Any type of surgery involves risk. This includes risks of the anaesthetic, problems during the procedure, such as bleeding or damage to other tissues, and post-operative complications such as infection.

Gender reassignment surgery is a complicated procedure and, although techniques have advanced significantly, the nature and time taken to complete the surgery means that complications unfortunately happen.

Complications of the surgery

Complications vary from individual to individual. Preoperative risk factors can be reduced beforehand, such as stopping smoking, keeping fit and healthy and losing excess weight.

Potential risks during the surgery are similar to those common to all prolonged major surgery. These include chest infections, wound infections and the risk of developing blood clots in the legs (deep vein thrombosis) or the lungs (pulmonary embolus). Life-threatening blood clots can be minimized by the use of medications to thin the blood (for example, heparin injections), surgical stockings and early mobilisation after surgery.

Other complications can include damage to the intricate structures within the pelvic area. The bladder and the urethra (the tube that carries urine from the bladder to the outside) can be bruised or injured which can lead to urinary difficulties or infections. This can sometimes lead to a narrowing of the opening (urethral stenosis) which can interfere with the stream of urine. This is relatively common (perhaps in as many as a third of all operations) and may require the tube to be stretched and reopened, a process known as dilatation.

Due to the close proximity to the large bowel, sometimes the surgery can lead to bruising and damage to the rectum. This, in some rare cases, can lead to the formation of something called a fistula, when the wall of the rectum becomes inflammed and sticks to other structures, breaks down and an opening occurs. This can lead to infection and may require further surgery to repair the damage.

If the blood supply is damaged or compromised during the procedure, it can lead to delayed healing, loss of sensation and in some unfortunate (albeit rare) cases, skin breakdown and necrosis (skin death). Microsurgical techniques allow for careful preservation of many of the blood vessels and so these problems are now very unusual.

It is also quite common for people to experience a degree of difficulty with sexual functioning later on. In most cases, sensation and the ability for sexual pleasure is retained, but the degree of functioning varies, depending on the type of surgery. Also sexual functioning requires a lot of post-operative care, both from the surgical team and the individual themselves, but with time, most people report a satisfying result.

Advice to prepare yourself for surgery

The Transgender Explored team have come up with ten simple tips to help make your surgical experience a successful one with the least amount of complications as possible.

1. Stop smoking. Go to your local doctor to arrange for nicotine replacement, if necessary. Try to stop smoking as long as possible before the planned surgery.

2. Lose any excess weight, gradually over time with a sensible eating plan and regular exercise. Don't try to crash diet or leave it until the last minute.

3. Limit your alcohol consumption.

4. Make sure that any coexisting conditions are well under control with the help of your local doctor.

5. Keep fit and active by exercising regularly, at least three times per week, if possible.

6. Speak to others who have been through the surgery itself. Learn from them the tips for a better and less stressful experience.

7. If you have the chance, try to visit the hospital before you go for the surgery. Ask to meet the ward manager and some of the nursing team. When the time comes for the operation, you will already be familiar with the ward and some of the faces, which reduces the stress of the whole experience considerably.

8. Discuss any concerns you have well in advance with the anaesthetist and the surgeon. Ask as many questions as you want and don't be afraid to express any worries you have.

9. Prepare your home for your return post-surgery. Make a list of essentials: have the fridge stocked up with lots of clear fluids, prepare extra cushions and somewhere comfortable to sit (in front of the TV), make sure you will have easy access to your bath or shower and have your own medical supplies kit prepared to include antiseptic wipes, tissues, dressings, painkillers and laxatives (such as Senna tablets).

10. Enlist help from friends and family early. Make sure they understand the support you will need, both emotionally and practically. Don't try to manage everything all on your own.

Have you had surgery yourself? Are you in the process of deciding which operation to have? Do you know someone who has experienced the procedures? Let us know your views in our Blog.