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'''[[Sex reassignment surgery]] from male to female''' involves reshaping the [[male genitals]] into a form with the appearance of and, as far as possible, the function of [[female genitalia]]. Prior to any surgeries, [[trans women]] usually undergo [[Hormone replacement therapy (male-to-female)|hormone replacement therapy]] and [[depilation|facial hair removal]]. Other surgeries undergone by trans women may include [[facial feminization surgery]] and various other procedures.
{{Transgender sidebar}}
== History ==
[[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: one of [[penectomy]] and [[orchiectomy]], one intended to transplant [[ovaries]], two to remove the ovaries after [[transplant rejection]], and [[vaginoplasty]]. However, she died three months after her fifth operation.
[[Christine Jorgensen|Christine Jørgensen]] was likely the most famous recipient of sex reassignment surgery, having her surgery done in [[Denmark]] in late 1952 and [[Coming out#Transgender and transsexual usage|being outed]] right afterwards. She was a strong advocate for the rights of transsexual people.
Another famous person to undergo male-to-female sex reassignment surgery was [[Renée 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.<ref>{{cite journal |last1=Wexler |first1=Laura |year=2007 |title=Identity Crisis |journal=Baltimore Style |volume= |issue=January/February |pages= |url= |doi= |accessdate=2009-10-12}}</ref> The first physican who performed sex reassignment surgeries in the United States was the late Dr. Elmer Belt. He stopped doing these surgeries in the late sixties.
== Genital surgery ==
When changing anatomical sex from male to female, the [[testicle]]s 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 [[wiktionary:sensate|sensate]] vagina ([[vaginoplasty]]). A [[clitoris]] fully supplied with [[nerve]] endings (innervated) can be formed from part of the [[glans penis|glans]] of the penis. If the patient has been [[circumcision|circumcised]] (removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the [[labia minora]], the [[pubic hair]] [[hair follicle|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 graft]]s from the thighs or hips, or a section of [[Colon (anatomy)|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 opening is identical, and the degree of sensation is approximately the same as that of most biological women so pleasure should not be less.{{Citation needed|date=February 2007}}
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]].
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 especially affected by [[Tobacco smoking|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. However, in the best cases, when recovery from surgery is complete, it is often very difficult for anyone, including [[gynecologist]]s{{Dubious|date=November 2008}}, to detect women who have undergone vaginoplasty.{{Citation needed|date=May 2008}}
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. However, many post-op trans women report that the skin used to line their vaginas develops mucosal qualities from months to years post-op. For others, lubrication is needed when having sex and occasional douching is advised so that bacteria does not start to grow and give off odors.
Because the human body treats the new vagina as a wound, any current technique of vaginoplasty requires some long-term maintenance of volume (vaginal [[Wiktionary:dilation|dilation]]), by the patient, using medical graduated dilators, [[dildo]]s, or suitable substitutes, to keep the vagina open. It is very important to note that [[sexual intercourse]] is not always 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 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 [[ovary|ovaries]] or [[uterus]]es. This means that they are unable to [[pregnancy|bear children]] or [[menstruation|menstruate]], and that they will need to remain on [[Hormone replacement therapy (male-to-female)|hormone therapy]] after their surgery to maintain female hormonal status.
== 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).
=== Breast implants ===
[[Breast implant]]ations is the enlargement of breasts, which some trans women choose 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. Estrogen is responsible for fat distribution to the breasts, hips and buttocks, while [[progesterone]] is responsible for developing the actual milk glands. Progesterone also rounds out the breast to an adult tanner stage 5 shape{{Citation needed|date=November 2010}} and matures and darkens the [[areola]].
=== Voice feminization surgery ===
{{See also|Voice therapy (trans)#Vocal surgeries}}
Some MTF individuals may elect to have [[Human voice|voice]] surgery altering the range or pitch of the person's vocal cords. However, this procedure carries the risk of impairing a trans woman's voice forever, as happened to transsexual economist and author [[Deirdre McCloskey]]. Because estrogens by themselves are not able to alter a person's voice range or pitch, some people proceed to seek treatment. Other options are available to people wishing to speak in a less masculine tone. [[Voice therapy (trans)|Voice feminization]] lessons are available to train trans women to practice feminization of their speech.
===Tracheal shaves===
[[Chondrolaryngoplasty|Tracheal shave]]s are also sometimes used to reduce the cartilage in the area of the throat to conform to more feminine dimensions, to greatly reduce the appearance of an [[Adam's apple]].
===Buttock augmentation===
Because male [[Hip (anatomy)|hips]] and [[buttocks]] are generally smaller than those of a female, some MTF individuals will choose to undergo [[buttock augmentation]]. 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-hip ratio|waist to hip ratio]] of around 0.8 and if estrogen is administered at a young enough age "before the bone plates close"{{Citation needed|date=July 2010}} some trans women may achieve a waist to hip ratio of 0.7 or lower. The pubescent pelvis will broaden under estrogen therapy even if the skeleton is physically male.
== See also ==
* [[List of transgender-related topics]]
* [[Sex reassignment surgery in Thailand]]
* [[Sex reassignment surgery (female-to-male)]]
[[Category:Gender transitioning]]
[[Category:Surgical procedures]]
{{enWP|Sex reassignment surgery (male-to-female)}}

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