Electrolysis In the transgender Male to Female Patient Preparing for Sexual Reassignment Surgery

By Susan Diskin RN and Cheryl Naumoff RN with the office of Toby R. Meltzer, MD, PC, Plastic and Reconstructive Surgery, Portland, Oregon

Reviewed By Toby R. Meltzer MD

Dr. Melter is a Board Certified Plastic and Reconstructive surgeon who has performed over 1000 Sexual Reassignment Surgeries since 1991. Presently, he performs three Vaginoplasty surgeries a week. He also is a Clinical Assistant Professor at Oregon Health Services University. Dr. Meltzer’s web site is www.tmeltzer.com

[editor's note: this document was sent to me by Linda Takata of Dr. Meltzer's office in March 2002. She writes:

He is now recommending that one clear the shaft all the way to the base (which creates just a slight ring) and the back of the scrotum (as indicated in the article). He found that even with decreasing the area around the base of the penis to 1cm, many patients (or electrologists were going to an extreme). He also found that the area beyond the base could be effectively done post SRS and this allows the patient to have better control of the area they would like to have hair.

The information below is presented verbatim. Although this information was up to date at the time I put it up, it's important to confirm with Dr. Meltzer's office that you have the most up-to-date information when planning genital electrolysis. --AJ]

Introduction

Opinions regarding techniques or the necessity for genital hair removal prior to Sexual Reassignment Surgery (SRS), specifically in the Male to Female (MTF) population, vary among practitioners. At the clinic of Dr. Toby R. Meltzer in Portland, Oregon electrolysis is the preferred method of hair removal. This method is permanent and, in concert with the surgeon, provides an excellent aesthetic result.

Vaginoplasty

Vaginoplasty, using Penile Inversion, is the most common MTF genital surgery. This utilizes the penile skin to line the vagina, and the scrotal skin to create the labia. The commencement of the vaginoplasty procedure is performed through an incision on the back or posterior portion of the scrotum. This portion of the scrotal skin, if adequate and well cleared through electrolysis, can satisfactorily be grafted to the apex or back of the vagina, avoiding the need for remote donor (graft) sites.
The area to be cleared for vaginoplasty must be completed no later than one week prior to surgery. The back of the scrotum should be cleared to 2 cm. from the anus. If there is abundant hair on the shaft of the penis, this should be cleared to the base. See Figs. 1-2.

Figure 1.

Figure 2.

Hair Removal

Intravaginal hair growth is not a naturally occurring phenomenon; consequently, it is undesirable. Since every hair cannot be removed following the completion of electrolysis, "scraping" - a technique of using a small surgical blade to remove hair during surgery - is implemented as an augment to electrolysis. However, this is not feasible for full genital hair removal. Laser hair removal, although widely popular, is limiting, in that it accurately targets only specific hair types, colors and textures, and regrowth is eventual.

One question that is frequently asked is "how much electrolysis is enough?" Consideration is given to variables such as, patient's tolerance for pain, the skill of the electrologist, the patient's color, texture and amount of hair, time constraints, travel and finances, to name a few.

Labiaplasty

Labiaplasty is the secondary procedure following the vaginoplasty. The purpose of the labiaplasty is to provide hooding to the clitoris and better define the inner labia. This creates a vulva that more closely resembles that of the genetic female. The labiaplasty can be performed as a second stage no sooner than three months from the vaginoplasty. [1] Electrolysis is often a requirement prior to this procedure

  • Begin electrolysis no earlier than six weeks after vaginoplasty.
  • Electrolysis must be complete no later than one week prior to labiaplasty.

Many patients choose to schedule their labiaplasty procedure as soon as three months after their vaginoplasty. Since electrolysis cannot be resumed for six weeks, the timeframe is limited. We recommend that attention be paid primarily to the area around the clitoris, as this will be the most inaccessible after the labiaplasty.

Figure 3.

Hair Removal

A two-centimeter circumferential area around the clitoris should be cleared of hair, as displayed in Figure 3. The area above the clitoris will be covered by the labial skin, which is brought to the midline. The midline incision heals well but is more imperceptible if hidden by the pubic hair. [2] Electrolysis around the clitoris should not extend beyond 2 cm.
The inner portion of the labia, which measures to approximately one centimeter of skin, should also be cleared. This area is accessible after labiaplasty and many patients choose to wait to have electrolysis here. Electrolysis along the inner labia and vulva should be based on what is aesthetic and natural in appearance.

Anesthetics

There is no doubt electrolysis is painful. This discomfort can be reduced with the use of anesthetics. Topical anesthetic creams that contain lidocaine and prilocaine are used frequently. Often clients will use prescription oral pain relievers or relaxants. Nerve blocks and numbing injections with marcaine can also be very effective with scrotal / genital electrolysis, but clients must find a physician willing to inject and coordinate timing with the electrologists.

Conclusion

Electrology remains to this day, the only proven permanent hair removal technique. This is very important to our patients and has greatly reduced the possibility of intravaginal hair growth and the need for remote scars from donor grafts. The diagrams presented in this article are based on the techniques of Dr. Toby R. Meltzer. Other surgeons may have differing recommendations for electrolysis. Overall, we look to provide our patients with the most aesthetic surgical outcome and in cooperation with credentialed electrologists, a natural female hair pattern.

References:

1 Meltzer, Dr. Toby R.: Takata, Linda L., “Procedures, Postoperative Care, and Potential Complications of Gender Reassignment Surgery for the Primary Care Physician,” Primary Psychiatry, June 2000; 7(6): pp74-78

2 http://www.tmeltzer.com/labiapl.htm

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