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No discussion of electrolysis in the male-to-female transsexual would be complete without some notes on the removal of hair from genital skin prior to gender reassignment surgery (G.R.S.).

The precise method of surgery used depends upon the surgeon performing the procedure; but all methods of G.R.S. place potentially hair-bearing tissue from the penis and/or scrotum in locations where hair would be undesirable and problematical (inside the vagina, under the clitoral hood, and perhaps inside the labia). For this reason, patients are well advised to seek the advice of their chosen surgeon as to which parts must be depilated, and then to obtain the necessary electrolysis well in advance of surgery (to allow the skin to recover).

Genital electrolysis can be exceedingly painful, and in addition to pain control methods used for facial electrolysis, it must be emphasised that hygiene before and after treatment is paramount, as there is a high risk of skin infections from genital electrolysis. Some patients report using Betadine liquid to good effect, before and after genital electrolysis.

Some patients have found genital electrolysis unbearably painful even with topical anaesthetic cream and analgesics / sedatives, and for this group subcutaneous local anaesthesia may be the only solution. Good results have been obtained with use of Xylocaine 2% with Adrenaline 1 in 200,000. The vasoconstrictor action of the adrenaline not only extends the duration of the pain block but effects a substantial reduction in the oedema which often results from electrolysis on genital tissue. It will be necessary for the patient to have the area to be treated clearly marked, so that multiple insertions of the needle can be used to ensure that the entire area is anaesthetised - as a guide, 5-10nl of solution will be required for the lower scrotal flap used in peno-scrotal inversion vaginoplasty, and the pain block can be expected to remain adequate for up to three hours. In many cases this is long enough for the Electrolysist to clear the entire area in one session. When this technique is used on scrotal tissue, a healing period of several weeks must be allowed prior to gender reassignment surgery to allow complete healing: not only does the electrolysis itself cause localised tissue damage that may take 2-3 weeks to heal, but the subcutaneous injection may result in small haematomata which, while generally harmless, must be allowed to heal prior to surgery.

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