Sex reassignment surgery male-to-female
Encyclopedia
Sex reassignment surgery
from male to female involves reshaping the male genitals into a form with the appearance of and, as far as possible, the function of female genitalia. Prior to any surgeries, trans women usually undergo hormone replacement therapy
and facial hair removal. Other surgeries undergone by trans women may include facial feminization surgery
and various other procedures.
was the first known recipient of male-to-female sex reassignment surgery in Germany
in 1930. She was the subject of five surgeries: one of penectomy
and orchiectomy, one intended to transplant ovaries, two to remove the ovaries after transplant rejection
, and vaginoplasty
. However, she died three months after her fifth operation.
Christine Jørgensen
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 strong advocate for the rights of transsexual people.
Another famous person to undergo male-to-female sex reassignment surgery was Renée 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. The first physician who performed sex reassignment surgeries in the United States was the late Dr. Elmer Belt. He stopped doing these surgeries in the late sixties.
s 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 sensitive 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 been circumcised
(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 the 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 opening is identical, and the degree of sensation is approximately the same as that of most biological 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 usually performed only under local anaesthetic, is called labiaplasty
.
The aesthetic, sensational, and functional results of vaginoplasty vary greatly. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by smoking
), any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. However, in the best cases, when recovery from surgery is complete, it is often very difficult for anyone, including gynecologists, to detect that someone has undergone vaginoplasty.
Supporters of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, whereas skin is not. However, many post-op trans women report that the skin used to line their vaginas develops mucosal qualities from months to years post-op. For others, lubrication is needed when having sex and occasional douching is advised so that bacteria does not start to grow and give off odors.
Because the human body treats the new vagina as a wound, any current technique of vaginoplasty requires some long-term maintenance of volume (vaginal dilation), by the patient, using medical graduated dilators, dildo
s, or suitable substitutes, to keep the vagina open. It is very important to note that sexual intercourse
is not always an adequate method of performing dilation.
Regular application of estrogen
into the vagina, for which there are several standard products, may help but this must be calculated into total estrogen dose. Some surgeons have techniques to ensure continued depth, but extended periods without dilation will still often result in reduced diameter (vaginal stenosis
) to some degree, which would require stretching again, either gradually or, in extreme cases, under anaesthetic.
With current procedures, trans women do not have ovaries
or uterus
es. This means that they are unable to bear children
or menstruate
, and that they will need to remain on hormone therapy
after their surgery to maintain female hormonal status.
or FFS).
is responsible for developing the actual milk glands. Progesterone also rounds out the breast to an adult tanner stage 5 shape and matures and darkens the areola
.
surgery altering the range or pitch of the person's vocal cords. However, this procedure carries the risk of impairing a trans woman's voice forever, as happened to transsexual economist and author Deirdre McCloskey
. Because estrogens by themselves are not able to alter a person's voice range or pitch, some people proceed to seek treatment. Other options are available to people wishing to speak in a less masculine tone. Voice feminization
lessons are available to train trans women to practice feminization of their speech.
s 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
.
and buttocks
are generally smaller than those of a female, some MTF individuals will choose to undergo buttock augmentation
. If however efficient hormone therapy is conducted before the patient is past puberty, the pelvis will broaden slightly and even if the patient is past their teen years a layer of subcutaneous fat will be distributed over the body rounding contours. Trans women usually end up with a waist to hip ratio of around 0.8 and if estrogen is administered at a young enough age "before the bone plates close" some trans women may achieve a waist to hip ratio of 0.7 or lower. The pubescent pelvis will broaden under estrogen therapy even if the skeleton is physically male.
Sex reassignment surgery
Sex reassignment surgery is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble...
from male to female involves reshaping the male genitals into a form with the appearance of and, as far as possible, the function of female genitalia. Prior to any surgeries, trans women usually undergo hormone replacement therapy
Hormone replacement therapy (male-to-female)
Hormone replacement therapy for transgender and transsexual people changes the balance of sex hormones in their bodies. Some intersex people also receive HRT, either starting in childhood to confirm the sex to which they were assigned, or later, if this assignment has proven to be incorrect...
and facial hair removal. Other surgeries undergone by trans women may include facial feminization surgery
Facial feminization surgery
Facial feminization surgery is a set of reconstructive surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features...
and various other procedures.
History
Lili ElbeLili Elbe
Lili Elbe was an Intersex person and one of the first identifiable recipients of male to female sex reassignment surgery. Elbe was born as a male in Denmark. Born as Einar Mogens Wegener, she identified as male for most of her life and was a successful artist with that name...
was the first known recipient of male-to-female sex reassignment surgery in Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
in 1930. She was the subject of five surgeries: one of penectomy
Penectomy
Penectomy is the surgical removal of the penis for medical or personal reasons.- Medical Reasons for Penectomy :Cancer, for example, sometimes necessitates removal of part or of the penis. The amount of the penis removed depends on the severity of the cancer. Some men have only the tip of their...
and orchiectomy, one intended to transplant ovaries, two to remove the ovaries after transplant rejection
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...
, and vaginoplasty
Vaginoplasty
thumb|right|300px|Vaginoplasty: the pre-operative aspect , and the post-operative aspect of a [[Labiaplasty|labial reduction]].Vaginoplasty is a reconstructive plastic surgery procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal...
. However, she died three months after her fifth operation.
Christine Jørgensen
Christine Jorgensen
Christine Jorgensen was the first widely known person to have sex reassignment surgery—in this case, male to female.-Early life:...
was likely the most famous recipient of sex reassignment surgery, having her surgery done in Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...
in late 1952 and being outed right afterwards. She was a strong advocate for the rights of transsexual people.
Another famous person to undergo male-to-female sex reassignment surgery was Renée Richards
Renee Richards
Renée Richards is an American ophthalmologist, author and former professional tennis player. In 1975, Richards underwent sex reassignment surgery. She is known for initially being denied entry into the 1976 US Open by the United States Tennis Association, citing an unprecedented women-born-women...
. 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
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
took place in 1966 at the Johns Hopkins University
Johns Hopkins University
The Johns Hopkins University, commonly referred to as Johns Hopkins, JHU, or simply Hopkins, is a private research university based in Baltimore, Maryland, United States...
Medical Center. The first physician who performed sex reassignment surgeries in the United States was the late Dr. Elmer Belt. He stopped doing these surgeries in the late sixties.
Genital surgery
When changing anatomical sex from male to female, the testicleTesticle
The testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
s are removed and the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
of foreskin
Foreskin
In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...
and penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
is usually inverted, as a flap preserving blood and nerve supplies (a technique pioneered by Sir Harold Gillies
Harold Gillies
Sir Harold Delf Gillies was a New Zealand-born, and later London based, otolaryngologist who is widely considered as the father of plastic surgery.-Personal life:Gillies was born in Dunedin, New Zealand...
in 1951) to form a fully sensitive vagina (vaginoplasty
Vaginoplasty
thumb|right|300px|Vaginoplasty: the pre-operative aspect , and the post-operative aspect of a [[Labiaplasty|labial reduction]].Vaginoplasty is a reconstructive plastic surgery procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal...
). A clitoris
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
fully supplied with nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
endings (innervated) can be formed from part of the glans
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
of the penis. If the patient has been circumcised
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
(removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the labia minora
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
, the pubic hair
Pubic hair
Pubic hair is hair in the frontal genital area, the crotch, and sometimes at the top of the inside of the legs; these areas form the pubic region....
follicles
Hair follicle
A hair follicle is a skin organ that produces hair. Hair production occurs in phases, including a growth phase , and cessation phase , and a rest phase . Stem cells are principally responsible for the production of hair....
are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Other scrotal tissue forms the labia majora
Labia majora
The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the...
.
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
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
may be grafted in (colovaginoplasty). These linings may not provide the same sensate qualities as results from the penile inversion method, but the vaginal opening is identical, and the degree of sensation is approximately the same as that of most biological 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
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
, since it involves skin, is never an exact art, and cosmetic refining to the outer vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
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 usually performed only under local anaesthetic, is called labiaplasty
Labiaplasty
Labiaplasty is a plastic surgery procedure for altering the labia minora and the labia majora, the paired tissue structures bounding the vestibule of the vulva. The indications for the correction of labial hypertrophy are two-fold: the correction of defect and deformity, and the cosmetic...
.
The aesthetic, sensational, and functional results of vaginoplasty vary greatly. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by smoking
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
), any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. However, in the best cases, when recovery from surgery is complete, it is often very difficult for anyone, including gynecologists, to detect that someone has undergone vaginoplasty.
Supporters of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, whereas skin is not. However, many post-op trans women report that the skin used to line their vaginas develops mucosal qualities from months to years post-op. For others, lubrication is needed when having sex and occasional douching is advised so that bacteria does not start to grow and give off odors.
Because the human body treats the new vagina as a wound, any current technique of vaginoplasty requires some long-term maintenance of volume (vaginal dilation), by the patient, using medical graduated dilators, dildo
Dildo
A dildo is a sex toy, often explicitly phallic in appearance, intended for bodily penetration during masturbation or sex with partners.- Description and uses :...
s, or suitable substitutes, to keep the vagina open. It is very important to note that sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
is not always an adequate method of performing dilation.
Regular application of estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
into the vagina, for which there are several standard products, may help but this must be calculated into total estrogen dose. Some surgeons have techniques to ensure continued depth, but extended periods without dilation will still often result in reduced diameter (vaginal stenosis
Stenosis
A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
) to some degree, which would require stretching again, either gradually or, in extreme cases, under anaesthetic.
With current procedures, trans women do not have ovaries
Ovary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
or uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
es. This means that they are unable to bear children
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
or menstruate
Menstruation
Menstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
, and that they will need to remain on hormone therapy
Hormone replacement therapy (male-to-female)
Hormone replacement therapy for transgender and transsexual people changes the balance of sex hormones in their bodies. Some intersex people also receive HRT, either starting in childhood to confirm the sex to which they were assigned, or later, if this assignment has proven to be incorrect...
after their surgery to maintain female hormonal status.
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 surgeryFacial feminization surgery
Facial feminization surgery is a set of reconstructive surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features...
or FFS).
Breast implants
Breast implantations is the enlargement of breasts, which some trans women choose if hormone therapy does not yield satisfactory results. Usually typical growth for trans women is one to two cup sizes below closely related females such as the mother or sisters. Estrogen is responsible for fat distribution to the breasts, hips and buttocks, while progesteroneProgesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
is responsible for developing the actual milk glands. Progesterone also rounds out the breast to an adult tanner stage 5 shape and matures and darkens the areola
Areola
This article is about the breast tissue. For the entomology term, see the glossary of Lepidopteran terms. For an artistic cloud motif, see aureola. For the cactus feature, see Areole....
.
Voice feminization surgery
Some MTF individuals may elect to have voiceHuman voice
The human voice consists of sound made by a human being using the vocal folds for talking, singing, laughing, crying, screaming, etc. Its frequency ranges from about 60 to 7000 Hz. The human voice is specifically that part of human sound production in which the vocal folds are the primary...
surgery altering the range or pitch of the person's vocal cords. However, this procedure carries the risk of impairing a trans woman's voice forever, as happened to transsexual economist and author Deirdre McCloskey
Deirdre McCloskey
Deirdre N. McCloskey is an American economics professor. Her job title at the University of Illinois at Chicago is Distinguished Professor of Economics, History, English, and Communication...
. Because estrogens by themselves are not able to alter a person's voice range or pitch, some people proceed to seek treatment. Other options are available to people wishing to speak in a less masculine tone. Voice feminization
Voice therapy (trans)
Voice therapy or voice training refers to any non-surgical technique used to improve or modify the human voice. Because voice is a gender cue, transsexual women frequently undertake voice therapy as a part of gender transition in order to make their voices sound female, and therefore increase their...
lessons are available to train trans women to practice feminization of their speech.
Tracheal shaves
Tracheal shaveChondrolaryngoplasty
Chondrolaryngoplasty is a surgical procedure in which the thyroid cartilage is reduced in size by shaving down the cartilage through an incision in the throat, generally to aid trans women in achieving a passable female appearance, and occasionally on cisgender men and women who are uncomfortable...
s 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
Adam's apple
The laryngeal prominence—commonly known as the Adam's Apple—is a feature of the human neck. This lump, or protrusion, is formed by the angle of the thyroid cartilage surrounding the larynx...
.
Buttock augmentation
Because male hipsHip (anatomy)
In vertebrate anatomy, hip refer to either an anatomical region or a joint.The hip region is located lateral to the gluteal region , inferior to the iliac crest, and overlying the greater trochanter of the femur, or "thigh bone"...
and buttocks
Buttocks
The buttocks are two rounded portions of the anatomy, located on the posterior of the pelvic region of apes and humans, and many other bipeds or quadrupeds, and comprise a layer of fat superimposed on the gluteus maximus and gluteus medius muscles. Physiologically, the buttocks enable weight to...
are generally smaller than those of a female, some MTF individuals will choose to undergo buttock augmentation
Buttock augmentation
thumb|right|250px|Gluteoplasty: the pre-operative, back and oblique-right aspects , and the like post-operative aspects , of a combined procedure of buttocks augmentation and thigh contouring.Gluteoplasty thumb|right|250px|Gluteoplasty: the pre-operative, back and oblique-right aspects (left), and...
. If however efficient hormone therapy is conducted before the patient is past puberty, the pelvis will broaden slightly and even if the patient is past their teen years a layer of subcutaneous fat will be distributed over the body rounding contours. Trans women usually end up with a waist to hip ratio of around 0.8 and if estrogen is administered at a young enough age "before the bone plates close" some trans women may achieve a waist to hip ratio of 0.7 or lower. The pubescent pelvis will broaden under estrogen therapy even if the skeleton is physically male.
See also
- List of transgender-related topics
- Sex reassignment surgery in ThailandSex reassignment surgery in ThailandThailand is believed to have the largest number of Male-to-female transsexuals per capita in the world. A number of international Transsexuals opt to travel to Thailand in order to pursue male-to-female sex reassignment surgery operations....
- Sex reassignment surgery (female-to-male)Sex reassignment surgery (female-to-male)Sex reassignment surgery from female to male includes a variety of surgical procedures for transsexual men that alter female anatomical traits to provide physical traits more appropriate to the trans man's male identity and functioning....