This is a surgery with many names: "sex change surgery", "gender confirmation surgery", "gender reaffirmation surgery"... but what is always the same is which it is one of the most invasive, risky and expensive surgery which all trans women desire, although some cannot due to a variety of factors. I for a year participated in two private facebook groups as I said at my first articles about trans women, and so, I acquired a lot of useful information about which every trans women should know and I am making them public so they do not remain at the hands of such groups only. Certainly I anonymized the data, selected only the most important points, include the result of my own research and in the future I will include my own surgery data. Now, pay attention.
Many think which this surgery concerns "cutting out" the penis or "birdie" of someone, which is not true. The top of the penis is used to build a clitoris, the remaining skin is shaved in order to remove the body hair follicles and inverted to be used as the inside of an artificial vaginal channel in case the chosen surgery technique is the "penile inversion". If the hair follices remain, it will grow body hair inside the vagina. The skin of the scrotum is used to create the external vulva; and if it is not enough skin will be taken from the inner thighs and can cause a scar at the place of extraction. Only what was not mentioned is thrown away, but sometimes it is used as donated material for other kinds of surgeries for other people. The urethral channel is adjusted for the urine to leave at the same position as in a woman. The so called "penile inversion" is the most cheap and popular technique just because it was the first to be developed, with the sacrifice of many trans women by the way.
When it is well done, the nerve endings are preserved and you can feel sexual pleasure from the clitoris, external vulva and vagina. With it, you will no longer need to poison your body with anti-androgens and will reduce the estrogen consumption to the minimum necessary for your bones to not break due to a lack of it. Without testosterone, this small quantity of estrogen would have the same effect as a greater quantity and will allow your body to change even more if you are still the 5 year period of changes. Some lesbian trans women store their sperm in expensive sperm banks in order to have descendants later, but there is always the option of adoption if you so desire.
What defines if you will need extra skin or not for your surgery? If you have an "advantage" enough male genitalia. Beyong that, you must have a size which is enough to compensate for the loss which will happend when your body switches from testosterone to estrogen. Even the female organism have a little testosterone, some even use medications containing it to increase their sexual drive. Other detail is the lubrication of the vaginal channel: The tissue used in the "penile inversion" do not allow that as it happens in a biological woman and it will be necessary to use products to keep that region lubricated. In order to "sell his fish", the brazilian site "Transgender center" claim which even biological women need lubrication products, but they do not say which is not in the frequency a trans woman with a penile inversion will need. Other detail is: If your gender dysphoria was so great and your self-control so small which you ended up cutting your "birdie" out, your gender confirmation surgery will be incomplete or even impossible.
There are variations of this surgery depending of the surgeon, be it at the aesthetical execution, technique or acquisition of tissues.
- Using part of the large intestine for the artificial vaginal channel, you will get something with a lubrication and texture similar to those of a biological woman. The negative point is which it is more invasive than the penile inversion and the tissue has the tendency of bacteria proliferation, leading to a bad smell. It is an intestinal tissue after all.
- Using a tissue called "jejunum ileum" from the small intestine; being the results and risks similar to the above, with the difference which the bad smell will not exist as that tissue kills bacteria. Few surgeons do such a kind of surgery.
The problems which may raise from such a surgery depending on the chosen technic would be:
- Detachment of the skin used for the neo-vagina. There is even a report of it falling in the water of the toilet.
- What is popularly known as "stump": When a trans woman feel sexual excitement, the remaining penis tissue under the skin gets swollen and becomes more visible; and a trans women obviously do not want that. With biological women, what get swollen are the external lips and clitoris.
- Infection or perforation of the intestine at the surgeries which use it. Both can lead to death if not identified and fixed quickly.
- Necrosis of the tissue after its replacement to become a neo-vagina and vulva.
- Colapse of the neo vagina, its "closing". The neo-vagina is a hole made where it did not existed in the male body, at first it is nothing more than a great open wound where you must use a kind of plastic penis in order for it to not close or for the orifice to not lose its depth until fully healed. After it will still be needed, it will just be less frequent.
- A breach between the vagina and the intestine, with faecal material passing from the second to the first.
- And more..
By the descripition you could already understand which the recovery process is long and somewhat painful. The person stay almost one month in a bed, with a tube inserted at her redirected urethra among the other things already mentioned. Next the person pass the next two months able to move but still not free from visits to the hospital. Eventually she can go home, but problems may still happen for a period of year, as all the other surgeries. At this surgery it is common for the stitches to break and it being needed to sew everything again... each technique have advantages and disadvantages. At first the looks are always ugly, but if well done, when healed the looks reach what was expected.
Each surgeon has his aesthetics for the external vulva, and for some, the result is awful; usually you can at least say what you expect and he will adjust to a point. I recommend for you to check that past art where an artist called Jamie Mc Cartney made casts of the most varied types of vulva, took photos and created a gallery. Take the photo which you most liked and show it to your surgeon. Some vulva are more delicate, remembering that of for example a child, while others are considered "more adult", so, your choice is personal and no one can judge. The artist idea was to show which there are an infite variery of vulva, and which a woman should not be ashamed of hers. A biological woman can not choose, but a trans woman yes, and the funny thing is which many choose a lot how they want theirs to look and not rarely do "review" surgeries later.
The tendency if which no matter how much the surgeon have studied about it, which he will have errors at his first surgeries of the kind (the guinea-pigs). What defines if a surgeon is bad would be a bad customer support from him or his receptionists, low quality medical environment and nurses, his first errors being grave, he charging for fixing his own errors and his insistence at the errors as if he did not learned anything with time. Anyway, avoid being one of such first "guinea-pigs". The medic must present photos and information about already done surgeries without you asking, and if the details given are coherent, that is a good sign. Study a while about the subject to know what is coherent or not. Do the surgery in a private way, as by the health care of poor countries such as Brazil, you may very well end up being that first "guinea-pig", it takes a long time to do it, the surgeon can be bad and you will not have a choice over the technique and final looks. Know how to differentiate surgeons who can only fix a bad surgery, those who can do the surgery but do not know how to fix it if needed and those who can do both (preferable).
In the absence of the data of private groups of social networks which sometimes can be stressful to obtain, ask for suggestions concerning surgeons from trans women to your psychologists, endocrinologists and if you have one, your local center for trans people. By the way, it is a fine way of knowing if you medic care enough about you to at least attempt obtaining such a data, even if he in the end fails by not having a large enough medical contact network. Research by yourself in the internet forums and sites which show such data to the public, journalistic articles which mention good medics and cross those information. Thailand is a reference in this kind of surgery due to social and cultural aspects, there being trans is not considered shameful; but as it is a poor country many end up selling their bodies to survive. That makes it more frequent the existence of good surgeons at cheaper prices, but also a greater number of "butchers". Some famous medics from there are Suporn, Kamol and Thep, but Thep does not have an official license to do surgeries of this type. In lesser numbers they exist around the world, but in the case of poor countries such as Brazil most only work by means of the public health care system, and from those who remain most have a bad customer support, lack experience or are not well known. Take a look at the blog ratings area for medics.
An important details is which not taking in account the medic, it depends on the organism of each person, what works for one may not work for other; but if you do an extensive research, your "homework", you can at least reduce the chances of something going wrong. It is your body after all.
The objetive of a vagina in a biological woman is to simply receive a penis and act as a way to the womb, where babies can be generated. By it every month the menstruation caused by a not fertilized egg comes out. That is why nature made sex a extremely pleasant thing, and by mean of hormones it controls living beings to do it in order for the wheel of life to continue turning with new beings; even if that generates all kind of sexual cruelty coming from those with more evil souls. Most of the biological women have the same sexual drive as men, but due to a patriarchal society, pregnancy risk and perhaps by the hormonal differences between estrogen and testosterone they may seem to have less interest in that. Many cis women and trans women have great sexual drives, and may lead to negative generalizations about us although not all of us are that way. I am not.
If you are like me and have an almost nonexistent sex drive, people sometimes called "assexual", be it because the hormone therapy took that from you or other reason, that may means which your surgery does not need to include a vagina. By not havign one, you will greatly decrease the costs, risks, suffering and recovery time. You will still get the external vulva and will feel some pleasure coming from the clitoris and from the big and small lips. What would be a nightmare to many women perhaps would suffice for you. I sex really more important to you than just removing the male genitalia? If it is, you are not a trans woman unless you wish both with equal intensity. There is a detail though: You cannot regret this decision, as there will be no return from it.
There is an alternative for trans women which are having trouble with their hormone therapy and do not have the money for a complete surgery: A bilateral Orchiectomy which leaves intact the scrotum tissue, a kind of surgery which only those who also do the complete version know how to do. The scrotum cannot be damaged in any way, or your future gender confirmation surgery can become incomplete. If you are not binary (not the target of this article), you can even do an orchiectomy which preserves part of the testicles if you want. "An orchiectomy does not removes the testicles?", well, not always, as there are many techniques. The surgery can have a negative effect at your erection capabilities however.
Remember, if a wrong choice do not take your life, it will at least ruin it.
Last Updated: 2022/02/13