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
(also called vaginoplasty or vaginal reconstruction 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 usually 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 previous surgery in the area can impact results, and surgery can be subject to infections or blood supply or nerve supply problems. However, in the best cases, when recovery from surgery is complete, the surgery is very difficult for even a gynaecologist to detect from natal women.
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, dildos, or suitable substitutes, to continue to keep the vagina open. It is very important to note that sexual intercourse is not 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 result in reduced diameter (vaginal stenosis) to some degree, which would require stretching again, either gradually or, in extreme cases under anaesthetic.
See also: List of transgender-related topics
Other related procedures
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).