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Full Gender Reassignment Surgery Female To Male

A transgender woman who underwent a vaginoplasty to have her penis turned into a vagina has described in graphic detail what the process was really like.

Jessica, who identifies as a queer woman, had already started hormone replacement therapy and gone all the way to South Korea to have vocal chord surgery to transform her baritone voice when she decided to have a breast augmentation surgery and a vaginoplasty in one operation. 

After her vaginoplasty, which she had near her home in East Bay Area, California, she warned 'there are going to be parts of you that are going to melt off' in an interview with Truth Speak Project.

Scroll down for video 

Melting: A transgender woman has described what it is like to undergo gender reassignment surgery; a video reenactment by the European Association of Urology shows what genitals might look like after the procedure

Jessica, whose partner was also born male and had already had the surgery, said there were elements of her recovery that she was not warned about by doctors, adding that it was 'really scary'. 

She said: 'There are going to be parts of you that are going to melt off...It is really scary. But it’s also perfectly normal and most people recover from that completely as if nothing has happened.

'Basically the furniture down there gets rearranged during the surgery. One of the many things I learned along this journey is that male genitalia and female genitalia aren’t that different. They’re arranged differently, but the individual parts are really similar.

'So vaginoplasty consists of a re-positioning and folding of all these tissues using the existing tissues.

'When that’s done, some of the tissues might not get as much blood flow as they did before, so they get starved of nutrients and oxygen.

'That’s when the surface tissue tends to die off — which is as gross as it sounds. It is really really awful.'

Warning: Jessica, who was born male, said: 'There are going to be parts of you that melt off' after surgery (medical diagram shown)

Although Jessica said she was expecting her vagina to 'look like Frankenp***y' after surgery, it was much worse that she could have imagined. 

At one point she claims she thought she was 'dying'. 

'It’s red, there’s stitches and it’s swollen, you can see the stitch lines. You expect that,' she said.

'What you don’t expect is this yellow-y, clumpy, almost mucus-y, looks-like-someone-sneezed-on-your-p***y kind of residue.

'So you might have a chunk of your inner labia just die off, just fall off, and it’ll just grow right back. It’s hard to believe because when you lose a limb or a toe it doesn’t grow back. But it turns out that your p***y does. It’s strange.

'And it’s gross and it’s funky and it’s awful and you think, "Oh my god, What is happening? My p***y is melting. I’m dying." But it turns out that it is perfectly normal.'

She said doctors should better prepare patients for what will happen following the surgery.

'It’s something doctors should tell patients beforehand. Because you’re already dealing with so many changes, working with so many geographic changes on your body.

Healing: She said she had anticipated her vagina looking 'like Frankenp***y' after surgery, pictured in diagram, but said it was much worse than she expected (medical diagram shown)

'Your clitoris, which used to be the head of your penis, is positioned in a completely different way,' she said.

In the early days after the operation, Jessica said there were occasions when she thought she still had male genitalia.

She said: 'There were times early on when I felt like I could feel my penis. I figured out what was going on though. 

'Basically, my clit was telling me that it was still the head of my penis, that the most sensitive part of it was still there. It took a lot of adjusting and it was pretty weird at first.'

She said she has shown her new sexual organs to cisgender females who have told her the surgeon 'did a great job'. 

Jessica said she has a G-spot and that she has had orgasms - but they are 'very different' to what she experienced before surgery. 

She said: 'I do have a G-spot. In fact, I still have a prostate, even though it’s much smaller than it was because of hormone replacement therapy. But it’s still there and it can still be stimulated. It’s still very enjoyable...

'Orgasms are very different. Oh my goodness. They were different even before my surgery after I started hormone replacement therapy. That’s when I started having more full-body orgasms. 

Icon: Transgender actress Laverne Cox, 31, left, has previously said she was pleased she could undergo gender reassignment in private; transgender model Andreja Pejic, right, also underwent the procedure in 2014

'The sensation wasn’t just concentrated immediately around my genitals anymore. It was more like waves of pleasure throughout my body. 

'So that started happening with just hormones. But then, of course, the surgery changes everything.' 

She added: 'I didn’t think that I would get such good results from my surgery but there they are.

'I definitely experience internal stimulation orgasms and they are different from the orgasms I get from clitoral stimulation. 

'They’re deeper and they’re more intense — always gush from internal orgasms.' 

She said the development of surgery has made experiences for people undergoing the procedure 'a lot better' in the last decade. 

She added: 'Some things are different for trans feminine people who had their surgery ten years ago.

'Doctors have gotten to a point now where they can make a vagina that allows you to come and really gush from internal vaginal stimulation just like a cis-gendered woman does, if that’s something that you’re capable of doing.' 

Jessica paid for her  breast augmentation herself but the vaginoplasty was covered by her insurance as required by California law after a doctor said it was medically needed.

Despite having done so herself, Jessica warned against having both surgeries in one operation.

'I woke up in the recovery room in a world of pain, unable to move,' she said. 'I really underestimated how much the recovery from breast augmentation takes out of you.' 

She said she opted for a full vaginal canal because she wanted to experience penetrative sex and to 'relate to cis-gendered women'.

Content: Jessica said she is pleased with the surgery, pictured above, and said since then she has found she has a G-spot and has had orgasms

Progress: Jessica said vaginoplasty surgery, pictured in diagram, has developed considerably over last decade

She added: 'I had to wear a pad every day and I get it. The struggle is real...I have this newfound respect and empathy for my fellow sisters. I get it now...

'I just had my first p-in-v sex as a vagina-haver and it was different from what I expected. It was more intense than I expected. 

'I had gotten used to the process of dilating my vagina, which I do with a medical phallus one to two times a day, to keep the new vagina from closing up. 

'I’ve been doing that for 9.5 months since my surgery. So having something in my vagina is a normal sensation for me because I experience it every day.

 'There are going to be parts of you that are going to melt off... It is really scary. But it’s also perfectly normal

Jessica, transgender woman

'But having a person inside my vagina was a relatively new experience for me. I’ve had fingers but I’ve never had a penis. 

'It was a little overwhelming, but it was pleasant and fun and I would totally do it again. The person I had sex with was a preoperative trans woman.' 

Transgender model Andreja Pejic underwent gender-reassignment surgery, also known as gender-reconfirmation surgery, in 2014.

Talking about the decision last year the Bosnian model told Vogue: 'Society doesn't tell you that you can be trans. I thought about being gay, but it didn't fit… 

'I thought, well, maybe this is just something you like to imagine sometimes'.

Orange Is The New Black star Laverne Cox said she does not like the focus on gender reassignment surgery - saying she is 'grateful' she could have gender reassignment surgery in 'private' unlike Caitlyn Jenner.

The transgender actress told Entertainment Weekly last year: 'I’m so grateful that I had the luxury of transitioning in private because when you transition in the public eye, the transition becomes the story. 

'I’m always disturbed when I see conversations about trans people that focus on surgery. But I believe Caitlyn will transcend this moment.' 

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Sex reassignment surgery

Definition

Also known as sex change or gender reassignment surgery, sex reassignment surgery is a procedure that changes genital organs from one gender to another.


Purpose

There are two main reasons to alter the genital organs from one sex to another.

  • Newborns with intersex deformities must early on be assigned to one sex or the other. These deformities represent intermediate stages between the primordial female genitals and the change into male genitals caused by male hormone stimulation.
  • Both men and women occasionally believe they are physically a different sex than they are mentally and emotionally. This dissonance is so profound that they are willing to be surgically altered.

In both cases, technical considerations favor successful conversion to a female rather than a male. Newborns with ambiguous organs will almost always be assigned to the female gender unless the penis is at least an inch long. Whatever their chromosomes, they are much more likely to be socially well adjusted as females, even if they cannot have children.


Demographics

Reliable statistics are extremely difficult to obtain. Many sexual reassignment procedures are conducted in private facilities that are not subject to reporting requirements. Sexual reassignment surgery is often conducted outside of the United States. The number of gender reassignment procedures conducted in the United States each year is estimated at between 100 and 500. The number worldwide is estimated to be two to five times larger.

Description

Converting male to female anatomy requires removal of the penis, reshaping genital tissue to appear more female, and constructing a vagina. A vagina can be successfully formed from a skin graft or an isolated loop of intestine. Following the surgery, female hormones (estrogen) will reshape the body's contours and stimulate the growth of satisfactory breasts.

Female to male surgery has achieved lesser success due to the difficulty of creating a functioning penis from the much smaller clitoral tissue available in the female genitals. Penis construction is not attempted less than a year after the preliminary surgery to remove the female organs. One study in Singapore found that a third of the persons would not undergo the surgery again. Nevertheless, they were all pleased with the change of sex. Besides the genital organs, the breasts need to be surgically altered for a more male appearance. This can be successfully accomplished.

The capacity to experience an orgasm, or at least "a reasonable degree of erogenous sensitivity," can be expected by almost all persons after gender reassignment surgery.


Diagnosis/Preparation

Gender identity is an extremely important characteristic for human beings. Assigning it must take place immediately after birth, for the mental health of both children and their parents. Changing sexual identity is among the most significant changes that a human can experience. It should therefore be undertaken with extreme care and caution. By the time most adults come to surgery, they have lived for many years with a dissonant identity. The average in one study was 29 years. Nevertheless, even then they may not be fully aware of the implications of becoming a member of the opposite gender.

In-depth psychological counseling should precede and follow any gender reassignment surgical procedure.

Sex change surgery is expensive. The cost for male to female reassignment is $7,000 to $24,000. The cost for female to male reassignment can exceed $50,000.


Aftercare

Social support, particularly from one's family, is important for readjustment as a member of the opposite gender. If surgical candidates are socially or emotionally unstable before the operation, over the age of 30, or have an unsuitable body build for the new gender, they tend not to fare well after gender reassignment surgery. However, in no case studied did the gender reassignment procedure diminish their ability to work.


Risks

All surgery carries the risks of infection, bleeding, and a need to return for repairs. Gender reassignment surgery is irreversible, so a candidate must have no doubts about accepting the results and outcome.


Normal results

Persons undergoing gender reassignment surgery can expect to acquire the external genitalia of a member of the opposite gender. Persons having male to female gender reassignment surgery retain a prostate. Individuals undergoing female to male gender reassignment surgery undergo a hysterectomy to remove the uterus and oophorectomy to remove their ovaries. Developing the habits and mannerisms characteristic of the patient's new gender requires many months or years.

To change male genitalia to female genitalia, an incision is made into the scrotum (A). The flap of skin is pulled back, and the testes are removed (B). The skin is stripped from the penis but left attached, and a shorter urethra is cut (C). All but a stump of the penis is removed (D). The excess skin is used to create the labia (external genitalia) and vagina (E). (

Illustration by GGS Inc.

)


Morbidity and mortality rates

The risks that are associated with any surgical procedure are present in gender reassignment surgery. These include infection, postoperative pain, and dissatisfaction with anticipated results. Accurate statistics are extremely difficult to find. Intraoperative death has not been reported.

The most common complication of male to female surgery is narrowing of the new vagina. This can be corrected by dilation or using a portion of colon to form a vagina.

A relatively common complication of female to male surgery is dysfunction of the penis. Implanting a penile prosthesis is technically difficult and does not have uniformly acceptable results.

Psychiatric care may be required for many years after sex-reassignment surgery.

The number of deaths in male-to-female transsexuals was five times the number expected, due to increased numbers of suicide and death from unknown cause.


Alternatives

There is no alternative to surgical reassignment to alter one's external genitalia. The majority of persons who experience gender disorder problems never surgically alter their appearance. They dress as members of the desired gender, rather than gender of birth. Many use creams or pills that contain hormones appropriate to the desired gender to alter their bodily appearance. Estrogens (female hormones) will stimulate breast development, widening of the hips, loss of facial hair and a slight increase in voice pitch. Androgens (male hormones) will stimulate the development of facial and chest hair and cause the voice to deepen. Most individuals who undergo gender reassignment surgery lead happy and productive lives.

Resources

books

Bostwick, John. Plastic and Reconstructive Breast Surgery, 2nd edition. St. Louis: Quality Medical Publishers, 1999.

Engler, Alan M. Body Sculpture: Plastic Surgery of the Body for Men and Women, 2nd edition. New York: Hudson, 2000.

Tanagho, Emil A. and Jack W. McAninch. Smith's General Urology, 15th Edition. New York: McGraw-Hill, 2000.

Walsh, Patrick C. and Alan B. Retik. Campbell's Urology, 8th Edition. Philadelphia: Saunders, 2002.

Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.

periodicals

Asscheman, H., L. J. Gooren, and P. L. Eklund. "Mortality and Morbidity in Transsexual Patients with Cross-Gender Hormone Treatment." Metabolism 38, No. 9 (1989): 869–73.

Docter, R. F. and J. S. Fleming. "Measures of Transgender Behavior." Archives of Sexual Behavior 30, No. 3 (2001): 255–71.

Fugate, S. R., C. C. Apodaca, and M. L. Hibbert. "Gender Reassignment Surgery and the Gynecological Patient." Primary Care Update for Obstetrics and Gynecology 8, No. 1 (2001): 22–4.

Harish, D., and B. R. Sharma. "Medical Advances in Transsexualism and the Legal Implications." American Journal of Forensic Medicine and Pathology 24, No. 1 (2003): 100–05.

Jarolim, L. "Surgical Conversion of Genitalia in Transsexual Patients." British Journal of Urology International 85, No. 7 (2000): 851–56.

Monstrey, S., P. Hoebeke, M. Dhont, G. De Cuypere, R. Rubens, M. Moerman, M. Hamdi, K. Van Landuyt, and P. Blondeel. "Surgical Therapy in Transsexual Patients: A Multi-disciplinary Approach." Annals of Surgery (Belgium) 101, No. 5 (2001): 200–09.


organizations

American Medical Association. 515 N. State Street, Chicago, IL 60610, Phone: (312) 464-5000. http://www.ama-assn.org/ .

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005, (888) 357-7924. Fax: (202) 682-6850. apa@psych.org.

American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242. (800) 374-2721 or (202) 336-5500. http://www.apa.org/ .

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201-5559. (410) 727-1100. http://www.auanet.org/index_hi.cfm .


other

Health A to Z [cited March 24, 2003]. http://www.healthatoz.com/healthatoz/Atoz/ency/sex_change_surgery.html .

Hendrick Health System [cited March 24, 2003]. http://www.hendrickhealth.org/healthy/001240.htm .

Intersex Society of North America [cited March 24, 2003]. http://www.isna.org/newsletter/ .

University of Missouri-Kansas City [cited March 24, 2003]. http://www.umkc.edu/sites/hsw/gendid/srs.html .


L. Fleming Fallon, Jr., MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



Gender reassignment surgery is performed by surgeons with specialized training in urology, gynecology, or plastic and reconstructive surgery. The surgery is performed in a hospital setting, although many procedures are completed in privately owned clinics.

QUESTIONS TO ASK THE DOCTOR



  • What will my body look like afterward?
  • Is the surgeon board-certified in urology, gynecology, or plastic and reconstructive surgery?
  • How many gender reassignment procedures has the surgeon performed?
  • How many of the type similar to the one being contemplated (i.e., male to female or female to male) has the surgeon performed?
  • What is the surgeon's complication rate?