Vaginoplasty: Male to Female Sex Reassignment Surgery

Historical Background

Transsexualism is not a “modern discovery”. 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.

   

The Development of Modern Sex Reassignment Surgery (SRS)

 

With the rapid advances in knowledge of sex hormones and plastic surgery following World War II, it finally became possible to contemplate complete medical and surgical solutions for transsexualism. During the 1950’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 1950’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.S. citizen, was among the first small group of transsexuals to undergo such a surgical “change of sex”. She was “outed” in 1952 by U.S. print media shortly after her initial surgery, and her story became a national sensation. 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 1954).

 

Although patients were extremely pleased with the results (especially when compared to their previous situations), there were major problems with this early method. 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.Y. and San Francisco, CA. Dr. Benjamin was the first physician/researcher to sort out the distinction between cross-gender identity and homosexuality. 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.D. invented the modern form of penile inversion MtF sex reassignment surgery for MtF transsexuals. Variations of Dr. Burou’s technique have been used ever since.

 

Dr. Burou performed these surgeries in his clinic in Casablanca, Morocco. In 1958-60, 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. Burou. 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.

 

Dr. Burou became both famous and notorious as news spread of his work. His “Clinique du Parc” at 13 Rue La Pebie in Casablanca, Morocco eventually became besieged by transssexual patients from all over the world. Dr. Burou began performing many hundreds of these operations every year. In 1973, Dr. Burou gave his first formal public presentation on his innovative surgical technique at a major interdiciplinary conference on transsexualism held at the Stanford University Medical School. By the time of that 1973 conference, he had performed over 3000 MtF surgical sex reassignments. By that time many other surgeons around the world had inferred and adapted Dr. Burou’s technique, and were applying it in similar SRS surgeries.

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).

 

Dr. 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.D., a prominent plastic surgeon in Mexico (Dr. Barbosa was Lynn’s SRS surgeon, and had performed over 300 SRS’s by 1973).

 

However, such surgeries were still virtually unheard in the U.S. even in the mid-to-late 60’s. Under intense pressure from religious groups following the publicity of the Jorgensen case in 1952, most U. S. hospitals installed policies that explicitly forbade such operations, and religious strictures were frequently drawn upon to support the witholding of any hormonal or surgical treatments of transsexuals. Then too, the U.S. medical community in the 60’s thought of transsexuals as “severely psychotic” rather than biologically mis-gendered. 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.S. resorted to castrating themselves in order to become more feminine and to bypass hospital restrictions on removal of testicles from “intact males” during SRS. 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. After a self-castration to further feminize herself, Aleshia was able to undergo SRS in the U.S. in 1962 with the help of Dr. Benjamin. As did so many postop transsexual women in the 1960’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.

 

Early Sex Reassignment Surgeries in the U. S.

 

Finally, in 1966, 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. Benjamin. The Hopkins’ Surgeons used a variant of Dr. Burou’s method.

 

In the fall of 1966, 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."

Then, on November 21, 1966, the
New York Times published an extensive front-page article on transsexualism. 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.

 

Dr. 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. Dr. 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. At the same time, the fact that Johns Hopkins was actually doing transsexual surgeries greatly enhanced the visibility of Dr. Benjamin’s theories and the attention that his research results received from the medical community.

 

 

Diagrams of the early John’s Hopkins MtF SRS Procedure

 

Following are illustrations that sketch the basic steps in the early Hopkins surgical method, which is a variation on Georges Burou’s method. These figures are taken from Chapter 22, by Howard W. Jones, Jr., M.D. in Transsexualism and Sex Reassignment, Richard Green, M.D. and John Money, Ph.D., Editors; Johns-Hopkins Press, 1969. By this time it was common to refer to this type of surgery as “sex reassignment surgery” (SRS). The illustrations were reproduced from an original article by Howard W. Jones, Jr., Horst K. A. Schirmer, and John E. Hoopes, ” A Sex Conversion Operation for Males with Transsexualism”, American Journal of Obstetrics and Gynecology 100 (1968): 101-9. (Note: See comments following the diagrams regarding the anatomically misleading/incorrect sketching in the final sketch, Figure 10.)

Figure 1. A sketch of the perineum showing the line of primary incision.

 


Figure 2. The right spermatic cord is clamped and ligated.

Figure 3. The primary incision is continued up the ventral side of the shaft of the penis.


Figure 4. The anterior flap is developed from the skin of the penis.

Figure 5. The urethra is dissected from the shaft of the penis.



Figure 6. The corpora cavernosa are separated to assure a minimal stump.

Figure 7. The perineal dissection.




Figure 8. The perineal dissection has been completed and the anterior flap perforated to position the urethral meatus. 

Figure 9. The skin flaps are sutured and placed in position in the vaginal cavity.

Figure 10. The preservation of the vaginal cavity is assured by use of a suitable vaginal form.







Note 1: Figure 10 is quite misleading and does not correspond to the anatomy the should result from this procedure. In figure 10, the vaginal opening is way too far forward from the anal opening, and the vaginal entry is shown going first in horizontally and then turning upwards after passing a large web of skin in front of the anus. (Compare this sketch with the later photos of the details of modern SRS results, especially the one showing the entry of a vaginal stent into a postop’s vagina). This very poorly conceived sketch has likely been the source of many botched surgeries in the early days, as surgeons copying the Hopkins procedure may have thought that a thick web of skin was needed in order to prevent tears into the rectum. Such webs of skin often prevented easy dilations and intercourse for patients after SRS, leading to vaginal stenosis (loss of depth and/or width).

 

Note 2: Over the years, the techniques for doing SRS have been steadily refined. It has also became common for post-op MtF’s to have additional genital surgery called “labiaplasty” that construct further details of the external female genitalia. For more information on modern SRS surgeries, see the links and the “Photo Details of Modern SRS Results" below.

 

 

SRS Becomes an Accepted Treatment for Transsexualism in the U.S.

 

The early Johns Hopkins announcement and publications coincided with the publication of The Transsexual Phenomenon, by Harry Benjamin, M.D. in late 1966. The result of many years of research observations and clinical practice by Dr. Benjamin became the seminal text on transsexualism. The book finally identified transsexualism as a distinct, major medical affliction in which patients have an innate gender identity opposite to the genital sex of their bodies. These theories and results obtained considerable attention within the U.S. medical community over the next several years - but most of it was highly skeptical.

 

Then, following interactions with Dr. Benjamin and some of his patients, physicians at the Stanford Medical Center started a exploratory gender clinic in 1969, led by Norman Fisk, M.D. and Donald Laub, M.D. SRS operations were undertaken on selected MtF patients, and the Stanford clinical and surgical results further validated the concept of SRS as treatment for those suffering from intense transsexualism. Acceptance of SRS as a serious and valid treatment for transsexualism began to slowly spread among thought leaders in the U.S. medical community. Hospitals around the country began gradually lifting their bans on transsexual surgeries, and surgeons at various locations began performing these surgeries on small numbers of selected patients in the U.S.

 

In 1969 Stanley Biber, M.D. (1924-2006*), a surgeon in Trinidad, Colorado, began performing MtF SRS vaginoplasty operations using information he obtained from the surgical team at Johns Hopkins. The excellent successes of his surgeries became widely known, and patients streamed to him.

 

Dr. Biber was one of the pioneering surgeons of the 20th century.  Over a 35 year period beginning in 1969, he performed over 5000 sex reassignment surgeries, almost single-handedly establishing SRS as an acknowledged and accepted treatment for transsexualism in the U.S.  Much beloved by the trans community, Dr. Biber passed away on Monday January, 16, 2006 at the age of 82.

 

 

 

The Current Protocol for Referring Transsexuals for Vaginoplasty (SRS)

 

Vaginoplasty (sex reassignment surgery) is a dramatic and irrevocable final step in male to female gender transition. This step is usually taken only after the deepest introspection and counselling regarding all the options. For those needing complete gender correction, this surgery is a life saving and life enhancing miracle, and can enable them to live a full and joyous life afterwards. However, carrying out of a mistaken urge for such a complete transformation could lead to permanent and terrifying emotional and psychological consequences. The background for this process is discussed in the introduction to the concepts of gender identity, transgenderism and transexualism found elsewhere in Lynn’s website.

 

The Standards of Care of the Harry Benjamin International Gender Dysphoria Association (HBIGDA) defines the currently accepted protocols for the medical treatment of transsexual women. These Standards cover all aspects of medical treatment, including the requirements for Real Life Experience (aka, Real Life Test), and other requirements that must be met before a trans woman is recommended for SRS. Most surgeons who perform vaginoplasty will only operate on transsexual women who have been treated under these Standards and who present the corresponding letters of recommendation for surgery from their case-counsellors.

 

For more information on the overall TS treatment and transition procedures, see Andrea James’ TS Roadmap website, which contains outstanding planning information for anyone contemplating MtF gender transition. For more details on Vaginoplasty, see Andrea’s Vaginoplasty page and follow the many links there.

 

 

 

Some Photos of Modern Vaginoplasty (SRS) Results

 

During the 80’s and especially during the 90’s, there were steady advances in vaginoplasty (SRS) techniques. When performed by the most experienced surgeons, the SRS results are much more predictable than in earlier years, both in appearance and function, and there are far fewer incidents of complications. (Note: We now often use the alternative term Vaginoplasty to refer to SRS. This term better communicates that the surgical goal is the construction of functional female genitalia - i.e., a vagina). The vaginoplasty surgery is often followed several months later by labiaplasty surgery to refine the external female genitalia (labia).

 

Following are photographs of the details of the female genitalia created by modern vaginoplasty and labiaplasty. These photos clarify the remarkably advanced state of modern MtF sex reassignment surgery. In these cases, the surgeries were performed in 1999-2000 by Eugene Schrang, M.D., of Neenah, WI. The patients are in the same orientation as in Figure 10 above (i.e., in stirrups with legs spread and labia separated). The middle photo shows the inner and outer labia spread apart and is labelled to identify the clitoris (c), the urethral opening (u) and the vaginal opening (v). The (z’s) note locations of faint z-plasty scar-lines where incisions were made during labiaplasty to construct the clitoral hood. Note the normal anatomical proximity of the vaginal and anal openings. 



 

Postoperative Care Following Vaginoplasty (SRS)

During the immediate postop period, the woman will be under the good care of her surgeon and hospital recovery environment. During this time, she will learn whether her surgery was fully successful, or whether some complications have occurred and have to be dealt with. Later, after leaving the hospital, she will have to take a lot of responsibility for long-term ongoing aftercare, and the long-term outcome of the surgery will depend on how consistently she performs that aftercare.

A high percentage of modern SRS surgeries done by the top surgeons are fully successful, aesthetically and functionally, without any major complications. However, when done by less experienced surgeons various complications can and do occur, and even the top surgeons will very occasionally encounter difficulties. Complications can include minor infections, bleeding, a sloughing-off and loss of some of the grafted skin. Most of these minor complications can easily be managed and will be under control before the woman leaves the hospital.

However, there is some risk of more serious complications. Anyone contemplating SRS should understand these risks, and should be sure to go to only the very TOP surgeons here or abroad who have track records of very low frequencies of serious complications. The more serious complications include major infection or bleeding, and damage to the bladder, prostate or major nerves during the dissection to form the vagina. These complications can be difficult to control and correct, may require major extension of the hospital stay, and can lead to permanent uncorrectable damage.

One of the most feared complications of all is the formation of a vaginal-rectal fistula. This can occur during the dissection of the vaginal cavity by accidentally cutting through the rectal wall, or it can occur due to vaginal-rectal tissue death from pressure of the packing during the immediate postop period. A fistula enables excrement to bypass the anal stricture and exude from the vagina. The excrement prevents proper healing of the fistula and an ongoing danger of infection. The only way to correct the damage is to perform a colostomy, and then wear a bag for many months while the fistula heals. Proper dilation of the neovagina may not be possible during this periond, often leading to closure of the neovagina. The patient may thus later need a complete redo of the SRS using skin grafts.

[Note: This terrible type of complication often goes unreported because the patient is dependent of the surgeon to correct the damage, and won’t want to alienate him by publicly revealing that the complication has occurred. She is also usually devastated emotionally and won’t want to reveal the horror she is going through. Be sure to go to one of the TOP surgeons if you want to minimize the risk of such awful complications.]

Once released from the hospital, the main concern facing the newly postop woman is to insure that her neovagina heals properly, and maintains its size and remains functional. In order to do this, the patient must dilate frequently using a vaginal stent for an extended period following surgery. There are a number of sources for such stents, and your surgeon will most likely recommend a source to you. One current internet source for stents is Duratek Plastics of Canada.

 

Vaginal stents typically range in size from about 1-1/8 to 1-1/2 inches or more in diameter (28 to 38 mm), and must be inserted to full depth (4 to 6 inches or more) into the woman’s vagina for 30-40 minutes several times per day for many months after the surgery. Increasing sizes are used to gradually widen and maintain the vaginal opening during the postop recovery period. Later-on, especially during any prolonged periods of sexual inactivity, basic dilation must be done at least once or twice a week to insure maintenance of vaginal width and depth. Even after many years, if the woman notices any tightening or constrictions from one week to the next, the frequency of dilation must be increased until that tightening episode has passed.

 

For more detailed information about dilation techniques and immediate postop care, carefully study the article Zen and the Art of Postop Maintenance. We cannot over-emphasize how essential it is to rigorously perform dilations according to the schedule provided by your surgeon. Many of the cases where surgical outcomes seem to be poor are actually the result of women not rigorously dilating, especially during the critical months immediately following SRS.

 

Following is a photo of a newly-postop transsexual woman, whose pubic hair is still shaven, undergoing one of her initial vaginal dilations (after SRS at Dr. Suporn clinic in Thailand). Note that the depth obtainable during SRS is a function of surgical technique, available penile and scrotal tissue for skin grafts and the patient’s pelvic anatomy. Typical SRS depths for most patients of the better surgeons are in the range of 4” to 6”. Here you see an above average result of SRS: a vaginal depth of about 6 to 6-1/2 inches. The stent in this photo is 30mm in diameter. As you can see the stent enters the body at the base of the vulva, and in a normal angle in line with the main torso. Thus this patient’s overall genital geometry is now the same as for any female, and will accomodate all the usual positions for sexual intercourse and lovemaking.

Lynn highly recommends that all women having SRS find a friendly, trustworthy, competent family practitioner or gynecologist beforehand. Tell them what you are about to do, so that they can help you with any minor complications that may be present or may arise once you return from your surgery. Unfortunately, few physicians have any clue about SRS. Therefore, if you suddenly have a complication at home after surgery, you may find it very difficult to get medical help. Many physicians will be afraid of helping for fear that lack of knowledge may lead them into malpractice problems, etc. It would be better if more of the top surgeons would write-up some aftercare information that included a section for general practitioners and gynecologists regarding postop care. This might help ease the concerns among local physicians about how to help a postop woman after SRS.

 

Note: Lack of local medical care was a huge problem for postop women in past decades. Many women returning from abroad with major complications in the 1960’s and 1970’s were unable to find any medical help here in the U.S. Some were even ejected from ER’s they had gone to with life-threatening complications. Some died for lack of access to basic postop medical care in the U.S. Fortunately, things aren’t this bad anymore in most places. But to be absolutely safe, be SURE to line up access to local medical care BEFORE going for SRS.

 

All postop patients should be very careful not to let fears and worries and embarrassments interfere with proper aftercare. If you are having any medical problems and are in doubt about your condition, go see a doctor! Don’t let a minor infection or bleeding or pain stop you from doing your scheduled dilations! If there is any problem at all, seek local medical help and also get back in contact with your primary surgeon. You must not let ANYTHING interfere with your dilations, or else you risk the loss of your neovagina.

After a couple of months have passed, healing will begin to be complete and you can relax a bit. The frequency of scheduled dilations will ease a bit, and you will begin to feel your new form of sexual arousals. At this point you are ready to fully begin your new sex life as a woman.

  

Some Practical Matters:

 Dilations require lubrication, and many postop gals use the water-soluble lubes such as K-Y for this purpose. However, if you need to lube “on the run” in rest room or similar situation, K-Y is rather messy because you need to wash with water to clean it off. Mineral oil is an inexpensive alternative lubricant for dilation that works well, and it cleans up without necessarily requiring washing it off. It can be almost completely removed with paper towels without water, and really isn’t very “oily” after all. The only problem with mineral oil is when travelling you have to pack your bottle of it inside a zip-lock bag lest it sneak out into your luggage.

 

Lubrication is also usually required during sex play and intercourse using your new vagina. Here too there is a good alternative to the ubiquitous K-Y. Astroglide is a much better lube. It takes less of it, and it feels much more “slimy” like natural mucous secretions do. It lasts well and is water soluble too. The only problem with it is that the Astroglide bottles have a little pop-up nozzle that it very sharp at the end - so do be careful when applying it in the heat of passion to yourself and especially to your lover. 

The postop woman may need to douche occasionally, especially after intercourse, in order to keep her neovagina clean and odor-free. There are many over-the-counter preprepared douches that work fine for this. They come in various scents and concentrations. Lynn prefers the “extra cleansing vinegar and water” mixtures, but all the mixtures work fine and will leave you feeling clean and fresh inside. The easiest way to use the douche is to stand in a bathtub or shower and relax and carefully insert it vertically in line with your vagina. Once it is in all the way (the tips are about 4” long), squeeze the bottle empty and let the fluid simply run down your legs. Wipe off with a wet washcloth, and you’re done.

 Most of these prepared douches, such as the Massengill brand, have a tip that tapers down to a fairly fine end, almost to a point. These tapered tips can be a bit painful to insert, especially during the first months after SRS. Since the shafts get larger as you insert further, you can sometime feel the rather sharp flutes along the shaft (slot where the fluid will be ejected from the bottle). Therefore, you’ll need to use quite a bit of lube all along those shafts in order to insert those tips, and the sensation may still be unpleasant.

However, there is one brand of douche, "Summers Eve" which uses a wider, hemispherical tip the size of a small finger, and the shaft behind the tip is smaller in diameter than the tip. Summers Eve douches insert very easily and painlessly with only a small amount of lube on the tip.

Initially, when newly postop, the girl may have difficulty with her urine unpredictably “spraying” all over the place when she sits to pee. However, as her urethral opening heals, she will gradually be able to direct her urine into a more predictable stream. This may take some learning on exactly how to sit and how to position the urethral opening when peeing - learning some things that all GG’s had to do when they were little girls. 

Many newly postop gals at some point suddenly become overly concerned about whether their new genitalia are going to look perfectly normal and whether they are “deep enough” for intercourse. These concerns can be very disabling and prevent the woman from relaxing, having fun, learning her body well, and then going out and dating and becoming open to sexual activities with a partner. This can become a kind of panic as the possibility of sexual intercourse as a woman begins to present itself. Newly postop women need to know that as long as they have at least 4” of depth, they will be able to have fun sex with most average-sized men. More than 4” is defintely better, but 4” is just enough. Many postops have about that much depth and do just fine in relationships with men. Also, most men find female genitalia a bit scary and just don’t look all that closely. If you are a fun sexual partner and your genitalia are sexually functional, then you should have no concerns about “looking perfect”.

 

By the way, quite a few GG women have confusions and concerns about “how they look”. A recent controversy in Australia clarifies this issue: Most GG women have not seen the details of many other women’s vulvas, but nowadays they may often see photos of other women in their boyfriends or husbands’ porno magazines. In Australia the men’s magazines such as Playboy and Penthouse are forced to digitally “pretty-up” and simplify the appearance of women’s genitals in their photos in order to be sold without plastic-wrap covers. As a result of seeing these modified photos, many women in Australia have now gotten a very unrealistic notion of what most women’s vulvas look like, and this has led to many women there to seek out plastic surgeons to make their genitals “look normal”! This story should help more postop TS women to relax a bit and not worry so much about “how they look”. There is a very wide range of vulvar appearances, and most postops these days fit somewhere within the rather “normal-looking” part of that spectrum.

 

It also turns out that most men find postop women quite wonderful feeling during intercourse, because postops are usually “tighter” than other girls those men have made love to. Postop women can also “snatch” their lovers’ penises and apply pressure by tightening their abdominal muscles, just as GG’s do, and thus make themselves even tighter. However, you must be sure to regularly dilate to at least 35mm in width (1-3/8 inch) in order to take in an average-sized male, and 38mm is even better (1-1/2 inch). Remember, your vagina is not as elastic in diameter as a GG’s vagina. It will stretch out only to the maximum size you’ve dilated to, and will then go no further. If you are in doubt about someone’s size, be sure to carefully “feel the width” of your date before indicating a desire for intercourse. That way you can see if he’s likely fit into you. If he’s definitely too wide, you can decide that you are “too tired” that night. Then find someone else to date.

  Sexual Arousal, Lovemaking and Orgasm in Postoperative Transsexual Women

 Many myths surround the effects of SRS on libido, sexuality and orgasm. Many preop TS women are understandably concerned about whether they will be able to fully enjoy and eagerly participate in lovemaking after SRS. Of special interests and concern is whether postop TS women can fully experience sexual arousal and orgasm. The ability to easily become aroused, to desire intimate and sensual contact, and to achieve sexual release through orgasm is a precious gift to bring into love relationships, especially when combined with a desire to give full and complete pleasure to one’s love partner too. A loss of these capabilities could ruin the woman’s chances of experiencing her full humanity after transition, especially for finding and enjoying a passionate, deeply-bonded love relationship. However, as we’ll see, SRS can provide those for whom it is right the chance to fully experience the joys of sex and lovemaking - and thus to finally enjoy a full human life.

 

Myths vs Reality, and the decision to undergo SRS

 Many people simply assume that the loss of the external male genitalia will result in a complete loss of sexuality. This very naive myth unnecessarily frightens many preop women, and it also furthers prejudice against postop TS women, who are often thought of by the general public as having “desexed themselves”.

 

Certainly a typical male would suffer a catastrophic impact on body image and libido from the loss of his external genitalia. However, it has long been known that with counseling and practice, even males who have lost their genitalia to cancer can recover the capability for arousal and orgasm.

 

Furthermore, intensely TS women are not “regular guys”. They do not suffer a negative impact on body image as a result of SRS, but instead find a greatly enhanced body image. The experiences of countless Hijra girls in India demonstrates that even primitive forms of SRS do not desex transsexual girls and in fact helps many of them. SRS has the opposite effect on intensely TS women as would the emasculation of a typical male. SRS usually releases and enhances the libidos of TS women, enabling them to frequently and fully “turn-on” and enjoy their physical sexuality and lovemaking, including achievement of orgasm during intercourse with a partner.

 

The myths and misunderstandings about the effects of SRS cause many preop TS women to remain in a state of indecision about having surgery. Although feeling an intense need to undergo SRS to achieve physical conformity with their gender identity, some preops may also feel extreme anxiety about whether or not they will still experience sexual arousal and orgasm after SRS.

 

This anxiety is enhanced by stories heard from many TS transition failures, including the cases of intense cross-dressers, drag queens and crossdressers who mistakenly underwent SRS for various sexual reasons and then found that their male libidos were greatly reduced and their male orgasmic capability eliminated. 

  1. somberdream2 reblogged this from fuckyeahmedicalstuff and added:
    A very informative post!
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    informative. Excuse...science I share thee.
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    Thank you!
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  16. mirificemirandus said: Thank you so much for posting this! You’re wonderful!
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    neat!
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