Genital gender-affirming surgery for transgender women

Transgender women may opt for genital gender-affirming surgery (gGAS), which comprises bilateral orchiectomy, gender-affirming vulvoplasty, or vaginoplasty. Vaginoplasty is chosen most frequently in this population, penile inversion vaginoplasty being the surgical gold standard. In selected cases, skin graft vaginoplasty, intestinal vaginoplasty, or peritoneal vaginoplasty may be indicated. In this article, we discuss the various types of gGAS for transgender women, (contra)-indications, intraoperative considerations, techniques, surgical outcomes, and postoperative patient-reported outcomes.</p

Genital gender-affirming surgery for transgender women

Transgender women may opt for genital gender-affirming surgery (gGAS), which comprises bilateral orchiectomy, gender-affirming vulvoplasty, or vaginoplasty. Vaginoplasty is chosen most frequently in this population, penile inversion vaginoplasty being the surgical gold standard. In selected cases, skin graft vaginoplasty, intestinal vaginoplasty, or peritoneal vaginoplasty may be indicated. In this article, we discuss the various types of gGAS for transgender women, (contra)-indications, intraoperative considerations, techniques, surgical outcomes, and postoperative patient-reported outcomes.</p

A revised phylogenetic classification of tribe Phyllantheae (Phyllanthaceae)

The majority of tribe Phyllantheae (Phyllanthaceae) is currently placed in the paraphyletic genus Phyllanthus and discussions have persisted on how to resolve this issue. Here, we split Phyllanthus into ten monophyletic genera, which are all reinstatements of former genera, but with changes made to the circumscription and constituent species of each group. The genera Breynia, Glochidion and Synostemon were recently found to be nested within Phyllanthus and discussions ensued whether or not to subsume everything into Phyllanthus s.l. Instead of combining all these genera, we here implement the solution of splitting Phyllanthus into strictly monophyletic genera to ensure that the classification is consistent with the latest phylogenetic results. The new classification is based on a phylogenetic framework combined with differences in habit, branching type, floral, fruit and pollen morphology. With this new division of the genus Phyllanthus, tribe Phyllantheae will consist of the following 18 genera: Breynia, Cathetus, Cicca, Dendrophyllanthus, Emblica, Flueggea, Glochidion, Heterosavia, Kirganelia, Lingelsheimia, Lysiandra, Margaritaria, Moeroris, Nellica, Nymphanthus, Phyllanthus, Plagiocladus and Synostemon. As a result of the reinstated genera, five new names for illegitimate combinations or previous overlooked nomenclatural anomalies and 645 new combinations are proposed. Several keys are provided to distinguish the reinstated genera. Full species lists are given for the reinstated genera treated here except for Breynia, Synostemon and Glochidion.Plant sciencesNaturali

The polarized image of a synchrotron-emitting ring of gas orbiting a black hole

High Energy Astrophysic

Constraints on black-hole charges with the 2017 EHT observations of M87*

InstrumentationHigh Energy Astrophysic