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Gender Confirmation Surgery: Guiding Principles Loren S. Schechter, MD, FACS,1 Salvatore D’Arpa, MD, PhD,2 Mimis N. Cohen, MD,3 Ervin Kocjancic, MD,4 Karel E. Y. Claes, MD,5 and Stan Monstrey, MD, PhD5 ABSTRACT Background: At this time, no formal training or educational programs exist for surgeons or surgery residents interested in performing gender confirmation surgeries. Aim: To propose guiding principles designed to aid with the development of formal surgical training programs focused on gender confirmation surgery. Methods: We use expert opinion to provide a “first of its kind” framework for training surgeons to care for transgender and gender nonconforming individuals. Outcomes: We describe a multidisciplinary treatment model that describes an educational philosophy and the institution of quality parameters. Results: This article represents the first step in the development of a structured educational program for surgical training in gender confirmation procedures. Clinical Implications: The World Professional Association for Transgender Health Board of Directors unanimously approved this article as the framework for surgical training. Strengths and Limitations: This article builds a framework for surgical training. It is designed to provide concepts that will likely be modified over time and based on additional data and evidence gathered through outcome measurements. Conclusion: We present an initial step in the formation of educational and technical guidelines for training surgeons in gender confirmation procedures. Schechter LS, D’Arpa S, Cohen MN, et al. Gender Confirmation Surgery: Guiding Principles. J Sex Med 2017;14:852e856. Copyright 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. Key Words: Gender Confirmation Surgery; Phalloplasty; Metoidioplasty; Vaginoplasty; Gender Surgery Fellowship INTRODUCTION Increased advocacy efforts and expanded third-party insurance coverage have improved access to health care for transgender and gender nonconforming individuals. As such, there has been a corresponding increase in the number of patients requesting gender confirming surgical procedures. The demand for these services has outpaced the number of qualified providers. At this time, no formal training or educational programs exist for surgeons or surgery residents interested in learning about the care of transgender individuals. In fact, at the 2015 Annual Meeting of the American Society of Plastic Surgeons, an educational panel discussing gender confirming surgeries was offered for the first time. In contrast, our European colleagues have recognized the need for postgraduate certification and/or accreditation for performing gender confirming procedures, and they have begun examining these processes for the practicing surgeon. Furthermore, requests for surgery from other parts of the world such as Africa, Asia, and Central and South America highlight the need to develop international surgical training programs with recognized quality metrics that are adaptable to regional variations in practice patterns. Within the community of gender surgeons, formal and informal discussions have taken place regarding certification and accreditation for surgeons performing gender confirmation surgery (Genital Surgery Meeting, Phillipsburg, Saint-Martin, Received December 7, 2016. Accepted April 3, 2017. 1 Loren S. Schechter, MD, SC, Ltd, Morton Grove, IL, USA; 2 Department of Plastic Surgery, University Hospital Ghent, Ghent, Belgium; 3 Division of Plastic Surgery, The University of Illinois at Chicago, Chicago, IL, USA; 4 Department of Urology, The University of Illinois at Chicago, Chicago, IL, USA; 5 Department of Plastic Surgery, University Hospital Ghent, Ghent, Belgium Copyright ª 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsxm.2017.04.001 852 J Sex Med 2017;14:852e856 February 28 to March 4, 2015; European Professional Association of Transgender Health, Gent, Belgium, March 12e14, 2015; Annual Meeting of the Danish Society of Plastic Surgery, Hindsgavl Castle, Middelfart, Denmark, April 23e24, 2015; International Symposium of the National Institutes of Health, Washington, DC, USA, May 7e8, 2015; and the Second Meeting of the European Association for Gender Surgeons, Brighton, UK, November 6, 2015). These conversations have suggested that there are variations in international practice patterns from a specialty perspective and an institutional perspective. As such, it is unlikely that a “one-size-fits-all” approach to providing gender care will meet the needs of all institutions and all providers throughout the world. While recognizing the diversity by which care is provided, this document is designed to highlight guiding principles to assist providers and institutions with
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