Internal Surgery
Internal Surgery is referring to the removal of the female reproductive organs. The types of procedures listed below are referring to the techniqes used, not specifically what is being removed from the abdominal cavity.
For example, depending on what is desired, the patient could opt for a partial (aka supracervical) hysterectomy, which only removes the upper portion of the uterus. A total hysterectomy would remove the entire uterus in addition to the cervix. Then, what is commonly referred to as a radical hysterectomy would remove the uterus, cervix and the upper part of the vagina. The removal of the ovaries is called an oopherectomy, and can be done at the same time as a hysterectomy.
You may find different resources calling these procedures by different names. What is important is that you understand what specifically you want removed: the uterus, ovaries, cervix, part of the vagina…and that you talk to your doctor about the pros and cons involved with your choice. For example, if you eventually want to proceed with some type of bottom surgery that will result in the complete closure of the vagina, this would help guide you in what should be removed during the hysterectomy…a mainstream idea is to remove the ovaries, uterus, cervix and possibly even the top portion of the vagina.
When considering what specifically should be removed, consider the following points -please note that this is certainly not exhaustive, and a consultation with a medical doctor specializing in this should be made:
- Removal of various reproductive tissues reduces the risks of certain cancers (especially with the use of hormone therapy – testosterone).
- If the ovaries are removed, the hormone levels are obviously impacted. This may or may not be very noticeable by the patient (like the experience of “hot flashes”).
- Some may want to have biological children before proceeding through this part of transition – once the ovaries are removed and discarded, those opportunities are gone. Hormone therapy may need to be delayed for this reason, as the use of testosterone could damage the reproductive system. If financially and physically possible, one could have their eggs retrieved and stored for future fertilization – which would later require surrogacy or a willing partner.
- Consider how much of the vagina should be removed…first of all, it provides structural support to other tissues (bladder, rectum). Generally, a true vaginectomy would not occur at this point and is often combined with other bottom surgeries, but the surgeon who does eventually perform that procedure (if elected) may have a preference or specific technique in regards to the vaginal tissue. Even if you are unsure of if or when you have other procedures in that area, it is worth thinking ahead at the possibilities. Once the tissue is gone, it is gone.
- More related to a true vaginectomy (removal of the vagina) is sexual satisfaction as it relates to the vagina. Many FTMs are absolutely disgusted by the existence of the vagina and do not use it during sexual activities at all, though it may still cause some level of sexual satisfaction for them. Others do use the vagina directly for sexual pleasure, and this can be a source of concern for when it comes time to removing any part of this organ.
A major point here is to be honest with yourself about what you like and don’t like – and what you want and don’t want. It isn’t an easy or simple decision and it is important to be well-informed and rational throughout the decision-making process.
Three methods are discussed on this website: