Gender Affirmation Surgery
Gender affirmation surgery, previously known as gender reassignment surgery, can include surgically altering your genitalia to align with gender identity. We do more than just perform surgery. We also provide counseling on fertility preservation, provide second opinions, do repair procedures, and help with complications. These procedures can help improve quality of life, comfort, and confidence.
At Mount Sinai, the Department of Urology has two expert gender-affirming surgeons, Dr. Rajveer Purohit and Dr. Miroslav Djordjevic. Our surgeons have performed more than 2,000 gender affirmation surgeries, including vaginoplasty, metoidioplasty, phalloplasty, orchiectomy, correction of complications such as urethral strictures, and placement of a penile prosthesis. Dr. Purohit is the Director of Reconstructive Urology at Mount Sinai and Dr. Djordjevic, a world-renowned transgender surgeon based in Serbia, joined our department in August 2019. Individuals who previously had to travel to Belgrade for world class care can now have their surgeries done closer to home and their family and continue to be monitored post-operatively in New York.
The Mount Sinai reconstructive urology team works as part of the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) to make sure you are fully cared for before and after any surgical procedures, using a holistic approach. We understand that the decision for gender affirmation surgery can be difficult. The team will help you with details informed by the WPATH Standards of Care. Our primary goal is protecting your health and safety.
We have no waitlist and have vast experience working with insurance companies. We can help you get clearance for surgery and get the information for obtaining coverage from your insurance carrier. We accept most major insurance plans, including Medicaid and Medicare. Our billing team will try our best to ensure coverage by your insurance carrier.
Procedures We Offer
Our urologists are experienced surgeons. We can construct or reconstruct your genitalia to align with your gender identity. We perform a wide variety of procedures, including both trans masculine and trans feminine surgeries. The most common procedures include the following:
Trans feminine Procedures
Trans women who want to decrease hormone requirements may consider removal of the testicles (called an orchiectomy), a procedure performed by Mount Sinai urologist, Aaron Grotas, MD. The testicles produce the masculinizing hormone testosterone. Most people recover quickly and leave the hospital the day of surgery. You can still have a vaginoplasty in the future after an orchiectomy.
We offer multiple approaches to vaginoplasty, the construction or reconstruction of a vagina. The most common, and the gold standard, is penile inversion vaginoplasty. Most surgeons leave a long sliver of erectile tissue called the corpora cavernosa behind. Our urology team approach lets us remove all penile erectile tissue while preserving the neurovascular bundle. The approach can decrease pain with arousal and ensure that you do not have a swollen mass in the vagina after surgery. And it preserves clitoral sensation and orgasm.
Alternatively, we can use a small piece of colon to create the new vagina. We can also use other approaches, such as taking skin from the abdominal (peritoneal) lining or from outside the scrotum.
Trans masculine Procedures
Metoidioplasty is the creation of a new phallus using a hormonally enlarged clitoris. This procedure has a low complication rate when performed by an expert. It provides excellent sensation and the ability to orgasm. However, because the size of the new penis ranges from 4 to 9 centimeters, most patients cannot penetrate during sexual intercourse. A variation of the surgery may permit urination while standing.
Phalloplasty involves creating a new penis using tissue from outside the genitalia. Most surgeons use tissue from the forearm. But this can leave a significant scar on the arm. At Mount Sinai, we can take tissue from the lateral chest wall to create a new penis. This results in a less concerning scar. Another option is the suprapubic phalloplasty, where we use tissue from the area above the groin. We pick the donor site based on your preference and what your body will permit.
Penile Prosthesis Insertion after Phalloplasty
Once we have built a penis, it needs help to become erect. Often, we insert a penile prosthesis. We usually insert this as a final-stage surgery, once you’ve healed from earlier procedures. Two kinds of prosthesis are most commonly used. The first is a malleable prosthesis, which stays partially stiff at all times. The second is an inflatable prosthesis that you pump to achieve an erection. Generally, we prefer the inflatable prosthesis because it looks more natural when flaccid and more rigid when erect. But you make the final decision, based on your desires and body structure. Both prostheses have a significant risk of complications such as infection.
We do more than just perform surgery. We can provide second opinions, do repair procedures, and help with complications. We can also discuss preserving your fertility.
We often see patients who have undergone surgery elsewhere. They come to us for a second opinion or repair, such as fixing a urethral stricture or fistula. In addition, we can help trans men with retained vaginal remnants. We can also help trans women with misdirected urine stream as well as incontinence.
Functional and Aesthetic Complications
Patients can have other complications of vaginoplasty. These include poor aesthetic outcome, residual painful erectile tissue, a misplaced or buried clitoris, and a misplaced urethral opening with excessive urethral remnant. Vaginal stenosis and shrinkage can also be a problem. Our team has experience with surgical repair of all these complications.
Some trans patients choose to preserve their eggs or sperm prior to surgery. We can help guide with current options available to you.
Meet Our Team
Rajveer Purohit MD, MPH joined Mt. Sinai in October 2017 as the Director of Reconstructive Urology and has extensive experience with complex cisgender and transgender reconstructive surgeries. Miroslav Djordjevic, MD, a world-renowned gender affirming surgeon based in Serbia, joined our department in August 2019. People who formerly had to travel to Belgrade for his world-class care can now have their surgeries done closer to home but still be monitored postoperatively here in New York.