Post Op Gender Reassignment Male To Female

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.

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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 for 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, patients usually undergo hormone replacement therapy (HRT), and, depending on the age at which HRT begins, facial hair removal. There are associated surgeries patients may elect to, including facial feminization surgery, breast augmentation, and various other procedures.

History[edit]

Lili Elbe was the first known recipient of male-to-female sex reassignment surgery, in Germany in 1930. She was the subject of four surgeries: one for orchiectomy, one to transplant an ovary, one for penectomy, and one for vaginoplasty and a uterus transplant. However, she died three months after her last operation.

Christine Jørgensen was likely the most famous recipient of sex reassignment surgery, having her surgery done in Denmark in late 1952 and being outed right afterwards. She was a strong advocate for the rights of transgender 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 transgender 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.[1] The first physician to perform sex reassignment surgery in the United States was the late Elmer Belt, who did so until the late 1960s.[citation needed]

In 2017, the United StatesDefense Health Agency for the first time approved payment for sex reassignment surgery for an active-duty U.S. military service member. 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.S. military hospitals lack the requisite surgical expertise.[2]

Genital surgery[edit]

Main article: 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 1951), 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 hairfollicles 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),[3][4] 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.[5][6][7] Penile-vaginal penetration with a sexual partner is not an adequate method of performing dilation. Daily dilation of the vagina for six months in order to prevent stenosis is recommended among health professionals.[4] Over time, dilation is required less often, but it may be required indefinitely in some cases.[7]

Regular application of estrogen into the vagina[citation needed] , 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 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]

Facial feminization surgery[edit]

Main article: 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. These are known as facial feminization surgery or FFS.

Breast augmentation[edit]

Breast augmentation is the enlargement of the breasts. Some trans women choose to undergo this procedure 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 and matures and darkens the areola.[citation needed]

Voice feminization surgery[edit]

See also: Voice therapy (trans) § Vocal surgeries

Some MTF individuals may elect to have 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 feminization lessons are available to train trans women to practice feminization of their speech.

Tracheal shave[edit]

Main article: Chondrolaryngoplasty

A tracheal shave procedure is also sometimes used to reduce the cartilage in the area of the throat and minimize the appearance of the Adam's apple, in order to conform to more feminine dimensions.

Buttock augmentation[edit]

Because anatomically masculine hips and buttocks are generally smaller than those that are anatomically feminine, 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 to hip ratio of around 0.8, and if estrogen is administered at a young enough age "before the bone plates close",[citation needed] some trans women may achieve a waist to hip ratio of 0.7 or lower.[citation needed] The pubescent pelvis will broaden under estrogen therapy even if the skeleton is anatomically masculine.

See also[edit]

References[edit]

  1. ^Wexler, Laura (2007). "Identity Crisis". Baltimore Style (January/February). Archived from the original on 2012-02-19. Retrieved 2009-10-12. 
  2. ^Kube, Courtney (November 14, 2017). "Pentagon to pay for surgery for transgender soldier". NBC News. 
  3. ^Lynne Carroll, Lauren Mizock (2017). Clinical Issues and Affirmative Treatment with Transgender Clients, An Issue of Psychiatric Clinics of North America, E-Book. Elsevier Health Sciences. p. 111. ISBN 0323510043. Retrieved January 8, 2018. 
  4. ^ abAbbie E. Goldberg (2016). The SAGE Encyclopedia of LGBTQ Studies. Sage Publications. p. 1281. ISBN 1483371298. Retrieved January 8, 2018. 
  5. ^Jerry J. Bigner, Joseph L. Wetchler (2012). Handbook of LGBT-Affirmative Couple and Family Therapy. Routledge. p. 307. ISBN 1136340327. Retrieved February 29, 2016.  
  6. ^Arlene Istar Lev (2013). Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Routledge. p. 361. ISBN 113638488X. Retrieved February 29, 2016.  
  7. ^ abLaura Erickson-Schroth (2014). Trans Bodies, Trans Selves: A Resource for the Transgender Community. Oxford University Press. p. 280. ISBN 0199325367. Retrieved February 29, 2016.  

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