This page sketches the historical development and surgical details of vaginoplasty surgery (often called sex reassignment surgery - SRS). Before reading this page, please read the introduction to the concepts of gender identity, transgenderism and transexualism elsewhere in this website, so that you'll understand why transsexual women undergo these operations. This page clarifies that post-operative MtF transsexual women really do have female genitalia, and will also help readers visualize some of the ordeals trans women endure to achieve their new physical gender status.
a photo from the book
Hijra-The Third Gender in India
"We are born with a gender identity crisis. It is not an imitated or learnt one, but a natural instinct that urges us to be women.'' - Dhanam
The Development of Modern Sex Reassignment Surgery (SRS)
Transsexual pioneer Christine Jorgensen,
who underwent an early for of SRS in 1952-54
[Note: I'd very much like to find a photo of Dr. Burou for this website. If you know of any photos of him, please contact me at firstname.lastname@example.org]
Transsexual pioneers Coccinelle (l) and April Ashley (r)
were among the very first of Dr. Burou's SRS patients (in 1958, 1960)
Aleshia (pre-op) as the star"Lee Shaw" at Finocchio's in 1961
Aleshia Brevard, shortly after her SRS in 1962
Aleshia as an actress in stealth mode, in the early 1980's
Early Sex Reassignment Surgeries in the U. S.
Harry Benjamin, M.D.
The great medical pioneer and compassionate physician
[photo taken by Lynn Conway in 1973]
Diagrams of the early John's Hopkins MtF SRS Procedure
Figure 1. A sketch of the perineum showing the line of primary incision.
Figure 2. The right spermatic cord is clamped and ligated.
Figure 3. The primary incision is continued up the ventral side of the shaft of the penis.
Figure 4. The anterior flap is developed from the skin of the penis.
Figure 5. The urethra is dissected from the shaft of the penis.
Figure 6. The corpora cavernosa are separated to assure a minimal stump.
Figure 7. The perineal dissection.
Figure 8. The perineal dissection has been completed and the anterior flap perforated to position the urethral meatus.
Figure 9. The skin flaps are sutured and placed in position in the vaginal cavity.
Figure 10. The preservation of the vaginal cavity is assured by use of a suitable vaginal form.
SRS Becomes an Accepted Treatment for Transsexualism in the U.S.
4A -WEDNESDAY MAY 24, 2000 - USA TODAY
Sex-Change nickname makes Colo. town cringe: 'Nobody cares'
Transformation via surgery has become common in community
By Pauline ArrillagaThe Associated Press
TRINIDAD, Colo. - The young waitress examined her customers as she refilled their coffee and haltingly asked whether anyone wanted more tea.
There was Elise, a buxom brunette in a crop top and hip-huggers. Kate, a Harvard graduate writer in khakis, hand-knit sweater and pearl earrings. Thea, a graphics designer sporting chic suede boots. And Jackie, a towering figure in trousers and blazer.
In the lunchtime crowd of merchants, housewives and farmers at the Main Street Bakery and Cafe, the four stuck out like fashion models on a pig farm.
Retreating to the kitchen, the waitress pulled her boss aside and stammered, "Those women I'm waiting on? They're men!"
Hardly anyone else gave the foursome a second glance. Not in the so-called "Sex-Change Capital of the World."
Repeat that phrase to, almost any of the town's 9,500 people and one would likely get a lecture on what the southern Colorado hamlet should be known for - its idyllic scenery, comfortable climate and friendly people.
Most don't mind that more sex-change operations have been done in their town than anywhere else (about 4,500 to date); they just hate that nickname.
"Nobody cares," says Monica Violante, owner of the Main Street Bakery. "It's just a part of Trinidad."
Town in transition
Although no formal statistics are kept on the number of sex reassignment surgeries, experts in the field agree that Trinidad's Stanley Biber - because of the year he began and his age - has performed more than anyone.
The International Foundation for Gender Education lists 14 surgeons in the USA and Canada that do the procedure, and, as spokeswoman Sara Herwig points out, "Biber's been doing it longer than most."
What makes Trinidad unique is not that it's the sex-change capital of the world, but the fact that this former mining town has come to accept its destiny, depend on it and even embrace it.
In 1969, Trinidad was a town in transition. Coal had been king in these parts since the turn of the century, but after World War II, the mines began closing. By the late '60s, only a few remained.
Families left, and Main Street, once a bustling collection of. department stores, car dealerships and restaurants, became a lifeless shell of shuttered storefronts.
Yet Biber was thriving from his fourth-floor office inside the First National Bank building.
As Trinidad's-s only general surgeon, Biber did it all - from delivering babies and removing appendixes to reconstructing the cleft palates of poor children.
Biber moved here in 1954 after serving as a MASH surgeon in Korea and finishing a stint at Camp Carson in Colorado Springs.
In those first 15 years, Biber built a comfortable life around a praactice he loved and a town he adored. In 1969, he encountered the patient who would forever change both.
A social Worker Biber had met asked him to perform her surgery. "Well, of course," he told her. "What do you want done?"
"I'm a transsexual," she replied. And Biber asked, "What is that?"
After consulting a New York physician who had done sex reassignment operations and obtaining hand-drawn sketches from Johns Hopkins University, Biber agreed to do the surgery. "She was very happy," he recalls. "And then it started spreading all over."
With less than a handful of doctors performing the procedure, Trinidad became THE place to come for a sex-change operation, and Biber was THE man to do it.
The town's sole hospital, Mt. San Rafael, was run by Catholic nuns, and Biber hid the charts of his first transsexual patients. But he knew he'd eventually need the approval of the hospital board and his neighbors. Biber explained his Work to the sisters and local ministers.
I went through the psychology of it all. They decided as long as we were doing a service and it was a good service, that there was no reason we couldn't continue doing them," he says.
Soon, Biber was lecturing to the hospital staff and the public.
"We figured that's his way of making a living; more power to him," says Linda Martinez, 54, a lifelong patient of Biber's.
Not all agree. The Rev. Verlyn Hanson, pastor of the First Baptist Church for the past three years says the town turned a blind eye to Biber's work because of the economic boost it provided. "The love of money is the root of all evil, and people will overlook a lot of evil to have a stronger economy," he says .
At one point, Biber's operations brought about $1 million a year to the hospital, according to his estimates. The basic procedure costs about $11,000, with the hospital taking in a little more than half.
At the height of his practice, Biber performed about 150 transsexual operations a year. His patients brought families and friends who remained in town during their loved ones' eight-day hospital stay.
Whether or not people liked what Biber did, they liked the squat, balding doctor who wore jeans and flannel shirts to work and always said hello.
At 77, Biber has scaled back his transsexual business to about 100 surgeries a year. The majority of his practice remains tending to the ills of Trinidad's citizens. He knows retirement may not be far off, and he's in search of a surgeon who will continue his work. "it started here, and I want the hospital to continue with it," he says.
[end of AP article on Dr.
The Current Protocol for Referring Transsexuals for Vaginoplasty (SRS)
Some Photos of Modern Vaginoplasty (SRS) Results
Postoperative Care Following Vaginoplasty (SRS)
Some Practical Matters:
Sexual Arousal, Lovemaking and Orgasm in Postoperative Transsexual Women
Consider also these words from
the webpage Zen and the Art of
Post-Operative Maintenance: "Another factor in sexual function is
your endocrine system...After surgery, some women find that their adrenal glands
(the other source of testosterone) do not produce enough to provide adequate
libido or orgasm. You may require a small amount of supplemental testosterone to
regain functioning. The amount required is typically far below the amount
that will cause any other unwanted side effects, such as hair growth. Not
everyone requires this, but keep in mind that some do."
Many natal women who are having
difficulty in feeling turned-on and in achieving orgasms (especially
post-menopausal women) are now taking Estratest tablets,
which contain a combination of estrogen and small amounts of testosterone.
Although Estratest is a somewhat controversial treatment, many natal women began
taking it after it was featured in a story on
Oprah Winfrey's hugely popular television show in the U.S. As a result of
this news, and of advice like that on the Zen page, some post-op women who were
experiencing difficulty in arousals and orgasms began using Estratest too, and
some report that the therapy helps them. These tablets contain either 1.25 mg or
0.625 mg of estrogens (as in Premarin tablets), but also include a small amount
of testosterone in each pill (for more information, see this link). There
may be some kind of threshold effect involved here, whereby some women need a
small amount of testosterone to maintain orgasmic capability. On the other hand,
many other postop (and post-menopausal) women enjoy strong orgasms even in the
complete absence of testosterone.
In any event, once a postop woman
begins experiencing arousals, the nerves in the clitoris and vulvar surfaces
become highly sensitized, and sensual and sexy feeling permeate her body. Then,
just as during pubertal sexual awakening, she will automatically feel urges to
play with her body and to masturbate. The arousals will gradually intensify as
her genital area fully heals from the SRS. Masturbation and sexual activity can
likely play a role in helping neural regeneration and sensitivity during this
There are many ways to masturbate, but one favorite way for girls to do it is
to "rub on a pillow". The girl does this by lying face down on her bed, with a
firm pillow between her legs. This way she can rub her vulva and clitoris on the
pillow while squeezing it, putting pressure on her clit and also being able to
thrust and thrash around. At the same time she can play with her breasts and
body with her hands. Alternatively, she can rub her clitoris with the fingers of
one hand while squeezing her legs and thrashing around to stimulate her body.
And there are many other ways to stimulate arousals and produce orgasms,
including using vibrators and other women's
sex toys. Girls discover these ways just as automatically as boys discover
"jerking off", even though girls have been more secretive about it our society
in the past.
While masturbating, the pubertal girl will suddenly begin to experience her
first orgasms, and she is then on her way to developing her full sexuality as a
woman. In just the same way, the postop woman needs to explore her new sexual
anatomy and masturbate, and learn her new sexual responses and experience her
first orgasms as a woman - learning what most girls do in their teens during
This ongoing pubertal aspect of immediate postop life can be very thrilling
and exciting, but also very confusing and scary for the woman, much in the same
way that the onset of sexual maturity is for any teenager.
For some insights into this process, I highly recommend that you read the
very candid webpage by entitled "M -> F Transexual
Post-Op Orgasms - A Personal Perspective", by Monica Stewart. Monica's site
stresses the need to gain experience with your new sexual responses prior to
having intercourse. It is also important to try to get over hang-ups about
what's "OK" and what's "naughty". Then too, many woman enjoy experiencing
playful anal stimulation, including using sex toys to overcome inhibitions and
enhance arousals. Most women also learn to use fantasies to trigger and enhance
arousals and orgasms. Those fantasies can be used during masturbation, and then
later used to help heighten one's experiences during intercourse with a lover.
Thus we see that transition and SRS are just the very beginning: They enable
the girl enter her new puberty. What she will make of herself as a woman is yet
to be determined!
Abstract: First physiologic study of orgasm in postoperative male-to-female transsexuals.
Ph.D. dissertation, The Institute for Advanced Study of Human Sexuality, San Francisco (Oct. 18, 2000).
Lynn Conway and Rom Birnbaum at Club Eros in San Francisco, where Rom made the first scientific physiologic measurements of orgasm in postop TS women, in 1999.
Who are the most active, prominent surgeons doing vaginoplasty (SRS) now?
Marci Bowers, M.D.
Toby Meltzer, M.D.
Eugene Schrang, M.D.
Sites containing photos of many vaginoplasty (SRS) results from many surgeons
[VIEW WITH CAUTION! The photo sequences listed here are definitely NOT FOR THE SQUEAMISH!]
Options that can reduce costs and enable feminization and transition earlier in life
Completion of transsexual body feminization by cosmetic surgeries
The joys and wonders of complete gender correction
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