Uniklinikum Tübingen: Sex-Reassignment: Male to Female Surgery 2009 from Azraels-Art on Vimeo.

The transition of sex from male to female sex involves the reshaping of the male genitals into the female genitalia both in appearance and in function as much as possible. Before any surgical operations can take place, the patient usually has to undergo HRT (Hormone Replacement Therapy) and facial hair removal depending on the age at which the hormone replacement therapy begins. Various other surgical operations also exist which the patient may select for further feminine characteristics like breast augmentation.

History of Sex Reassignment

The very first known male to female sex reassignment surgery took place for Lili Elbe in 1930 in Germany. Lili was subjected to 5 surgical operations for her transition of sex but she expired after three months of her 5th surgery.

Another sex reassignment surgery was performed in Denmark in 1952 which produced a famous advocate who later fought for the rights of the transgender people. This famous recipient of the sex reassignment surgery was Christine Jørgensen.

The first male to female sex reassignment surgical operation took place in United States of America in 1966 at Johns Hopkins University Medical Center.

Surgical Procedure

When the surgical operation is performed from male to female, the testicles are removed and the skin of the penis and the foreskin is usually inverted as a flap, which harbors blood and nerve supplies, to form a fully sensitive vagina. This procedure is also called the Vaginoplasty. A fully innervated clitoris can be formed from part of the gland of penis. If the techniques used by the surgeons use more skin in the formation of the labia minora, the pubic hair tissues are used and incorporated in the vagina by the surgeons.

In an extremely rare event of the skin shortage or in case of the failure of the Vaginoplasty, skin grafts from the hips or thighs can be used to create a vaginal lining. Alternatively, a section of colon may also be grafted in. This procedure is called Colovaginoplasty. These linings are not able to provide the same sensitive qualities which result from the penile inversion method but they offer the identical vaginal opening and provide the approximately same degree of sensation as that of the most biological women which eliminates any problems regarding the feeling the same pleasure like the other women.

The procedures, requirements and the recommendations made by the operating surgeon vary enormously in the days before and after the months following these procedures.

 

Plastic Surgery

Since the plastic surgery involves the skin, it never is a procedure which follows the exact same methods so it sometimes requires some cosmetic refining to the outer vulva. Some of the surgeons treat this procedure as a second surgery and prefer to wait for recovery of the other tissues, blood and nerve supplies from the first surgery before beginning crafting of the outer vulva in their second surgical operation. This surgical operation is a relatively minor operation which is usually performed under the local anesthetic. The name of this surgical procedure is Labiaplasty.

Vaginoplasty

The results of the Vaginoplasty can vary greatly according to its functionality, aesthetics and sensations. Each surgeon usually uses different techniques and skills to perform Vaginoplasty; the skin of the patients varies in elasticity and healing ability as well which is dependent on the age, physical activities, nutrients and smoking. The results can also be affected by any previously performed surgeries in the area and surgical operations can also get complicated by problems such as blood loss, nerve damage or infections.

Colovaginoplasty

Those in the support of the Colovaginoplasty say that the Colovaginoplasty is a better method than the use of the skin grafts. The reason behind their statement is that the skin is not mucosal whereas the colon already is. However, many of the post operated transsexual women reported that the skin used to line their vaginas developed the mucosal qualities from the months to years after their operations. While some of the transsexual women were stuck with this problem, the others reported that they needed lubrication when having sex. Occasionally, some douching is also advised for these women so that the bacteria do not start to grow and give off odors.

Vaginal Dilation

After surgical operation for a new vagina, the body treats that new vagina as wound and will try to heal it by losing it off. Because of this, any techniques which currently exist for the Vaginoplasty require some long-term maintenance of volume, which is called the vaginal dilation, by the patient using some medical graduated dilators, dildos or other suitable substitutes, to keep the vagina open. Sexual intercourse is a method not adequate enough for performing dilation.

Regular application of estrogen into the vagina, for which there are several standard products, may help, but this must be calculated into the total estrogen dose. Some surgeons have techniques to ensure continued depth, but the extended periods without dilation will often result in reduced diameter (vaginal stenosis) to some degree which would require the                re-stretching of the vagina gradually or under anesthetic in extreme cases.

References

Sex reassignment surgery (male-to-female) – Wikipedia

https://en.wikipedia.org/wiki/Sex_reassignment_surgery_(male-to-female)

Vaginoplasty: Male to Female Sex Reassignment Surgery

http://ai.eecs.umich.edu/people/conway/TS/SRS.html

How does a sex change work? The fascinating and eye-watering details about Kellie Maloney’s op – Mirror

http://www.mirror.co.uk/news/uk-news/how-sex-change-work-fascinating-4455484

How Gender Reassignment Surgery Works – Science, How Stuff Works

http://science.howstuffworks.com/life/genetic/gender-reassignment.htm

Sex Reassignment Surgery – Encyclopedia of Surgery

http://www.surgeryencyclopedia.com/Pa-St/Sex-Reassignment-Surgery.html

How Gender Reassignment Surgery Works (Infographic) – Live Science

http://www.livescience.com/39170-how-gender-reassignment-surgery-works-infographic.html