Anyone who decides to adapt the physical sex to the perceived inner sex must prepare for lengthy, complicated plastic surgery and hormone treatments. The risks of the operation are also considerable: Patients have to reckon with wound healing disorders, undesirable scarring, loss of feeling, and limited functionality of the genital organs, which can only be reconstructed externally. In addition, there is a risk of inflammation, the formation of fistulas (inflammatory tubules), temporary or permanent incontinence (loss of control over the passage of urine). Long-term urinary incontinence has been observed very rarely.
The development of male genital organs, an elongated urethra, and a penoid or neo-penis is particularly complicated. In the opposite way, the adaptation woman-to-man, the urethra, must also be relocated. At the same time, it is shortened and positioned inside the surgically manufactured vagina.
In both cases of sex change (성 변화 which is the term in Korea), a bladder catheter is used temporarily so as not to impair wound healing. Incontinence occurs in the described procedures if constipation or inflammatory processes irritate the bladder, and surroundings. The ureter can temporarily narrow or become blocked during healing. The detrusor muscle (the muscle that initiates voiding) may also become irritated.
The operation can also affect the nerves responsible for micturition (the process of passing urine). With adhesions between the neo-vagina and the bladder, a wrong connection, a fistula, occasionally forms. As a result, the urine cannot be controlled via the sphincter, but instead drains away.
The symptoms of incontinence should gradually subside during the healing process after the procedure. If they do not, improvements are necessary to ensure that the new organs function properly. The mentioned inflammation, bleeding, or blockage of the displaced urethra occurs in both directions during the sex adjustment. Temporary incontinence is quite common.
In the long term, this type of intervention tends to burden the patient with psychological problems, the consequences of hormone intake, pain during urination or intercourse, or wound healing disorders in the initial.