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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 and features.

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.

These are known as facial feminization surgery or FFS. Breast augmentation is the enlargement of the breasts. Some trans women choose to undergo this procedure 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. Progesterone also rounds out the breast to an adult Tanner stage -5 shape and matures and darkens the areola.

Some MTF individuals may elect to have voice surgery, which alters an individual's vocal range or pitch. However, this procedure carries a risk of impairing a trans woman's voice forever.

Since estrogen alone does not alter a person's vocal range or pitch, some people take the risk that comes along with voice feminization surgery.

Other options, like voice feminization lessons, are available to people wishing to speak with less masculine mannerisms.

A tracheal shave procedure is also sometimes used to reduce the cartilage in the area of the throat and minimize the appearance of the Adam's apple in order to assimilate to female physical features.

Some MTF individuals will choose to undergo buttock augmentation because anatomically, male hips and buttocks are generally smaller than those presented on a female.

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. From Wikipedia, the free encyclopedia. Sex reassignment surgery. This article needs additional citations for verification.

Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.

Gender identities. Health care and medicine. Rights issues. Society and culture. Theory and concepts. By country. See also. Main article: Vaginoplasty.

Main article: Facial feminization surgery. Main article: Chondrolaryngoplasty. Transgender portal. Archived from the original on Right: Photo of the details of the genitalia of a TS woman with her legs spread in stirrups and her labia partially opened after undergoing vaginoplasty SRS and labiaplasty performed by Eugene Schrang, M.

Bahasa Malaysia in progress. This page sketches the historical development and surgical details of vaginoplasty surgery also often called 'sex reassignment surgery' SRS or 'gender reassignment surgery' GRS.

Before reading this page, please read the introduction to the concepts of gender identity, transgenderism and transexualism elsewhere in this website, so that you'll understand why transsexual women undergo these operations.

This page clarifies that post-operative MtF transsexual women really do have female genitalia, and will also help readers visualize some of the ordeals trans women endure to achieve their new physical gender status.

Historical Background. Instead it is a not-uncommon, naturally-occurring variation in human gendering that has been observed and documented since antiquity.

In many cultures, including native tribes in North America, transsexual individuals have long had the choice to cross-dress and live their lives as women, including taking husbands.

The surgical alteration of genitalia to relieve intense cross-gender feelings was also not "invented in the twentieth century".

In some cultures, even ancient ones, many transsexuals have voluntarily undergone surgeries to modify their bodies in such a way as to "change their sex".

The surgical methods and the effects of castration were everywhere for the ancients' to see. It's use in the domestication of animals quickly taught ancient people that removal of a human male's testicles at a young enough age would prevent his masculinization too.

Such a person would forever be childlike - or "girly". These surgeries were also often forcibly done upon captive adult male slaves in order to "domesticate them" as "eunuchs".

Performing such surgeries on normal post-pubertal males does not change their gender feelings or gender identity, although is lessens their sexual drives somewhat and sharply reduces their ability to develop male musculature.

The accumulating knowledge about the effects of castration was further extended to help MtF transsexuals: Untold millions of transsexuals over thousands of years have voluntarily sought and undergone surgeries vastly riskier and more dramatic in effect than mere castration.

In these surgeries transsexuals are completely emasculated by total removal of the testes, penis and scrotum.

In addition, the external pubic area is often roughly shaped to look like a girl's vulva. No one knows precisely how it started, but such transsexual surgeries were well known by the time of ancient Greece and especially in sexually-permissive ancient Rome, and were often traditionalized in various "religious rituals" that provided the resulting "women" with a place in society.

By undergoing these surgeries, young MtF transsexuals if they survived not only avoided becoming men, but also gained genitalia that looked somewhat like those of a woman.

Although lacking vaginas and lacking the powerfully feminizing effects of female sex hormones, young transsexuals in the past could nevertheless live life better as women after undergoing such surgery.

Even today, very large numbers of desperate young transsexuals in India and Bangladesh run away from home to join the "Hijra" caste. To become Hijra, these teens voluntarily undergo fully emasculating surgeries under primitive conditions, just as they would have in ancient times, with only opium as an anesthetic.

Most undergo the surgery in their teens shortly after the onset of puberty, with results as seen in photo below.

By being castrated just early enough, many avoid the development of male secondary sex characteristics except for the breaking and lowering of the voice , and their bodies can remain permanently soft, childlike and girly.

Contrary to popular myth, total external emasculation after puberty does not necessarily "de-sex" the person.

Complete castration after puberty leaves the young Hijra with her newfound feelings of sexual arousal and her newfound orgasmic capabilities.

While the psychological impact of such surgery would usually cripple the libido of a normal male, the effect on a young transsexual girl is usually just the opposite: The surgery can be liberating and can enable a fuller expression of her sensuality and her female libidinous feelings.

Just as in the case of modern post-operative transsexual women, many Hijra can have strong feelings of sexual arousal in the inner remnants of their genitalia even though they lack the external nerve tissue left by modern SRS, they retain the internal portions of the erectile corpora cavernosa and of course the prostate, with its spasmodic orgasmic capabilities.

Although Hijra lack vaginas, many greatly enjoy to orgasm penetrative anal sexual activities with men. Because of their complete external emasculation, Hijra genitalia and pelvic regions look very "girly", and many men in India greatly enjoy lovemaking with them.

The Hijra in turn accept their fate and their limited, but real, possibilities for finding at least a little bit of love as a woman in this life.

Many also work as prostitutes and beggars in this lowly but traditional Indian caste. Some Hijra today are fortunate to have access to female hormones, and can feminize their bodies by growing breasts and developing natural female body contours.

The combination of emasculation as teenagers combined with use of estrogen enables some Hijra now to become very beautiful - even though, sadly, they do not have female genitalia vaginas and are not socially accepted as women.

The origins of the Hijra caste goes back hundreds of years in Indian history. This widespread practice enables transsexuals to escape the angst and fate of masculinization as teenagers, and provides a safe though lowly place in society for them.

The agonizing extremes to which these transsexual youngsters will go in order to "approximately have a female gender", with full knowledge that they will never see their families again and will face social degradation for the rest of their lives, is a testament to the reality and extremity of the gender conflict that they face within themselves.

There are several million Hijra in India and Bangladesh today. It is not an imitated or learnt one, but a natural instinct that urges us to be women.

By fully emasculating themselves, and then falling upon the medical system for "patching up", they can thus achieve a "low-cost SRS early in life".

A number of girls in the U. Even larger numbers of young TS girls in the U. The long history of traditional 'Hijra-style' surgeries extends from ancient times right up to today, continuing onward in countries such as India and Bangladesh.

The detailed knowledge of the postoperative effects of the Hijra-type emasculations provided an important empirical background for the development of modern transsexual surgeries.

Abraham, M. During the 's, transsexual women began to benefit enormously from the newly available female sex hormones, which enable the development of breast, soften the skin and over time produce female body contours.

Also during the 's, a few surgeons began exploratory surgeries to construct vaginas in MtF transsexuals by using skin grafts taken from the thighs or buttocks, drawing upon then recently developed techniques for constructing vaginas in intersexed girls.

Christine Jorgensen, a U. She was "outed" in by U. Through her story, many transsexuals for the first time learned of the existence of the new hormonal and surgical treatments.

However, access to this new, experimental surgery was limited to a tiny handful of patients in Europe. At the time of Christine's surgery in the '50's, doctors first removed the transsexual's male organs in one or more surgeries.

The patient then waited through an extended period for healing. Then, in a surgery similar to those done to create vaginas for intersexed patients, surgeons constructed the patient's vagina by using skin grafts taken from her thighs or buttocks Christine's vaginoplasty surgery was in The skin grafts were unreliable, and sometimes partially failed to "take".

The use of extensive grafts also left large disfiguring scars at the donor sites. In addition, a lot of sensitive genital tissue was forever lost in the first step, affecting patients' feelings of sexual arousal and capacity for orgasm.

During the late 50's and into the 60's, several hundred transsexuals in the United States came under the care of Harry Benjamin, M.

D, a compassionate physician and endocrinologist who had offices in New York, N. Instead of viewing transsexuals as mentally ill deviants as did most psychiatrists of the day, he began to visualize transsexuals as truly suffering from a genuine mis-gendering condition of unknown origins.

In efforts to ease their suffering, he began prescribing estrogen to selected patients in response their profound pleas for medical feminization.

He also maintained close watch on the results of transsexual surgeries being performed, and began to refer his most intensely transsexual patients to those surgeons who were obtaining the best results.

Then, in the late 50's, a french plastic surgeon named Georges Burou, M. Variations of Dr. Burou's technique have been used ever since. Burou's classic innovation was to use the male genitalia as source of skin and sensitive erotic tissue to create the new female genitalia, including the vagina.

Thanks to Pascale from France for finding these photos of Dr. Burou performed these surgeries in his clinic in Casablanca, Morocco. In , several famous and very beautiful young "female impersonators" from the club Le Carrousel in Paris, France, including Coccinelle more info , Bambi and April Ashley , were successfully transformed into women by Dr.

Many of the young Le Carrousel girls had received female hormones as a side-benefit of working at the club, and as a result had become incredibly beautiful, feminine and sexy.

Several returned to perform at the club after their genital surgery. Their successful "sex changes" became widely known about, and they became sought after as love objects by many prominent, wealthy men.

Some very wealthy men including Aristotle Onassis would occasionally "sponsor" the sex change surgery of a Le Carrousel girl, who would then became their mistress for a while.

Among the keys to the success of these surgeries were i the use of the skin of the penis and scrotum to form the new labia and a sexually functional vagina thus avoiding the source area disfigurement caused in earlier operations by the use of large, deep skin grafts , and ii the careful dissection and placement of the terminated corpora cavernosa and the saving and relocation of some of the sensitive nerves and a small amount of erectile tissue.

If done properly, the post-operative patient can have powerful feelings of sexual arousal erection of the corpora stumps remaining inside her body and can easily be orgasmic the prostate is left intact, and can spasm during orgasm just as before SRS - while the nerve tissues throughout the corpora, the clitoris and the vulva spasm, throb and release at the same time, just as in any other woman.

Benjamin's practice grew rapidly as more and more transsexuals learned that they could obtain compassionate treatment from him.

He began referring ever larger numbers of patients to surgeons, especially to Dr. Burou in Casablanca. By the mid 60's, several other top surgeons abroad began performing SRS surgeries on transsexuals using Dr.

Burou's techniques, and Dr. Benjamin referred patients to these surgeons too. The most notable of these was Jose Jesus Barbosa, M.

However, such surgeries were still virtually unheard in the U. Under intense pressure from religious groups following the publicity of the Jorgensen case in , most U.

Then too, the U. Instead of receiving help for gender-transition from medical professionals, many transsexuals were forced into mental institutions, where psychiatrists tried to "cure them of their mental illness" by electroshock therapy and aversion therapy.

During the late 50's and into the early 60's, a number of intensely transsexual girls in the U. Once no longer intact, the girl might hope to obtain complete SRS in some hospitals here - if she had the money to pay for it.

See for example, the story of transsexual pioneer Aleshia Brevard. At a young age and feminized on estrogen, Aleshia became a star performer at Finocchio's, the world famous "female impersonator" nightclub in San Francisco.

As did so many postop transsexual women in the 's including Lynn Aleshia left her past life behind and entered stealth mode.

She went on to become a showgirl, a "Playboy Bunny" a hostess at one of the famous "Playboy" clubs , a widely recognized actress in movies, on stage and on TV, and got married three times!

Aleshia only recently came out to tell her story in a wonderful book about her amazing life. Finally, in , surgeons at the John Hopkins Medical Center began performing a limited number of MtF SRS operations in effort to help some intensely transsexual patients under care of Hopkins' new gender identity clinic.

The Hopkin's staff believed that transsexuals were mentally ill, but they also believed that there was no psychological method for reversing the "incorrectly formed gender identity".

In an experimental program they began to explore the possibility of helping patients via surgery, as was being recommended by Dr.

The Hopkins' Surgeons used a variant of Dr. Burou's method. In the fall of , newspapers around the country propagated the following item from a column in the New York Daily News: "Making the rounds of Manhattan clubs these nights is a stunning girl who admits she was a male less than one year ago and that she underwent a sex change operation at, of all places, Johns Hopkins Hospital in Baltimore.

Surprisingly, the hospital confirms the case, saying surgery followed psychotherapy. Such operations, although rare in this country, are neither illegal nor unethical, according to a Johns Hopkins spokesman.

Officials at a number of major hospitals here agreed with Johns Hopkins on the legality and ethics of the operations but none could recall such an operation ever having been performed in New York.

The Times article provided extensive information on the surgical and hormonal treatments then being done abroad, and on the new program at John's Hopkins University Medical Center, where several surgeries had recently been done.

The article also identified Dr. Benjamin as being the world's leading authority on transsexualism, and as author of a new textbook on the subject entitled The Transsexual Phenomenon see this link for an online version of the original text.

Harry Benjamin, M. Benjamin was the pioneer of the whole new area of medical knowledge of transsexualism.

His paradigm-shifting medical text described his experiences with many patients over several decades. He was the first researcher to recognize how gender identity and sexual orientation are two independent dimensions of each person's human nature.

Benjamin recommend how "intense transsexuals" could and really should be treated, in order to enable them to live in the gender they sought.

His book documented the results of the new, innovative surgical and hormonal treatments and put those treatments into a rational context as therapy for transsexualism.

This book gave fresh hope to many transsexuals, and opened the door for the modern medical approaches that we now take for granted.

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