from illnesses or diseases. Hysterectomy has long been considered the first and only solution for treating women with certain gynaecological problems. However, today, there may be other options available. Since hysterectomy is a major surgical and permanent procedure, it is important to ask any questions you may have and make sure you receive clear answers so you can make the choice that best meets your needs.

Here are the main conditions that might require a hysterectomy:

• significant uterine fibroids;
• excessive uterine bleeding;
• a severe endometriosis;
• a severe uterine prolapse (descent of the uterus into the vagina); and
• gynaecological cancers (cancer of the uterus, cervix, ovaries, fallopian tubes).

* Hysterectomy can be performed to treat 10% to 12% of these cancers.

What are the different types of hysterectomies ?

There are four types of hysterectomies. The type of hysterectomy performed depends on the problem being treated:

• Subtotal hysterectomy (partial) involves removing the body of the uterus, but leaving the cervix in place.
• Total hysterectomy involves removing the body of the uterus as well as the cervix.
• Total hysterectomy with salipingo-oophorectomy (bilateral if both ovaries are removed) involves removing the body of the uterus, the cervix, as well as the ovaries and Fallopian tubes.
• Radical hysterectomy is done specifically in the case of invasive gynaecological cancer, is the same procedure as a total hysterectomy but also involves the removal of the upper part of the vagina as well as the pelvic lymphatic ganglions.

How are hysterectomies done?

The removal of the uterus is done through the vagina, through the vagina assisted by laparoscopy or through the abdomen:

• ·         Abdominal hysterectomy. The operation is done through a 10-to-15-centimetre incision in the abdomen. This incision could be horizontal (under the pubic hair line) or vertical (between the pubis and the navel). This procedure allows the surgeon to easily reach the uterus and Fallopian tubes, in particular, in the case of a radical hysterectomy. This also makes it easier to extract a uterus or large fibroma. However, it requires several days’ hospital stay and leaves a visible scar.
• Vaginal hysterectomy. This operation involves a small incision in the rear of the vagina. The uterus is then removed through this incision. This procedure is chiefly used in the case of uterine prolapse (descended uterus) when the uterus has already descended towards the vagina. This approach only requires a short hospital stay and does not leave any visible scar.
• Vaginal Hysterectomy with Laparoscopy. This involves small incisions (between 2 and 4) in the abdomen into which a laparoscope* is inserted. Using this instrument, the surgeon “disconnects” the uterus and then removes it following the same procedure as in vaginal hysterectomy. This procedure has the same advantages as vaginal hysterectomy.
• *Laparoscope: an instrument the size and shape of a pencil and has a light and various accessories on one end used to “disconnect” the uterus.

The information on hysterectomy has been found on the Canadian Women’s Health Network website.

in the letter of recommendation.

You must obtain two recommendations done by certified doctors, i.e. PhD, EdD., D.Sc., D.S.W., Psy. D., accredited from University in medicine. One of these two doctors will need to have followed you for a period of at least six months in psychiatric therapy before making a recommendation for surgery. The second recommendation is a confirmation of the first. We also need a letter from your endocrinologist about your hormonal therapy and a short letter from your family doctor explaining that you are perfectly healthy and without any physical indication against your surgery. In addition, we would appreciate a picture of you to be attached to your file.  Once the file is complete, we will contact you for a consultation with the surgeon in order to apply for the government program. No appointment for consultation will be made without these documents. Upon receipt of government approval, a surgery date is offered.

Technique used for surgery

It is performed under general anaesthesia. Surgery lasts 90 to 120 minutes. Most of the time a semicircular U shape incision is done located at the junction of normal skin and areola skin. The incision leaves minimal scarring. However, if the breast is large and low, there will be excess skin after mastectomy. It is recommended to let it heal for a period of nine to twelve months. During this time, the skin will retract in part and the excess can be removed under local anaesthesia. In this event, you must expect that the scars will be more visible (i.e., an inverted T). The need for a second operation can be confirmed at the postoperative visit or immediately after mastectomy. It is very important not to be overweight before undergoing this surgery so that the breasts are as small as possible.

International Gender Dysphoria Association, Inc.”, meaning that you must have lived as a man during at least 12 consecutive months. You must obtain two recommendations done by two certified doctors, i.e. PhD, Ed.D., D.Sc., D.S.W., Psy. D., accredited from University in medicine. One of these two doctors will need to have followed you for a period of at least six months in psychiatric therapy before making a recommendation for surgery. The second recommendation is a confirmation of the first. In addition we need a letter from your endocrinologist about your hormonal therapy and a short letter from your family doctor explaining that you are perfectly healthy. Please note that all patients in a chronic health condition such as diabetes, hypertension, heart problems, obesity, etc. will not be operated; the risk of operative complications is too great in their case. The patient to be operated must be in excellent health condition. Once the file is complete, we will contact you for a consultation with the doctor (NDLT: ou surgeon) in order to apply for the government program. No appointment for consultation will be made without these documents. Upon receipt of government approval, a surgery date is offered.

Technique used for surgery

Phallic construction is performed by two (2) surgical teams working simultaneously. The forearm skin is taken to construct the urethra, the glans and the penis shaft. The labia majora are used to construct the scrotum and the vaginal cavity is removed. A skin graft is taken from the thigh covering the donor area on the forearm. Clitoral nerves are preserved for the sensitivity of the constructed penis (the clitoris is amputated). We provide diagrams explaining the operation.

A second surgery is required to implant the prosthetic penis (erection). This surgery is performed under general anaesthesia and lasts two hours. It cannot be achieved before nine to twelve months following the phallic reconstruction; from the time when the sensitivity is present in the penis. A third surgery will follow for the insertion of testicular implants and will be performed under local anaesthesia at Dr. Brassard’s clinic.

 Gender Dysphoria Association, Inc.”, meaning that you must have lived as a man during at least 12 consecutive months. You must obtain two recommendations done by two certified doctors, i.e. PhD, Ed.D., D.Sc., D.S.W., Psy. D., accredited from University in medicine. One of these two doctors will need to have followed you for a period of at least six months in psychiatric therapy before making a recommendation for surgery. The second recommendation is a confirmation of the first. In addition we need a letter from your endocrinologist about your hormonal therapy and a short letter from your family doctor explaining that you are perfectly healthy. Please note that all patients in a chronic health condition such as diabetes, hypertension, heart problems, obesity, etc. should be evaluated before scheduling a date for surgery. Once the file is complete, we will contact you for a consultation with the doctor (NDLT: ou surgeon) in order to apply for the government program. No appointment for consultation will be made without these documents. Upon receipt of government approval, a surgery date is offered.

Technique used for surgery

1) Metaidoioplasty is done under general anaesthesia and lasts 3 hours. In this procedure, the vagina is closed, but the female genitals are kept intact to construct male genitals. The clitoris is released and becomes the penis, the labia becomes the scrotum, then part of the vagina and labia minora are used to lengthen the urethra, allowing you to urinate standing up. A catheter is placed through the penis into the bladder for a period of 4 weeks. As the risk of infection and loss of implants is high, the insertion of testicular prostheses is not made at the time of metaidoioplasty. The implants will be inserted into the scrotum when the healing is completed about six months later. This procedure is performed under local anaesthesia and lasts from 45 to 60 minutes. Hysterectomy and oophorectomy must be made ​​at least six months before the metaidoioplasty. Ideally, the third top of the vagina should be removed along with hysterectomy.

2) Release of the clitoris is done under general anaesthesia and lasts 1 1/2 hours. This procedure allows extending the clitoris by releasing its ventral attachment. Testicular implants are placed inside the labia majora, on each side. It will not allow urination standing because the vagina remains open. The scrotum by itself is not formed.

The testicular implants used for this surgery are made of semi-solid polymer. They are soft and cannot run if accidentally broken.