Gender-affirming surgery (male-to-female): Difference between revisions

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Sex reassignment surgery from male to female includes surgeries which will shape a male body into a body with the appearance of and, as far as possible, the functioning of a female body.

Prior to any surgeries, transgendered or transsexual people usually undergo hormone replacement therapy.

Lili Elbe was the first known recipient of male-to-female sex reassignment surgery in Germany in 1930. She was the subject of five surgeries- penectomy and orchidectomy, one intended to transplant ovaries, one to remove the ovaries after transplant rejection, and vaginoplasty. Tragically, she died three months after her fifth operation.

Christine Jorgensen was likely the most famous recipient of sex reassignment surgery, having her surgery done in Denmark in late 1952 and being outed right afterwards. She was a very strong advocate for the rights of transsexual people.

Another famous person to undergo male-to-female sex reassignment surgery was Renee Richards. She transitioned and had surgery in the mid-1970s, and successfully fought to have transsexual people recognized in their new sex.

The first male-to-female surgeries in the United States took place in 1966 at the Johns Hopkins University Medical Center.

Genital reassignment surgery

For changing anatomical sex from male to female, the testicles are removed and the skin of foreskin and penis is usually inverted, as a flap preserving blood and nerve supplies (a technique pioneered by Sir Harold Gillies in 1951) to form a fully sensate vagina (vaginoplasty). A clitoris fully supplied with nerve endings (innervated) can be formed from part of the glans of the penis. If the patient has suffered male "circumcision" (removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the labia minora, the pubic hair follicles are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Other scrotal tissue forms labia majora.

In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from skin grafts from the thighs or hips, or a section of colon may be grafted in (colovaginoplasty). These linings may not provide the same sensate qualities as results from the penile inversion method, but the vaginal entrance is the same, and the degree of feeling is approximately the same as that of most women so pleasure should not be less.

Surgeon's requirements, procedures and recommendations in the days before and after, and the months following these procedures vary enormously.

Plastic surgery, since it involves skin, is never an exact art, and cosmetic refining to the outer vulva is sometimes required. Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. This relatively minor surgery, which is sometimes performed only under local anaesthetic, is called Labiaplasty.

Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by smoking), any surgery, but especially very fine surgery can be subject to infections or blood supply or nerve supply problems, but in the best cases, because male and female genitalia have similar skin and develop from common original forms, the appearance and functionality, when recovery from reassignment surgery is complete, is in every way impossible for even a gynaecologist to detect from other women who have had a total hysterectomy without an unusually critical examination, and is as satisfactory, indeed pleasurable for it's owner.

Because there is never enough skin available to create a folded capacity identical to the most generous normal in women, any current technique of vaginoplasty may require some long-term maintenance of volume (vaginal dilation), either by penile penetration, or by the patient using medical graduated dilators, dildos, or suitable substitutes, to continue to enable ease of coitus, although penis sizes varying considerably is a factor. Regular application of estrogen within the vagina, for which there are several standard products, helps in many ways. Some surgeons have techniques to ensure continued depth, but extended periods with neither penile penetration nor other dilation will result in reduced diameter (vaginal stenosis) of at least some part, might require stretching again, either gradually or, in extreme cases under anaesthetic. Techniques for creating skin, currently under development may change that. Not all women desire penile penetration.

Breast augmentation

Breast augmentation is the enlargement of breasts, which can be necessary if hormone therapy did not yield satisfactory results.

Facial feminization surgery

Occasionally these basic procedures are complemented further with feminizing cosmetic surgeries or procedures that modify bone or cartilage structures, typically in the jaw, brow, forehead, nose and cheek areas (facial feminization surgery or FFS).

Voice surgery

Some MTF individuals may elect to have voice surgery altering the range or pitch of the person's vocal chords. Estrogens by themselves are not able to alter their voice range or pitch. Voice lessons are available to train the MTF to practice feminization of their speech.

Tracheal shaves

Tracheal shaves are also sometimes used to reduce the cartilage in the area of the throat to conform to more feminine dimensions, to greatly reduce the appearance of an Adam's Apple.

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 == Genital reassignment surgery ==
+For changing anatomical sex from male to female, the [[testicle|testicles]] are removed and the [[skin]] of [[foreskin]] and [[penis]] is usually inverted, as a flap preserving blood and nerve supplies (a technique pioneered by Sir [[Harold Gillies]] in 1951) to form a fully [http://www.answers.com/sensate&r=67 sensate] vagina ([[vaginoplasty]]). A [[clitoris]] fully supplied with [[nerve]] endings (innervated) can be formed from part of the [[glans]] of the penis. If the patient has suffered male "[[circumcision]]" (removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the [[labia minora]], the [[pubic hair]] [[follicles]] are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Other scrotal tissue forms [[labia majora]].
-Primary [[male-to female]] (MTF) procedures fall under one of two categories:  [[penile inversion]] or (less commonly) [[colovaginoplasty]]. Sex reassignment surgery can be completed in either a single surgery or two surgeries, depending on the surgeon's technique.
-For changing anatomical sex from male to female, the [[testicle|testicles]] are removed and the [[penis]] is usually inverted to form a vagina ([[vaginoplasty]]), or, if additional depth or self-lubrication are desired, a section of colon may be grafted in ([[colovaginoplasty]]). For additional vaginal depth, [[pubic hair]]s are removed from scrotal tissues via electrolysis prior to the SRS procedure which is then incorporated by the surgeon to extend the vaginal shaft where penile tissues alone were found insufficient. If either technique performed involved two surgeries, the second surgery is a minor surgery called [[labiaplasty]].
+In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from [[skin graft]]s from the thighs or hips, or a section of [[colon]] may be grafted in ([[colovaginoplasty]]). These linings may not provide the same sensate qualities as results from the penile inversion method, but the vaginal entrance is the same, and the degree of feeling is approximately the same as that of most women so pleasure should not be less.
+Surgeon's requirements, procedures and recommendations in the days before and after, and the months following these procedures vary enormously.
-A third, crudest form of reassignment is where the penile tissue is removed altogether ([[penectomy]]) and vagina tissue created from grafts.
+[[Plastic surgery]], since it involves skin, is never an exact art, and cosmetic refining to the outer [[vulva]] is sometimes required. Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. This relatively minor surgery, which is sometimes performed only under local anaesthetic, is called ''Labiaplasty''.
-Any technique of vaginoplasty performed will require [[vaginal dilation]] of the patient for the rest of her life with a set of [[vaginal stents]]. This is due to the body treating the vagina as a wound, thus trying to close it. Dilation is started several days after surgery, when the temporary packing inserted during surgery is removed. After several weeks of several dilations per day, the patients will eventually be able to cut down to one dilation per week. It is important to note that [[sexual intercourse]] does not count as a dilation- the body requires the hard presence of the stents to keep the vagina from losing depth.
+Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by [[smoking]]), any surgery, but especially very fine surgery can be subject to infections or blood supply or nerve supply problems, but in the best cases, because male and female [[genitalia]] have similar skin and develop from common original forms, the appearance and functionality, when recovery from reassignment surgery is complete, is in every way impossible for even a [[gynaecologist]] to detect from other women who have had a total [[hysterectomy]] without an unusually critical examination, and is as satisfactory, indeed pleasurable for it's owner.
+Because there is never enough skin available to create a folded capacity identical to the most generous normal in women, any current technique of vaginoplasty may require some long-term maintenance of volume (vaginal [[dilation]]), either by penile penetration, or by the patient using medical graduated dilators, [[dildo]]s, or suitable substitutes, to continue to enable ease of [[coitus]], although [[penis size]]s varying considerably is a factor. Regular application of [[estrogen]] within the vagina, for which there are several standard products, helps in many ways. Some surgeons have techniques to ensure continued depth, but extended periods with neither penile penetration nor other dilation will result in reduced diameter (vaginal [[stenosis]]) of at least some part, might require stretching again, either gradually or, in extreme cases under [[anaesthetic]]. Techniques for creating skin, currently under development may change that. Not all women desire penile penetration.
 == Breast augmentation ==