Sex reassignment surgery in Turkey

Sex reassignment surgery is an older name for what most clinicians now call gender-affirming genital surgery, and what many people call bottom surgery. It covers operations that change the genitals so they match a person's gender identity. It does not cover chest surgery, facial surgery or voice surgery, which are separate operations with their own recovery, and it is not a single procedure that everyone has.

The two directions have almost nothing in common surgically. For trans women the operation is a vaginoplasty, or a smaller procedure such as an orchiectomy. For trans men it is a metoidioplasty or a phalloplasty, usually built in stages. Comparing prices or recovery between the two tells you nothing useful, and a clinic that quotes one number for gender surgery has not told you which operation it means.

These build a phallus, and they are usually not one operation but a series. Which parts you want is decided before you start, because some choices cannot be added easily later.

Revision is common with phalloplasty rather than exceptional. Plan on the basis that you may need more than one trip, and ask in writing who pays for what if a stage has to be redone.

These operations remove the gonads, so they end the possibility of biological children permanently. That is not a side effect to think about later; it has to be settled before you go.

Sperm, egg or embryo banking has to happen beforehand, and hormone therapy may already have reduced fertility, so the conversation is worth having as early as possible with the doctor who prescribes your hormones. Ask about it even if you are certain you do not want children. It is one of the few parts of this process that cannot be revisited.

This is major surgery with permanent consequences, and it goes well for people who arrive prepared rather than in a hurry.

• You have worked through what you want with clinicians you trust and can say clearly which operation you are asking for and why.
• You are in good general health and you do not smoke. Smoking is a genuine barrier here, not a formality: it starves healing tissue of blood and it is the main reason flaps and grafts fail.
• Your fertility decision is made and acted on.
• For a vaginoplasty, hair removal is finished or well under way.
• You can take a long time off work, not a fortnight.
• You have somewhere to recover and someone to help, and a doctor at home who has agreed to see you afterwards.
• You understand that revision is possible and, for phalloplasty, common.

There are also good reasons to wait.

• You are still deciding between operations, or between having one and not.
• You cannot stop smoking yet.
• You have not sorted out who provides your aftercare at home.
• Money is so tight that a complication or a second stage would be unaffordable.
• You are being rushed, by a clinic or by a deadline. Nothing about this needs to happen this month.

The operation is a day. The aftercare is the part that decides your result, and for vaginoplasty it does not end.

Dilation is the one that never ends. If you have a vaginoplasty with a canal, you will dilate for the rest of your life. It is frequent at first and becomes less frequent, but it never stops entirely. If you stop, the canal narrows and depth can be lost permanently, and regaining it is not always possible. Ask for the schedule in writing before you travel, and be honest with yourself about whether it fits your life. This is the main reason some people choose a zero-depth vaginoplasty, and that is a reasonable choice rather than a compromise.

For phalloplasty and metoidioplasty the equivalent is the urinary side: a catheter for a period, then learning the new plumbing, and watching for the stream weakening or spraying, which is how a stricture announces itself. Donor site care and staged operations continue over a long period.

• Wound care and hygiene, taught before you are discharged. Ask for it written down as well as demonstrated.
• Swelling and bruising take a long time to settle, and the early appearance is not the result.
• Sensation returns slowly and unevenly, over months. Numb patches early on are expected.
• No sitting on it, no heavy lifting, no swimming and no sex until you are cleared, and those timelines come from your surgeon, not from a forum.
• Low mood in the first weeks is common and does not mean you made the wrong decision. Arrange support before you go.

These are long operations on tissue with a complicated blood supply, and complications are not rare. A surgeon who does not go through this list with you has not given you what you need to consent.

• The general risks of major surgery: bleeding, infection, clots, and reactions to the anesthetic.
• Wound breakdown and delayed healing, more likely if you smoke.
• Changes in sensation, including numbness or areas of pain, which may not fully resolve.
• After vaginoplasty: narrowing or loss of depth, granulation tissue, prolapse, and rarely a fistula between the canal and the bowel or bladder.
• After phalloplasty with urethral lengthening: strictures and fistulas, which are common enough that they should be discussed as likely rather than unlikely.
• Flap or graft failure, partial or complete, and donor site problems including scarring and reduced function.
• Implant infection, movement or extrusion, sometimes needing removal.
• Dissatisfaction with the appearance, which is a real outcome and is why seeing the surgeon's own results matters.

Ask directly: what is your own complication rate for this operation, what do you do when it happens, would a revision be charged again, and would I have to travel back.

This work is done by plastic surgeons and urologists with specific training in gender surgery, often operating as a team. A hospital being excellent at other cosmetic surgery tells you very little about its genital surgery results. Check that the hospital is registered with the Ministry of Health, and ask these before you decide.

• Which exact operation are you recommending for me, and why that one?
• How many of these do you perform in a year, and how long have you been doing them?
• Can I see your own photographs, including results that did not go to plan?
• What is your complication rate, and specifically your rate of strictures and fistulas if urethral lengthening is involved?
• Who operates, who does the ward rounds, and who answers when I am back home?
• What exactly is in the quote, what is not, and what would a revision cost?
• What do you require from me before you will operate, and in what form?
• How long do I stay in Turkey, and what happens if I am not fit to fly?
• Can I speak to a former patient?

Ask for the answers in writing, from the surgeon and not from a coordinator. If the only person you can reach is a coordinator, that is information too.

• Settle the fertility question and act on it.
• Start hair removal early if you are having a vaginoplasty.
• Stop smoking, properly and well in advance.
• Get the technique, the stages, the aftercare schedule and the revision policy in writing.
• Line up a doctor at home who will see you afterwards, and tell them what is being done.
• Arrange enough time off, and someone to be with you for the first stretch.
• Prepare where you will recover: somewhere you can lie down, keep clean and reach a bathroom easily.
• Arrange emotional support for afterwards, not just practical help.

Comparing clinics for this operation is mostly about the surgeon's volume, honesty and follow-up rather than the building.