History[ edit ] Lili Elbe was the first known recipient of male-to-female sex reassignment surgery, in Germany in She was the subject of four surgeries: However, she died three months after her last operation. She was a strong advocate for the rights of transgender people.
She transitioned and had surgery in the mids, and successfully fought to have transgender people recognized in their new sex. The patient, an infantry soldier who identifies as a woman, had already begun a course of treatment for gender reassignment. The procedure, which the treating doctor deemed medically necessary, was performed on November 14 at a private hospital, since U. Vaginoplasty When 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 , 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.
Surgeon's requirements, procedures, and recommendations vary enormously in the days before and after, and the months following, these procedures. Plastic surgery , since it involves skin, is never an exact procedure, 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 affected by age, nutrition, physical activity and 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.
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. Lubrication is needed when having sex and occasional douching is advised so that bacteria do not start to grow and give off odors. Because of the risk of vaginal stenosis the narrowing or loss of flexibility of the vagina ,   any current technique of vaginoplasty requires some long-term maintenance of volume vaginal dilation , by the patient, using medical graduated dilators to keep the vagina open.
Daily dilation of the vagina for six months in order to prevent stenosis is recommended among health professionals. 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 uteri. This means that they are unable to bear children or menstruate until a uterus transplant is performed, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status.
Other related procedures[ edit ].