender issues who plays the most essential role in the proper development of that child. Young children may express feeling uncomfortable in their biological gender as early as 3-5 years old. I heard a brilliant statement that I’m unable to attribute:
“Don’t be your child’s first bully!”
That’s an aphorism for parents that extends even beyond trans issues. Listen and seek out advice beyond your place of worship. Pediatricians, mental health professionals, gynecologists, and many primary care physicians serve an incredible role in helping individuals express themselves without necessarily being herded into undergoing gender affirming procedures.
By the time they see me as a “bottom surgeon,” most patients have undergone their “top” (breast) surgery. And some have undergone facial feminization or masculinization. Virtually all have been on hormones for years and most “present” (physically express) opposite their biological gender.
Patients seek me out toward the end of their surgical journey and affirm their desire to have their physical body congruent with their self-identified gender. All patients have letters of support from two mental health professionals and their hormone provider.
Creating a penis & vagina:
Bottom surgery is extremely complex and has been described as the “Super Bowl” of reconstructive surgery. Creating a realistic penis with sensation and blood flow requires two surgical teams, transferring a rolled skin/fat donor site (arm or thigh) to the area where a cis-gender penis would ordinarily reside. A scrotum is created, the previous genitalia (vulva and vagina) are removed. And a urethra (urinary channel) is created to bring urine flow all the way to the tip of the new penis. Less complex surgery may be completed by building a penis and scrotum using adjacent skin – this procedure is called a metoidioplasty.
Conversely, a vagina can be created by using inverted penile and scrotal skin. And fashioning the skin of the new vulva to approximate the appearance of the labia. After surgery, patients may seek out other procedures in the future to allow more functional use of the newly created genitalia.
Yes, virtually all patients have sensation after surgery – there are small nerves that we find with special eyeglasses. And then connect using a microscope and suture finer than hair.
We know how important sexuality is to our patients and provide reasonable expectations to them preoperatively to help them plan for their sexual life after surgery. Patients who undergo gender affirming surgery only very rarely express any regret of their physical transformation.
I have yet to be asked to reverse or undo any gender affirming surgery so that a patient can have genitalia that looks like their pre-operative anatomy.
This remains a fascinating field for me. And I am energized by my wonderful patients who trust their bodies and lives to me. And I learn from every patient, not simply how to improve the operation, but to understand the challenges they and their loved ones’ experience.
As mentioned, be sure to listen to the full podcast episode where Dr. Safir really gets into it.
x, The Skinny Confidential team.
+ check out the top lessons Lauryn has learned from being podcast host.
++ stalk this post on female empowerment from Tiffany Hendra.