Obstetrician-gynecologist at the Nancy University Hospital and member of the medical team at the establishment’s Center for the Care of Trans People, Dr Sophie Harter trained in vulvoplasty in Lyon. She has just performed her first procedure on a transgender person. The doctor allowed him to change sex. Banned for minors in France, the operation lasted five hours. It consists of constructing a vulva from male organs.
The surgeon performed an orchiectomy, removal of the testicles. A vulvoplasty is different from a vaginoplasty where the “scrotum will be used to form a vaginal cavity”, indicates Sophie Harter who explains: “We will create a cavity between the rectum and the urethra in front. At this location, there is muscular and connective tissue, so the operation can be painful. »
Vaginoplasty or vulvoplasty?
In the case of his first patient, it was not a question of piercing a vagina, but of shaping a vulva by making the penis disappear. “You have to shorten the urethra and use the penis to compose the clitoris, the labia minora and majora,” describes the practitioner. The only part that is actually removed is the testicles. Neither the prostate nor the seminal vesicle is removed. Everything is transformed to design the vulva. There is no vaginal depth here. »Vulvoplasty is therefore essentially aesthetic. Vaginoplasty allows sexual penetration.
“In this case, we obtain a functional organ, but which requires rigorous maintenance. Who says skin graft, says skin that will work. A scar can shrink and become fibrotic. Trans women must therefore ensure that they exercise daily dilation throughout their lives, which can prove dissuasive for some,” emphasizes Sophie Harter. Postoperative sexuality is then an intimate matter, knowing that a neovagina will never have the same sensitivity and the same abilities as that of a woman. With vulvoplasty, even if the seminal vesicle is preserved and the erectile bodies modified to avoid swelling of the vulva, ejaculation is generally no longer possible due to the blocking of testosterone by taking female hormones, estrogens.
For the gynecologist who considers that her role is “to help people get better”, the subject is not secondary, but she does not perceive it as the driving force behind the initial approach either. What takes precedence, according to the doctor, lies elsewhere in the “patients’ life project”: “Given the journey of these women and their difficulty in accessing this surgery, I think that the simple fact of granting their request transforms so many things in their lives that their sexuality will inevitably blossom differently. By recognizing themselves more in their new body, I think that there is a tangle of things in them more important than the pleasure strictly speaking of the organ. » Providing multidisciplinary care and listening within the public hospital also takes precedence over the quality of sensations in the long term. “We arrive at the end of a very long journey for most of these women, the main thing is not what we might imagine,” agrees Sophie Harter.
This transition is irreversible. It is the tipping point of a long journey which does not stop after the operation. And which started well in advance. “Psychological and hormonal care is essential. I am part of a process during which it is important to respect different stages and measure the different changes before considering surgery,” explains Sophie Harter. In France, the very long operating times leave space for this reflection. Largely due to the lack of specialized surgeons, they allow “to advance step by step in order to be able to recognize oneself in its final modification”. Please note that this major operation is now 100% covered by health insurance.
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