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Dutch Translation in Progress

 

Vaginoplastie:

Man naar Vrouw

Geslachtsaanpassende

Chirurgie

 

Historisch overzicht, beschrijvingen, foto’s, referenties en links.

door Lynn Conway

Copyright @ 2000-2006, Lynn Conway. All Rights Reserved.

Dutch translation by Femke Olyslager and JH

 

Rechts: Foto met details van de genitaliën van een TS vrouw (ze ligt met haar benen open op de houders van een gynaecologische onderzoekstafel en met haar schaamlippen gedeeltelijk geopend) na het ondergaan van een vaginoplastie (SRS) en labiaplastie uitgevoerd door Eugene Schrang, M.D. uit Neenah, WI.

 

Deutsch, Engels, Español,

Français, עברית, Português

 
 

Deze pagina geeft een overzicht van de historische ontwikkelingen en de chirurgische details van vaginoplastie chirurgie (vaak ook geslachtsaanpassende chirurgie genoemd, in het Engels spreekt men van 'sex reassignment surgery' (SRS) of 'gender reassignment surgery' (GRS )).  Lees eerst de pagina  introductie tot de concepten genderidentiteit, transgenderisme en transseksualiteit elders op deze website zodat U begrijpt waarom transseksuele vrouwen deze chirurgische ingrepen ondergaan. Deze pagina toont aan dat postoperatieve man naar vrouw  transseksuele vrouwen weldegelijk beschikken over vrouwelijke genitaliën. De lezer zal ook geholpen worden om inzicht te krijgen in een aantal vooroordelen die transseksuele vrouwen moeten doorstaan om hun nieuwe fysische genderstatus te bereiken.

 

BELANGRIJKE OPMERKING: Deze pagina bevat grafisch visueel material en andere medische informatie die mogelijks choquerend is of die zeer storend kan zijn voor sommige lezers.

 

LEES NIET VERDER als U zich ongemakkelijk voelt bij chirurgische ingrepen of indien U angsten hebt over Uw eigen genitaliën.

 

Toegang tot deze medische informatie is NIET TOEGELATEN voor personen JONGER DAN 18 JAAR. Door deze pagina verder te lezen bevestigd U dat U 18 jaar of ouder bent.

 

 

 

Inhoud

 

 Historische Achtergrond (nl)

 De Ontwikkeling van Moderne Geslachtsaanpassende Chirurgie (nl)

 Early Sex Reassignment Surgeries in the U. S.

 Diagrams of the early John's Hopkins MtF SRS Procedure

 SRS Becomes an Accepted Treatment for Transsexualism in the U.S.

The Current Protocol for Referring Transsexuals for Vaginoplasty (SRS)

Some Photos of Modern Vaginoplasty (SRS) Results 

Postoperative Care Following Vaginoplasty (SRS)

Sexual Arousal, Lovemaking and Orgasm in Postoperative Transsexual Women 

 Who are the most active, prominent surgeons doing Vaginoplasty (SRS) now?

 Sites containing photos of many Vaginoplasty (SRS) results from many surgeons

 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
 
 
 

Historische Achtergrond

Transseksualiteit is geen “moderne ontdekking”, integendeel. Sedert de oudheid is het niet ongewoon natuurlijkvoorkomende en gedocumenteerde variaties in het menselijke gender vast te stellen. In vele culturen, zoals bij de inheemse stammen in Noord-Amerika, hebben, transseksuele personen lange tijd de keuze gehad om zich te kleden als het andere geslacht en te leven als vrouwen, zelfs met de mogelijkheid om een echtgenoot te hebben. Zelfs de chirurgische aanpassing van de genitaliën met het oog op het wegnemen van intense transgendere gevoelens is ook niet “uitgevonden in de 20e eeuw”. In sommige soms hele oude culturen hebben transseksuelen zich vaak vrijwillig aan chirurgische ingrepen onderworpen met het oog op het “veranderen van hun geslacht”.

Voor de mensen uit de oudheid waren de technieken voor en de effecten van castratie genoegzaam bekend. Inderdaad, het gebruik ervan in de domesticatie van dieren leerde de mensen uit de oudheid al gauw dat het wegnemen van de menselijke mannelijke testikels (teelballen) op voldoende jonge leeftijd de vermannelijking voorkomt. Zo iemand zou voor altijd een kinderlijk uiterlijk hebben – of “meisjesachtig” blijven. Dergelijke ingrepen werden vaak ook uitgevoerd op gevangen volwassen mannelijke slaven met het oog hen te “domesticeren” als “eunuchs”. Het uitvoeren van een castratie op een normale man na de puberteit verandert zijn gendergevoelens of genderidentiteit niet. Het zal wel zijn seksuele driften wat verminderen en heel sterk de verdere ontwikkeling van het mannelijk spierstelsel onderdrukken.

De kennis die in de loop der tijd werd vergaard over de effecten van castratie werd verder uitgebreid om man naar vrouw transseksuelen te helpen: Wellicht miljoenen transseksuelen gedurende de voorbije duizenden jaren hebben vrijwillig chirurgische ingrepen ondergaan die veel risicovoller en veel ingrijpender waren dan een eenvoudige castratie. In deze operaties werden transseksuelen volledig ontmannelijkt bij de algehele verwijdering van de testikels, de penis en het scrotum (balzakje). Bijkomend werd de schaamstreek vaak min of meer hervormd om het uitzicht van die van een meisje na te bootsen. Niemand kent precies de origine van dit soort ingrepen maar transseksuele ingrepen waren welbekend in de tijd van het oude Griekenland en in het bijzonder in het seksueeltollerante oude Rome. Ze waren vaak deel van “religieuze rituelen” die de resulterende “vrouw” een plaats in de samenleving gaven.

Dit soort ingrepen voorkwam dat jonge man naar vrouw transseksuelen (als ze het overleefde) man werden en het gaf hen ook genitaliën die min of meer op die van een vrouw geleken. Zelfs zonder vagina en zonder de krachtige vervrouwelijkende effecten van vrouwelijke geslachtshomonen, konden jonge transseksuelen in het verleden een beter leven als vrouw leiden na dergelijke chirurgische ingreep.

Zelfs vandaag lopen een aanzienlijk aantal jonge en hopeloze transseksuelen weg van huis in Indië en Bangladesh om toe te treden tot de “Hijra” caste. Om Hijra te worden ondergaan deze tieners vrijwillig volledig ontmannelijkende chirurgische ingrepen in primitieve omstandigheden, net zoals in de oudheid, met alleen de werking van opium als verdoving. De meeste ondergaan de ingreep als tieners juist na het begin van de puberteit. Een resultaat hiervan is weergegeven in onderstaande foto. Door de castratie net vroeg genoeg uit te voeren wordt de ontwikkeling van secundaire mannelijke geslachtskenmerken (behalve het breken en verlagen van de stem) vermeden. Hun lichaam blijft zacht, zoals van een kind en meisjesachtig.

In tegenstelling wat men vaak denkt leidt een totale externe ontmannelijking na de pubertijd niet noodzakelijk tot een asseksueel persoon. Volledige castratie na de puberteit bezorgt de jonge Hijra nieuwe te ontdekken gevoelens en orgasmische mogelijkheden. Waar de psychologische impact van zo’n ingreep normaal de libido van een normale man zou ondermijnen is het effect ervan op het transseksuele meisje net omgekeerd: De ingreep kan haar bevrijden en kan haar toelaten om haar sensualiteit en haar vrouwelijke libido meer te beleven. Net zoals in moderne postoperatieve transseksuele vrouwen zullen vele Hijra sterke gevoelens van seksuele opwinding vinden in de innerlijke overblijfselen van hun genitaliën (ondanks het feit dat er geen extern zenuwgevoelig weefsel aanwezig is zoals bij moderne SRS behouden ze de interne delen van de zwellichaampjes en de prostaat met spasmodische orgasmische capaciteiten). Ondanks het feit dat Hijra’s geen vagina hebben zullen velen in belangrijke mate genieten (met het oog op orgasme) van penetrale (anale) seksuele activiteiten met mannen. Door de volledige externe ontmannelijking lijken de genitaliën en de schaamstreek van een Hijra erg “meisjesachtig” zodat vele mannen in India graag met hen vrijen. De Hijra op hun beurt aanvaarden hun lot en hun beperkte, maar toch reële mogelijkheden om toch ten minste een beetje liefde in het leven te vinden.

 

 

Een jonge Hijra in India, die haar genitaliën toont

 
 
De meest Hijra leven als vrouw samen met ander Hijra in “familie groepen”, waarbij ze hun bestaan verdienen door op te treden in traditionele ceremonieën op huwelijksfeesten en geboortes. Velen werken ook als prostitué en bedelaars in deze lage maar traditionele Indische caste. Sommige Hijra hebben vandaag het geluk toegang te hebben tot vrouwelijke hormonen zodat ze hun lichaam verder kunnen vervrouwelijken door het krijgen van borsten en meer vrouwelijke lichaamscontouren. De combinatie van ontmannelijking als tiener samen met oestrogenen laat de Hijra toe om heel mooi te worden ondanks het erg spijtige feit dat ze zonder vrouwelijke genitaliën (vagina) niet sociaal geaccepteerd worden als vrouw.
 
De origine van de Hijra caste gaat vele honderden jaren terug in de Indische geschiedenis. Deze wijdverspreide praktijk laat transseksuelen toe te ontsnappen aan de vrees en het noodlot van vermannelijking als tiener en het biedt hen een veilige, zei het een hele lage, positie in de maatschappij. De extremen door dewelke deze transseksuelen gaan om “ongeveer een vrouwelijk gender te bekomen”, in de volle wetenschap dat ze hun familie nooit meer weer zullen zien en dat ze geconfronteerd worden met sociale degradatie voor de rest van hun leven, zijn een hard bewijs van de realiteit en extremiteit van het genderconflict dat ze ondervinden in zichzelf.
 
Momenteel zijn er verschillende miljoenen Hijra in Indië en Bangladesh. Voor meer informatie zie de Kinnar (Hijra) website met URL http://www.kinnar.com/ en het BBC verhaal over Hijra in Bangladesh. Vele hele mooie foto’s van Hijra zijn terug te vinden in het boek Hijra-The Third Gender in India (Hijra – Het Derde Geslacht in Indië), door Takeshi Ishikawa. Ondanks het feit dat dit alles voor vele eeuwen gehuld was in misterie onder het geheim van de caste is de onderliggende aandoening die jonge tieners aanzet om Hijra te worden duidelijk transseksualiteit. Dhanam een leider van een Hira familie (een Hijra 'Guru') zegt het volgende:

“We zijn geboren met een genderidentiteitscrisis. Het is geen imitatie of iets dat we leerden, maar een natuurlijk instinct dat ons drijft om vrouw te zijn.” – Dhanam

("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)

 
Het is niet ongewoon dat in de moderne westerse wereld uitzichtloze jonge transseksuele meisjes uit wanhoop besluiten om “Hijra te plegen” bij zichzelf. Door zichzelf volledig te ontmannelijken en dan terug te vallen op de medische hulpverlening om hen “op te lappen”, kunnen ze een “lage-kost SRS” bekomen op jonge leeftijd. Een aantal meisjes in de V.S. hebben dit bij zichzelf gedaan, en dan zichzelf verder vervrouwelijkt met oestrogenen om snel passabel te worden als mooie meisjes (ongelukkigerwijze maakt het verlies van de huid van de penis en het scrotum een latere vaginale reconstructie met behulp van SRS veel moeilijker). Een groter aantal jonge transseksuele meisjes in de V.S. hebben hun toevlucht gezocht in zelfcastratie om vermannelijking te vermijden. Dit vooral tijdens de vijftiger en zestiger jaren van vorige eeuw toen er in de hospitalen in de V.S. strenge beperkingen bestonden om SRS uit te voeren op “intacte mannen” (zie hieronder).
 
De lange geschiedenis van “Hijra”-type chirurgie loopt van in de oudheid tot vandaag en blijft bestaan in landen als Indië en Bangladesh. De gedetailleerde kennis van de postoperatieve effecten van “Hijra”-type ontmannelijkingen bezorgden een belangrijke empirische achtergrond voor de ontwikkeling van moderne transseksuele ingrepen.
 
 
 

De Ontwikkeling van Moderne Geslachtsaanpassende Chirurgie

[Later toe te voegen: Bespreking van de vooruitgang in de plastische chirurgie na de eerste wereldoorlog, en over vooruitstrevende ontwikkelingen in vaginoplastie bij transseksuele vrouwen rond 1930 door F. Abraham, M.D., in Duitsland - - - zie http://www.symposion.com/ijt/ijtc0302.htm#Case%201 - - - ]

Samen met de snelle vooruitgang in de kennis van geslachtshormonen en de plastische chirurgie na de Tweede Wereldoorlog werd het eindelijk mogelijk een volledige medische en chirurgische oplossing voor transseksualiteit te overwegen. Tijdens de jaren 1950 konden transseksuele vrouwen ten volle genieten van de voordelen van de nieuw beschikbare vrouwelijke geslachtshormonen. Deze lieten borstvorming een zachte huid en op termijn meer vrouwelijke lichaamscontouren toe. Rond die tijd begonnen een aantal chirurgen verkennende operaties uit te voeren in man naar vrouw transseksuelen waarbij de vagina’s werden gevormd met behulp van huidenten genomen op de dijen of billen. Dit onderzoek steunde op recent ontwikkelde technieken om vagina’s te construeren in meisjes met een interseksuele aandoening.

 

Christine Jörgensen uit de V.S. was bij de eerste kleine groep van transseksuelen om een “verandering van geslacht” te ondergaan. Ze werd “ge-out” in 1952 door de Amerikaanse gedrukte pers kort nadat ze haar initiële operatie had ondergaan. Haar verhaal werd een nationale sensatie. Dankzij haar verhaal hoorden vele transseksuelen van het bestaan van deze nieuwe hormonale en chirurgische behandelingen. Nochthans bleef de toegang tot deze nieuwe en experimentele vormen van chirurgie beperkt tot een handvol Europese patiënten.

 

In de tijd van Christine haar operatie in de vijftiger jaren werden eerst in één of meer operaties de mannelijke organen weggenomen. De patiënt diende dan een hele periode te wachten zodat alle wonden zich konden herstellen. Vervolgens, in een operatie gelijkaardig aan deze die gebruikt werd om vagina’s te creëren in interseksuele patiënten, werd dan de vagina geconstrueerd met behulp van huidenten uit de dijen of billen (Christine haar vaginoplastie werd uitgevoerd in 1954).

 

Transseksuele pioneer Christine Jörgensen,

die een vroege vorm van SRS onderging in 1952-54

 

Ondanks het feit dat patiënten zeer tevreden waren over de resultaten (zeker in vergelijking met eerdere resultaten) ging deze vroege methode toch nog met grote problemen gepaard. De huidenten waren niet erg betrouwbaar en gaven soms aanleiding tot gedeeltelijke mislukkingen omdat ze niet “pakten”. Het gebruik van grote huidenten gaf ook aanleiding tot grote lelijke littekens op de plaats waar ze genomen werden. Daarbij kwam nog dat in de eerste stap van de ingreep een groot gedeelte van het gevoelige genitale weefsel voor goed verloren ging. Dit beïnvloedde de gevoelens van seksuele opwinding van de patiënt en zijn mogelijkheid om een orgasme te krijgen.

Tijdens de late vijftiger en zestiger jaren kwamen vele honderden transseksuelen in de V.S. onder de goede zorgen van Harry Benjamin, M.D., een zeer begrijpende en gedreven dokter en endocrinoloog die een praktijk had in New York, N.Y., en in San Francisco, CA. Dr. Benjamin was de eerste dokter en onderzoeker die het onderscheid tussen een genderidentiteit die verschilt van het biologische gender en homoseksualiteit maakte. In plaats van transseksuelen te aanzien als mentaal gestoorden zoals de meeste medici in die tijd begon hij hen te aanzien als ernstig lijdende patiënten onder een fout-gender aandoening met onbekende origine. In een poging om hun lijden te beperken schreef hij oestrogenen voor aan geselecteerde patiënten in antwoord op hun sterke vraag naar medische feminisatie. Hij volgde ook de resultaten van transseksuele chirurgie op de voet op en begon zijn meest intense transseksuele patiënten door te verwijzen naar de chirurgen die de beste resultaten boekten.

 

Vervolgens, in de late jaren vijftig, ontwikkelde de Franse chirurg Georges Burou de moderne vorm van man naar vrouw geslachtsaanpassende chirurgie voor man naar vrouw transseksuelen gebaseerd op de zogenaamde penile inversie waarbij de huid van de penis de binnenbekleding van de vagina vormt. Sinds toen werden vooral variaties op Dr. Borou’s techniek toegepast. Dr. Burou’s klassieke uitvinding bestond in het gebruik van mannelijke genitaliën als een bron van huid en gevoelig erotisch weefsel om nieuwe vrouwelijke genitaliën te creëren inclusief een vagina.

 
 

Met dank aan Pascale uit Frankrijk voor het vinden van deze foto’s van Dr. Burou.

[Ze dateren van juli 1970 uit een artikel in de "National Police Gazette" (een mannenblad uit de V.S.).]

 

 

Dr. Burou voerde deze operaties uit in zijn hospitaal in Casablanca in Marokko. In 1958-60 werden vele bekende en zeer mooie jonge “vrouwelijke imitators” uit de de club Le Carrousel in Parijs, Frankrijk, door Dr. Burou succesvol getransformeerd in vrouwen. Onder hen Coccinelle (meer informatie), Bambi en April Ashley. Vele van de jonge meisjes uit Le Carrousel kregen vrouwelijke hormonen als een toemaatje voor hun werk in de club met als resultaat dat zij zeer mooi, vrouwelijk en sexy werden. Velen keerden na de chirurgische ingreep terug naar de club om verder op te treden. Hun succesvolle “geslachtsveranderingen” werden wijdverbreid bekend en ze werden zeer begeerde liefdesobjecten bij vele zeer prominente en zeer begoede mannen. Occasioneel “sponsorden” zeer rijke mannen de geslachtsaanpassende ingreep bij een Le Carrousel meisje, die dan voor een tijdje hun maîtresse werd.
 

 

Dr. Burou werd zowel bekend als berucht als het nieuws over zijn werk zich verspreidde. Zijn ”Clinique du Parc” in 13, Rue La Pebie in Casablanca, Marokko, werd uiteindelijk overrompeld door transseksuele patiënten vanuit de hele wereld. Dr. Bourou begon honderden dergelijke operaties per jaar uit te voeren. In 1973 gaf  Dr. Burou zijn eerste publieke voorstelling over zijn vernieuwende chirurgische technieken op een belankrijke interdisciplinaire conferentie over transseksualiteit in de Stanford University Medical School. Op het moment van dit congres in 1973 had hij meer dan 3000 man naar vrouw geslachtsaanpassende operaties uitgevoerd. Op dat ogenblik hadden vele chirurgen, overal ter wereld, de technieken van Dr. Burou overgenomen en aangepast.
   
 

Transseksuele pioniers Coccinelle (l), Bambi en April Ashley (r)

zij waren bij de eerste patiënten van Dr. Burou voor SRS (in 1958-1960)

 

 

 

Deze operaties waren succesvol om volgende redenen: (i) het gebruik van de huid van de penis en het scrotum om nieuwe schaamlippen te vormen en een functionele vagina te creëren (dit vermijdt de littekens op de plaatsen waar bij vroegere technieken grote en diepe huidenten werden genomen), en (ii) de voorzichtige dissectie en plaatsing van de ingekorte zwellichaampjes (copora cavernosa) en het behoud en de relocatie van een deel van de gevoelige zenuwen en behoud van een klein deel van het erectiel weefsel.  Als dit goed wordt uitgevoerd kan de postoperatieve patiënt zeer sterke gevoelens van seksuele opwinding hebben (erectie van de ingekorte zwellichaampjes binnen in haar lichaam) en kan eenvoudig orgasmisch zijn (de prostaat is intact gelaten en kan tijdens een orgasme spasmodisch worden net zoals voor de ingreep – terwijl het zenuwrijk weefsel in de zwellichaampjes, de clitoris en de vagina terzelfdertijd samentrekken en ontspannen, zoals bij elke andere vrouw).

De praktijk van dr. Benjamin groeide snel als meer en meer transseksuelen hoorden dat ze een begrijpende behandeling bij hem konden krijgen. Hij begon steeds meer patiënten naar de chirurgen te sturen, voornamelijk naar Dr. Borou in Casablanca. Tijdens het midden van de zestiger jaren begonnen ook andere excellente chirurgen in het buitenland SRS operaties op transseksuelen uit te voeren met de technieken van Dr. Borou. Dr. Benjamin refereerde dan ook patiënten naar deze chirurgen. De meest bekende was Jose Jesus Barbosa, M.D., een prominente plastische chirurg in Mexico (Dr. Barbosa was de chirurg die Lynn behandelde, hij had in 1973 reeds meer dan 300 SRS ingrepen uitgevoerd).

Nochthans, in de V.S. werden zelfs in het midden tot late jaren zestig nagenoeg geen dergelijke operaties uitgevoerd. Onder zware druk van religieuze groepen ten gevolge van de publiciteit over het geval Jörgensen in 1952 werd in het beleid van vele hospitalen het expliciet verbod op dergelijke ingrepen ingevoerd. Religieuze beperkingen werden vaak aangehaald als motief om elke hormonale en chirurgische behandeling aan transseksuelen te ontzeggen. Toen, in de jaren zestig, dacht de medische gemeenschap in de V.S. dat transseksuelen “ernstig psychotisch” waren eerder dan een fout biologisch gender hebbende. In plaats van hulp te krijgen voor een gendertransitie werden ze gedwongen in psychiatrische instellingen waar psychiaters hen trachtte “te genezen van hun mentale ziekte” met elektroshocktherapie en aversietherapie.

 
Tijdens de late jaren vijftig en vroege jaren zestig namen intens transseksuele meisjes in de V.S. hun toevlucht in zelfcastratie zodat ze meer vrouwelijk werden en zodat ze de restrictie tot het verwijderen van de testikels van “intacte mannen” tijdens SRS konden omzeilen. Als het meisje niet meer “intact” was kon ze hopen om haar SRS te laten vervolledigen in een hospitaal in de V.S. – als ze dat ten minste kon betalen. Zie bijvoorbeeld het verhaal van de transseksuele pionier Aleshia Brevard. Op jonge leeftijd en gefeminizeerd door oestrogenen werd Aleshia een ster in Finocchio’s, de werldbekende “vrouwen imitatoren” nachtclub in San Francisco. Na zelfcastratie om zichzelf verder te vervrouwelijken, was het in 1962 voor Aleshia mogelijk om SRS te ondergaan in de V.S. met de hulp van Dr. Benjamin. Zoals zovele postoperatieve transseksuelen in de jaren zestig (waaronder ook Lynn) liet Aleshia haar vroegere leven achter en vermeed dat iemand nog dat verleden zou ontdekken (ze ging in “stille mode”). Ze werd een bekende showgirl als “Playboy Bunny” (een hostess in één van de beroemde “Playboy” clubs), een welbekende film-, toneel- en televisieactrice en ze huwde zelfs drie maal! Pas recent kwam Aleshia naar buiten met haar verhaal in een prachtig boek over haar ongelooflijke leven
 
 
Aleshia (pre-operatief) als de ster "Lee Shaw"in Finocchio in 1961
 

Aleshia Brevard,

Kort na haar SRS in 1962

Aleshia als een actrice in stille mode,

in het begin van de tachtiger jaren

 
 
Vroege Geslachtsaanpassende Operaties in de Verenigde Staten
 
Uiteindelijk, in 1966, begonnen chirurgen in het John Hopkins Medical Center een beperkt aantal MV geslachtsaanpassende operaties uit te voeren, om een aantal extreem transexuele patienten te helpen, onder de zorg van de nieuwe genderklinkiek in het John Hopkins Medical Center. De Hopkins staf geloofde, dat transexuelen mentaal ziek waren, maar gellofde ook, dat er geen psychologische methodiek was, om een "incorrect gevormde gender identiteit" omkeerbaar te maken. In een experimeneel programma begonnen zij de mogelijkheid te onderzoeken deze patienten te helpen via chirurgie, zoals aanbevolen door Dr. Benjamin. De Hopkins chirurgen gebruikten een variant op de Dr. Burou Methode.
 
In de herfst van 1966 verspreidden de kranten in het hele land het volgende artikel uit een column van de New York Daily News:
 
"In het uitgaanscircuit van de Manhattan nachtclubs loopt een aantrekkelijke vrouw rond, die toegeeft, dat zij nog geen jaar geleden nog man was, en dat zij een geslachtsaanpassende operatie onderging in nota bene, het Johns Hopkins Hospital in Baltimore. Verrassend genoeg, bevestigt het ziekenhuis het geval, met de toevoeging, dat de operatie volgde op psychotherapie. Dergelijke operaties, hoewel zeldzaam in dit land, zijn noch illegaal, noch onethisch, volgens de woordvoerder van het John Hopkins. Gezaghebbenden in een aantal andere ziekenhuizen bevestigen de uitspraken over legaliteit en ethiek van de operaties, echter niemand kan zich herinneren, dat een dergelijke operatie eerder is uitgevoerd in New York."
 
Vervolgens, op 21 november 1966, publiceert de New York Times een uitgebreid artikel over transexualiteit. De Times vermeldde uitgebreide informatie over de operatieve en hormonale behandelingen in het buitenland, en over het nieuwe programma in het  John's Hopkins University Medical Center, waar de operatie recentelijk werd uitgevoerd. Het artikel schoof ook Dr. Benjamin naar voren als de leidende autoriteit op het gebied van transexualiteit, en als de auteur van het boek met de titel "The Transsexual Phenomenon" (volg deze link voor een online versie van de originele tekst).
 
Harry Benjamin, M.D.

De grote medische pionier en toegewijde arts

[foto door Lynn Conway in 1973]

 
Dr. Benjamin was de pionier van het heel nieuwe gebied van medische kennis over transexualiteit. Zijn paradigma verschuivende medische tekst beschrijft zijn ervaringen met vele patienten over decennia. Hij was de eerste onderzoeker, die herkende, dat gender identiteit en sexuele voorkeur twee onafhankelijke dimensies zijn van de menselijke natuur. Dr. Benjamin formuleerde aanbevelingen hoe "intense transexuelen" behandeld kunnen worden, en ook behandeld zouden moeten worden, om hen in staat te stellen te leven, in het geslacht, zoals ze willen. Zijn boek documenteert de resultaten van nieuwe innovatieve chirurgische en hormonale behandelingen en plaatst de behandelingen in de rationele context als therapie voor transexualiteit. Dit boek geeft nieuwe hoop voor transexuelen, en opent de deur naar moderne medische benaderingen, welke we nu als vanzelfsprekend aannemen. op hetzelfde moment, vergroot het feit, dat het John Hopkins daadwerkelijk geslachtsaanpassende operaties uitvoert, de zichtbaarheid van  Dr. Benjamin theorin en de aandacht van de medische wereld voor zijn onderzoeksresultaten.
 
 
Diagrammen van de vroege John's Hopkins MV SRS Procedure
 
Hieronder volgen illustraties, welke de basisstappen schetsen van de vroege Hopkins chirurgische methode, een variant van de Georges Burou's methode. De schetsen zijn van hoofdstuk 22, door Howard W. Jones, Jr., M.D. in Transexualiteit en Geslachtsaanpassing, Richard Green, M.D. en John Money, Ph.D., Editors; Johns-Hopkins Press, 1969. Tegen deze tijd was het gebruikelijk deze chirurgie aan te duiden als "sex reassignment surgery" (SRS). De illustraties zijn overgenomen van een artikel, orgineel door Howard W. Jones, Jr., Horst K. A. Schirmer, en John E. Hoopes, " A Sex Conversion Operation for Males with Transsexualism", American Journal of Obstetrics and Gynecology 100 (1968): 101-9. (Notitie: Zie het commentaar bij de schetsen ten aanzien van de anatomisch misleidende / incorrecte weergave in de uiteindelijke schetsen, Figuur 10.)
 
 
Figuur 1. Een schets van het perineum, met de aanduiding van de lijn van de primaire incisie.
 
 
 
 
Figuur 2. De rechter zaadleider is afgeklemd en doorgesneden.
 
 
 
 
Figuur 3. De primaire incisie is doorgevoerd naar de buikzijde van de penis.
 
 
 
 
Figuur 4. De voorflap is geprepareerd uit de huid van de penis.
 
 
 
 
Figuur 5. De urinebuis is losgemaakt van de schacht van de penis.
 
 
 
 
Figuur 6. De corpora cavernosa zijn gescheiden om een minimale stomp te verzekeren.
 
 
 
 
 
Figuur 7. De perineale scheiding.
 
 
 
 
Figuur 8. De perineale scheiding is voltooid en de voorflap is geperforeerd om de urethral meatus te plaatsen.
 
 
 
 
Figuur 9. De huidflappen zijn gehecht en horizontaal geplaatst in de vaginale holte.
 
 
 
 
Figuur 10. Het behoud van de vaginale holte is verzekerd door het gebruik van een passende vaginale vorm.
 
 

Notitie 1: Figuur 10 is nogal misleidend en komt niet overeen met de anatomie, die moet leiden tot het resultaat van deze procedure. In figuur 10 is de vaginale opening veel te ver naar voren verwijderd van de anale opening, en de vaginale opening is weergegeven als eerste horizontaal naar binnen te gaan, en dan omhoog draaiend nadat een groot weefselgebied voor de anus is gepasseerd. (Vergelijk de schets met de latere detail foto's van moderne SRS resultaten, speciaal die foto, welke het inbrengen toont van een vaginale stent in de post-operatieve vagina). Deze zeer slecht weergegeven schets is meer dan waarschijnlijk de oorzaak van vele opgelapte operaties in de vroege dagen, waarbij chirurgen, die de Hopkins procedure kopiëerden, gedacht kunnen hebben, dat een dik weefselgebied nodig was om inscheuren in de anus te voorkomen. Dergelijke dikke weefselgebieden verhinderden vaak makkelijk dilateren en gemeenschap voor de patienten na de SRS. Dit leidde dan tot vaginale stenosis (verlies van diepte en/of wijdte).

Notitie 2: in de loop der jaren, zijn de SRS technieken steeds verder verfijnd, Het is inmiddels ook gangbaar voor port-op MV's om aanvullende labiaplastiek te ondergaan, welke verdergaande details van de externe genitalia construeert. Voor meer informatie over moderne SRS operatietechnieken, zie de links en de "Detailfoto's van moderne SRS resultaten" hieronder.

 

 
SRS wordt een geaccepteerde behandeling voor transexualiteit in de V.S.
De vroege Johns Hopkins aankondiging en publicaties vielen samen met de publicatie van The Transsexual Phenomenon, door Harry Benjamin, M.D. in de nadagen van 1966. Het resultaat van vele jaren onderzoek, observaties en klinische praktijk zijn samengevat tot een rudimentaire tekst over transexualiteit.Het boek identificeerde transexualiteit als een unieke, ingrijpende medische kwelling, in welke patienten een ingeboren gender identiteit hebben, tegengesteld aan de geslachtskenmerken van hun lichaam. Deze theoriën en resultaten kregen aanmerkelijke aandacht binnen de medische wereld in de Verenigde Staten gedurende de daaropvolgende jaren - echter de meeste aandacht was uiterst sceptisch.
 
Daarna, volgend op interacties met Dr. Benjamin en een aantal van zijn patienten, artsen aan het Stanford Medical Center startten een gender onderzoeks kliniek in 1969, geleid door Norman Fisk, M.D> en Donald Laub, M.D. SRS operaties werden uitgevoerd op geslecteerde MV patienten, en de Stanford klinische en chirurgische resultaten valideerden verder het concept van SRS als behandeling voor diegenen die leden aan transexualiteit. Acceptatie van SRS als serieuze en daadwerkelijke behandeling voor transexualiteit begon zich langzaam te verspreiden onder de leiders in de Amerikaanse medische wereld. Ziekenhuis door het hele land, begonnen geleidelijk het verbod op geslachtsaanpassende operaties op te heffen, en chirurgen begonnen op diverse locaties deze operaties uit te voeren op geselecteerde patienten..
 
In 1969 Stanley Biber, M.D. (1924-2006*), een chirurg in Trinidad, Colorado, begon met het uitvoeren van MV SRS vaginoplastiek operaties, met gebruik van de informatie, die hij kreeg van het chirurgische team van het Johns Hopkins. De uitstekende successen van zijn operaties verspreidde zich snel en ver and de patienten stroomden naar hem toe. Gedurende vele jaren voerde Dr. Biber meer dan 150 MV SRS operaties per jaar uit, en tegen het jaar 2000 had hij meer dan 4500 SRS operaties uitgevoerd. Een artikel in USA Today vertelt het verhaal van Dr. Biber als volgt:

Translation in progress (JH)

 

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 Arrillaga
The 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 practice 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.

Lucrative operations

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. Biber]

*Stanley Biber, M.D.

 

Dr. Biber was one of the pioneering surgeons of the 20th century.  Over a 35 year period beginning in 1969, he performed over 5000 sex reassignment surgeries, almost single-handedly establishing SRS as an acknowledged and accepted treatment for transsexualism in the U.S.  Much beloved by the trans community, Dr. Biber passed away on Monday January, 16, 2006 at the age of 82.

 

 
 
The Current Protocol for Referring Transsexuals for Vaginoplasty (SRS)
 
Vaginoplasty (sex reassignment surgery) is a dramatic and irrevocable final step in male to female gender transition. This step is usually taken only after the deepest introspection and counselling regarding all the options. For those needing complete gender correction, this surgery is a life saving and life enhancing miracle, and can enable them to live a full and joyous life afterwards. However, carrying out of a mistaken urge for such a complete transformation could lead to permanent and terrifying emotional and psychological consequences. The background for this process is discussed in the introduction to the concepts of gender identity, transgenderism and transexualism found elsewhere in Lynn's website.
 
The Standards of Care of the Harry Benjamin International Gender Dysphoria Association (HBIGDA) defines the currently accepted protocols for the medical treatment of transsexual women. These Standards cover all aspects of medical treatment, including the requirements for Real Life Experience (aka, Real Life Test), and other requirements that must be met before a trans woman is recommended for SRS. Most surgeons who perform vaginoplasty will only operate on transsexual women who have been treated under these Standards and who present the corresponding letters of recommendation for surgery from their case-counsellors.
 
For more information on the overall TS treatment and transition procedures, see Andrea James' TS Roadmap website, which contains outstanding planning information for anyone contemplating MtF gender transition. For more details on Vaginoplasty, see Andrea's Vaginoplasty page and follow the many links there.
 
 
 
Some Photos of Modern Vaginoplasty (SRS) Results
 
During the 80's and especially during the 90's, there were steady advances in vaginoplasty (SRS) techniques. When performed by the most experienced surgeons, the SRS results are much more predictable than in earlier years, both in appearance and function, and there are far fewer incidents of complications. (Note: We now often use the alternative term Vaginoplasty to refer to SRS. This term better communicates that the surgical goal is the construction of functional female genitalia - i.e., a vagina). The vaginoplasty surgery is often followed several months later by labiaplasty surgery to refine the external female genitalia (labia).
 
Following are photographs of the details of the female genitalia created by modern vaginoplasty and labiaplasty. These photos clarify the remarkably advanced state of modern MtF sex reassignment surgery. In these cases, the surgeries were performed in 1999-2000 by Eugene Schrang, M.D., of Neenah, WI. The patients are in the same orientation as in Figure 10 above (i.e., in stirrups with legs spread and labia separated). The middle photo shows the inner and outer labia spread apart and is labelled to identify the clitoris (c), the urethral opening (u) and the vaginal opening (v). The (z's) note locations of faint z-plasty scar-lines where incisions were made during labiaplasty to construct the clitoral hood. Note the normal anatomical proximity of the vaginal and anal openings. (See the web-links at the end of this page for more photos of SRS and labiaplasty results):
 
 
Results of modern SRS surgeries performed by
Eugene Schrang, M.D., of Neenah, WI
 
 
Here is a photo of the appearance of the external genitalia of a TS patient one year after SRS (vaginoplasty only) was performed on her in Montreal, Canada at the Clinic of Yvon Menard, M.D. and Pierre Brassard, M.D. ( en español ).  In this case the patient is shown with her legs close together and we are looking upwards from the direction of her knees. Therefore the outer labia are pressed together, and the inner details of her genitalia are not visible. This photo is fairly typical of the normal-looking external appearance of TS women's genitalia after basic SRS. Note that electrolysis can be applied to the genital area so as to remove unwanted hair from the labial areas, if needed to produce a natural final appearance.
 
 
 
 
 
 
Postoperative Care Following Vaginoplasty (SRS)
 
During the immediate postop period, the woman will be under the good care of her surgeon and hospital recovery environment. During this time, she will learn whether her surgery was fully successful, or whether some complications have occurred and have to be dealt with. Later, after leaving the hospital, she will have to take a lot of responsibility for long-term ongoing aftercare, and the long-term outcome of the surgery will depend on how consistently she performs that aftercare.
 
A high percentage of modern SRS surgeries done by the top surgeons are fully successful, aesthetically and functionally, without any major complications. However, when done by less experienced surgeons various complications can and do occur, and even the top surgeons will very occasionally encounter difficulties. Complications can include minor infections, bleeding, a sloughing-off and loss of some of the grafted skin. Most of these minor complications can easily be managed and will be under control before the woman leaves the hospital.
 
However, there is some risk of more serious complications. Anyone contemplating SRS should understand these risks, and should be sure to go to only the very TOP surgeons here or abroad who have track records of very low frequencies of serious complications. The more serious complications include major infection or bleeding, and damage to the bladder, prostate or major nerves during the dissection to form the vagina. These complications can be difficult to control and correct, may require major extension of the hospital stay, and can lead to permanent uncorrectable damage.
 
One of the most feared complications of all is the formation of a vaginal-rectal fistula. This can occur during the dissection of the vaginal cavity by accidentally cutting through the rectal wall, or it can occur due to vaginal-rectal tissue death from pressure of the packing during the immediate postop period. A fistula enables excrement to bypass the anal stricture and exude from the vagina. The excrement prevents proper healing of the fistula and an ongoing danger of infection. The only way to correct the damage is to perform a colostomy, and then wear a bag for many months while the fistula heals. Proper dilation of the neovagina may not be possible during this periond, often leading to closure of the neovagina. The patient may thus later need a complete redo of the SRS using skin grafts.
 
[Note: This terrible type of complication often goes unreported because the patient is dependent of the surgeon to correct the damage, and won't want to alienate him by publicly revealing that the complication has occurred. She is also usually devastated emotionally and won't want to reveal the horror she is going through. Be sure to go to one of the TOP surgeons if you want to minimize the risk of such awful complications.]
 
Once released from the hospital, the main concern facing the newly postop woman is to insure that her neovagina heals properly, and maintains its size and remains functional. In order to do this, the patient must dilate frequently using a vaginal stent for an extended period following surgery. There are a number of sources for such stents, and your surgeon will most likely recommend a source to you. One current internet source for stents is Duratek Plastics of Canada.
 
Vaginal stents typically range in size from about 1-1/8 to 1-1/2 inches or more in diameter (28 to 38 mm), and must be inserted to full depth (4 to 6 inches or more) into the woman's vagina for 30-40 minutes several times per day for many months after the surgery. Increasing sizes are used to gradually widen and maintain the vaginal opening during the postop recovery period. Later-on, especially during any prolonged periods of sexual inactivity, basic dilation must be done at least once or twice a week to insure maintenance of vaginal width and depth. Even after many years, if the woman notices any tightening or constrictions from one week to the next, the frequency of dilation must be increased until that tightening episode has passed.
 
For more detailed information about dilation techniques and immediate postop care, carefully study the article Zen and the Art of Postop Maintenance. We cannot over-emphasize how essential it is to rigorously perform dilations according to the schedule provided by your surgeon. Many of the cases where surgical outcomes seem to be poor are actually the result of women not rigorously dilating, especially during the critical months immediately following SRS.
 
Following is a photo of a newly-postop transsexual woman, whose pubic hair is still shaven, undergoing one of her initial vaginal dilations (after SRS at Dr. Suporn clinic in Thailand). Note that the depth obtainable during SRS is a function of surgical technique, available penile and scrotal tissue for skin grafts and the patient's pelvic anatomy. Typical SRS depths for most patients of the better surgeons are in the range of 4" to 6". Here you see an above average result of SRS: a vaginal depth of about 6 to 6-1/2 inches. The stent in this photo is 30mm in diameter. As you can see the stent enters the body at the base of the vulva, and in a normal angle in line with the main torso. Thus this patient's overall genital geometry is now the same as for any female, and will accomodate all the usual positions for sexual intercourse and lovemaking.
 
 
 
 
Lynn highly recommends that all women having SRS find a friendly, trustworthy, competent family practitioner or gynecologist beforehand. Tell them what you are about to do, so that they can help you with any minor complications that may be present or may arise once you return from your surgery. Unfortunately, few physicians have any clue about SRS. Therefore, if you suddenly have a complication at home after surgery, you may find it very difficult to get medical help. Many physicians will be afraid of helping for fear that lack of knowledge may lead them into malpractice problems, etc. It would be better if more of the top surgeons would write-up some aftercare information that included a section for general practitioners and gynecologists regarding postop care. This might help ease the concerns among local physicians about how to help a postop woman after SRS.
 
Note: Lack of local medical care was a huge problem for postop women in past decades. Many women returning from abroad with major complications in the 1960's and 1970's were unable to find any medical help here in the U.S. Some were even ejected from ER's they had gone to with life-threatening complications. Some died for lack of access to basic postop medical care in the U.S. Fortunately, things aren't this bad anymore in most places. But to be absolutely safe, be SURE to line up access to local medical care BEFORE going for SRS.
 
All postop patients should be very careful not to let fears and worries and embarrassments interfere with proper aftercare. If you are having any medical problems and are in doubt about your condition, go see a doctor! Don't let a minor infection or bleeding or pain stop you from doing your scheduled dilations! If there is any problem at all, seek local medical help and also get back in contact with your primary surgeon. You must not let ANYTHING interfere with your dilations, or else you risk the loss of your neovagina.
 
After a couple of months have passed, healing will begin to be complete and you can relax a bit. The frequency of scheduled dilations will ease a bit, and you will begin to feel your new form of sexual arousals. At this point you are ready to fully begin your new sex life as a woman.
 
 
Some Practical Matters:
 
Dilations require lubrication, and many postop gals use the water-soluble lubes such as K-Y for this purpose. However, if you need to lube "on the run" in rest room or similar situation, K-Y is rather messy because you need to wash with water to clean it off. Mineral oil is an inexpensive alternative lubricant for dilation that works well, and it cleans up without necessarily requiring washing it off. It can be almost completely removed with paper towels without water, and really isn't very "oily" after all. The only problem with mineral oil is when travelling you have to pack your bottle of it inside a zip-lock bag lest it sneak out into your luggage.
 
Lubrication is also usually required during sex play and intercourse using your new vagina. Here too there is a good alternative to the ubiquitous K-Y. Astroglide is a much better lube. It takes less of it, and it feels much more "slimy" like natural mucous secretions do. It lasts well and is water soluble too. The only problem with it is that the Astroglide bottles have a little pop-up nozzle that it very sharp at the end - so do be careful when applying it in the heat of passion to yourself and especially to your lover!
 
The postop woman may need to douche occasionally, especially after intercourse, in order to keep her neovagina clean and odor-free. There are many over-the-counter preprepared douches that work fine for this. They come in various scents and concentrations. Lynn prefers the "extra cleansing vinegar and water" mixtures, but all the mixtures work fine and will leave you feeling clean and fresh inside. The easiest way to use the douche is to stand in a bathtub or shower and relax and carefully insert it vertically in line with your vagina. Once it is in all the way (the tips are about 4" long), squeeze the bottle empty and let the fluid simply run down your legs. Wipe off with a wet washcloth, and you're done.
 
Most of these prepared douches, such as the Massengill brand, have a tip that tapers down to a fairly fine end, almost to a point. These tapered tips can be a bit painful to insert, especially during the first months after SRS. Since the shafts get larger as you insert further, you can sometime feel the rather sharp flutes along the shaft (slot where the fluid will be ejected from the bottle). Therefore, you'll need to use quite a bit of lube all along those shafts in order to insert those tips, and the sensation may still be unpleasant.
 
However, there is one brand of douche, "Summers Eve" which uses a wider, hemispherical tip the size of a small finger, and the shaft behind the tip is smaller in diameter than the tip. Summers Eve douches insert very easily and painlessly with only a small amount of lube on the tip.
 
Initially, when newly postop, the girl may have difficulty with her urine unpredictably "spraying" all over the place when she sits to pee. However, as her urethral opening heals, she will gradually be able to direct her urine into a more predictable stream. This may take some learning on exactly how to sit and how to position the urethral opening when peeing - learning some things that all GG's had to do when they were little girls.
 
Many newly postop gals at some point suddenly become overly concerned about whether their new genitalia are going to look perfectly normal and whether they are "deep enough" for intercourse. These concerns can be very disabling and prevent the woman from relaxing, having fun, learning her body well, and then going out and dating and becoming open to sexual activities with a partner. This can become a kind of panic as the possibility of sexual intercourse as a woman begins to present itself. Newly postop women need to know that as long as they have at least 4" of depth, they will be able to have fun sex with most average-sized men. More than 4" is defintely better, but 4" is just enough. Many postops have about that much depth and do just fine in relationships with men. Also, most men find female genitalia a bit scary and just don't look all that closely. If you are a fun sexual partner and your genitalia are sexually functional, then you should have no concerns about "looking perfect".
 
By the way, quite a few GG women have confusions and concerns about "how they look". A recent controversy in Australia clarifies this issue: Most GG women have not seen the details of many other women's vulvas, but nowadays they may often see photos of other women in their boyfriends or husbands' porno magazines. In Australia the men's magazines such as Playboy and Penthouse are forced to digitally "pretty-up" and simplify the appearance of women's genitals in their photos in order to be sold without plastic-wrap covers. As a result of seeing these modified photos, many women in Australia have now gotten a very unrealistic notion of what most women's vulvas look like, and this has led to many women there to seek out plastic surgeons to make their genitals "look normal"! This story should help more postop TS women to relax a bit and not worry so much about "how they look". There is a very wide range of vulvar appearances, and most postops these days fit somewhere within the rather "normal-looking" part of that spectrum.
 
It also turns out that most men find postop women quite wonderful feeling during intercourse, because postops are usually "tighter" than other girls those men have made love to. Postop women can also "snatch" their lovers' penises and apply pressure by tightening their abdominal muscles, just as GG's do, and thus make themselves even tighter. However, you must be sure to regularly dilate to at least 35mm in width (1-3/8 inch) in order to take in an average-sized male, and 38mm is even better (1-1/2 inch). Remember, your vagina is not as elastic in diameter as a GG's vagina. It will stretch out only to the maximum size you've dilated to, and will then go no further. If you are in doubt about someone's size, be sure to carefully "feel the width" of your date before indicating a desire for intercourse. That way you can see if he's likely fit into you. If he's definitely too wide, you can decide that you are "too tired" that night. Then find someone else to date.
 
 
 
 
Sexual Arousal, Lovemaking and Orgasm in Postoperative Transsexual Women
 
Many myths surround the effects of SRS on libido, sexuality and orgasm. Many preop TS women are understandably concerned about whether they will be able to fully enjoy and eagerly participate in lovemaking after SRS. Of special interests and concern is whether postop TS women can fully experience sexual arousal and orgasm. The ability to easily become aroused, to desire intimate and sensual contact, and to achieve sexual release through orgasm is a precious gift to bring into love relationships, especially when combined with a desire to give full and complete pleasure to one's love partner too. A loss of these capabilities could ruin the woman's chances of experiencing her full humanity after transition, especially for finding and enjoying a passionate, deeply-bonded love relationship. However, as we'll see, SRS can provide those for whom it is right the chance to fully experience the joys of sex and lovemaking - and thus to finally enjoy a full human life.
 
 
Myths vs Reality, and the decision to undergo SRS
 
Many people simply assume that the loss of the external male genitalia will result in a complete loss of sexuality. This very naive myth unnecessarily frightens many preop women, and it also furthers prejudice against postop TS women, who are often thought of by the general public as having "desexed themselves".
 
Certainly a typical male would suffer a catastrophic impact on body image and libido from the loss of his external genitalia. However, it has long been known that with counseling and practice, even males who have lost their genitalia to cancer can recover the capability for arousal and orgasm.
 
Furthermore, intensely TS women are not "regular guys". They do not suffer a negative impact on body image as a result of SRS, but instead find a greatly enhanced body image. The experiences of countless Hijra girls in India demonstrates that even primitive forms of SRS do not desex transsexual girls and in fact helps many of them. SRS has the opposite effect on intensely TS women as would the emasculation of a typical male. SRS usually releases and enhances the libidos of TS women, enabling them to frequently and fully "turn-on" and enjoy their physical sexuality and lovemaking, including achievement of orgasm during intercourse with a partner.
 
The myths and misunderstandings about the effects of SRS cause many preop TS women to remain in a state of indecision about having surgery. Although feeling an intense need to undergo SRS to achieve physical conformity with their gender identity, some preops may also feel extreme anxiety about whether or not they will still experience sexual arousal and orgasm after SRS.
 
This anxiety is enhanced by stories heard from many TS transition failures, including the cases of intense cross-dressers, drag queens and crossdressers who mistakenly underwent SRS for various sexual reasons and then found that their male libidos were greatly reduced and their male orgasmic capability eliminated. See the "WARNING " in Lynn's TS information pages, for clarification of what can happen when male-gendered crossdressers or drag queens become misguided and have SRS. There have been so many of these misguided cases that the urban myths about SRS have escalated over the years, and there is now a lot of confusion about what to expect after SRS.
 

 SRS Warning

 
On the other hand, many other transsexual girls learn to visualize from their preop sexual experiences (as Lynn did) that they'll probably still "turn-on" sexually and be orgasmic as women after SRS: Many preop women hide their genitals by inserting the testicles up into the abdomen, and then tightly tucking the male organ back through the crotch (with tight underwear or taping). In this configuration, the penis cannot usually get enough blood supply for full external penile erection. Even though the external part of the penis cannot erect when tucked tightly, the girl nevetheless experiences the familiar female "glow" and warmth throughout her interior genital region when she is aroused, for example, by a man's warm attentions. In addition, the corpora cavernosa shafts inside her body can become erect once the girl is sexually aroused, and that arousal feels really wonderful - even though the external part of the penis is flaccid. Sexual stimulation by rubbing and caressing the genital area and the breasts can then lead to orgasm for a girl who is sufficiently aroused.
 
From experiences like this, preop women can visualize that after undergoing SRS the remaining internal stumps of her corpora will still engorge and become erect, and that she can experience similar feelings of sexual arousal when she is postop. In addition, the postop woman can now also experience wonderful sensations from caressing her clitoris, which, in contrast to the previously hidden penis, can now be openly played with without her experiencing angst about her body-image.

 

There are thus many dimensions to postop women's sexuality, and the actual postop effects of SRS on arousal and orgasm vary greatly from case to case. Those who are male-gendered, and who have male sexual urges focused in the external genitalia, are likely to experience great loss over time. Those who are "in between somewhere" will likely experience a mixture of losses and gains. Those who are female gendered and who have strong female sexual urges are likely to benefit greatly, as a whole new life of sensuality, sexuality and lovemaking opens up to them. All of this is of course contingent upon the person having a normal-level of libido, having no "hang-ups" about being sensual and sexual, and also upon a successful surgical result.
Thus the decision for SRS must be taken with great internal soul searching and introspection, and with complete honesty with oneself about one's own gender identity, body image and likely psychic reactions to the body changes of SRS. This is especially true if sexual arousal and orgasm are very important in one's life. However, for those for whom SRS is the right thing to do, that surgery can release them fully from the physical gender trap they had been living in, and free them to experience their full humanity in sexual and lovemaking relationships.
 
 
Initial sexual response of postoperative TS women: Entering a second puberty
 
There is a wide range of libidos in postop women, just as in natal women. Some women are very highly sexed, the majority are moderately sexed, and some are asexual and have little libido at all. This section is relevant for those postop women who have healthy libidos, who experience sexual arousals and who desire ongoing sexual fulfillment and orgasms.
 
Most postop women having healthy libidos begin to experience their first postop arousals within a month or two after surgery. After a initial period of low sensations and even numbness, they then experience "turning on" due to engorgement of remaining internal erectile tissue (corpora and spongiosum) that was left during SRS. The arousals produce a feeling of "erection", but one that is different than for guys, since it is inside their bodies.
 
For some postop women, it may take much longer for these arousals to begin, especially if they were inactive sexually and/or asexual prior to SRS due to their gender angst. However, even these postop women will eventually begin to experience genital arousals and the onset of sexual desires if they have active libidos.

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 period.

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 puberty.

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!

 
Some advice to postop women about finding the right lover and losing your virginity
 
This section is aimed at postop women who have gained some experience with their new bodies and new sexual responses, and for whom "losing your virginity" is now a "goal". This can be a good thing to get behind you, because you'll be much more comfortable in the knowledge that you can really "do it", and it'll be easier the next time when it might really count.
 
By doing this you can get over your fears of whether you will pass or "look OK" in the sack, and whether your body or scars or whatever will lead to comments or difficulties. It turns out that most guys won't notice a thing even in very problematic cases as long you are sexually functional. Most guys just don't look very close. And there is such a wide range of vulvar appearances among natal women that most postop women look OK anyways. So you'll soon be able to relax about all that, and feel comfortable "cutting loose" and enjoying lovemaking without being self-conscious.
 
However, it is important to avoid doing it with just "any guy", especially someone whose persona or approach doesn't turn you on, or who doesn't try to make you feel good. Instead try hard to find someone you have something in common with, and with whom you can test out if there is any "chemistry" in advance, before jumping into the sack. And of course, you really should try to figure out if the guy is a nice person who won't get violent with you if he somehow "finds out".
 
One mistake many girls make is to hope for too much and too quickly, and then becoming greatly disappointed with how sex feels. By expecting sex with "just any guy" to be fun, they can become extremely disappointed. They may mistakingly think that guys know how to turn them on, instead of needing to get aroused themselves. They may simply discover that they have little or no genital sensation when they are not turned on, even with the man penetrating them and ejaculating into them. This can erroneously lead them to believe that they "lack sensation", leading to all sorts of fears and worries.
 
However, not "feeling much" when having sex with a man while you are not turned on is pretty much the same for ALL women, TS or not!  It is a common experience nowadays among young teenage girls who cave in under pressure to "have sex with someone". It's not even a lot different from the situation a guy who isn't turned on faces while being pressured to have sex by a girl. Touching, rubbing and attempting intercourse simply do not feel good and do not produce results, unless you are turned on! That's why "being in love" with someone really does mean something folks!
 
Only if your libido kicks-in and you get a feeling of "erection" or warm arousal, will all the external sensitive tissue begin to give really good sensation and will sex be fun and potentially lead to orgasm. Also, just as for any GG, postop women should not expect much sensation from inside the vagina. Most of the sensation when you are turned on will be from the external clitoral area and the outer vulva (for the TS woman there will also be strong sensations from the erect corpora and the prostate inside her).
 
So, the problem is how to find a guy whose presence and voice and warm touch makes you feel "melty", and who turns you on and makes you feel really comfortable and sensual and excited. You'll know it when it happens. Then definitely do jump into the sack and let your inhibitions go!
 
Many of these same issues arise for postop gals who seek women as love partners. They may feel even stronger concerns about whether their bodies and genitals look OK, and whether they will really be accepted as women. On the other hand, they may feel a lot less physical fear of their partners than do gals going out with men. Beyond this, the situations are similar: For lovemaking to work, you and your partner must both be aroused and be comfortable with each other, and you must find sweet and compatible ways to share and enjoy lovemaking together.
 
Even if you find a good loving partner who turns you on and who is a good lover, you may still need some advance practice in order to easily reach orgasm. Some of this depends upon the sexual positions you both like best, and upon how you have previously been masturbating. You may need to modify your private masturbation habits, and migrate to positions and stimulations more similar to those you experience during intercourse with your partner. Also, be sure to TELL your partner what you like. If he or she enjoys being with you and wants to make you happy, they will try to help you feel good. But they can't do that if they don't know what you like.
 
 
Thinking about intercourse positions
 
Some intercourse positions make it easier for a woman to reach orgasm than others. Most guys will let YOU tell them or guide them towards what you like (i.e., what position sequence you like to use). However, if you don't tell them what you like, you may end up flat on your back in the "missionary position" and get nothing out of it even IF you are turned on!
 
Remember, you are no different from GG women in that most of your sexual sensations will come from your clitoral area and outer-areas of the vulva, and you won't feel much sensation from down inside your vagina unless you are highly aroused. Therefore, just like most other women, simple penile penetration alone is not going to do much for you (contrary to most guys' misconceptions about female sexual response). Thus you don't want to leave it up to your man to just do it his way. It's very important to have some ideas of positions and lovemaking moves that will make you feel really good too.
 
For many women it may be easiest to control your erotic sensations during penetrative intercourse if you are "kneeling on top". Thus the "woman on top" position (see photo of Jenny Hildouaki below) is considered by some women to be the easiest way to reach orgasm through intercourse alone, even without extra manual clitoral stimulation.
 
Kneeling on top of her partner, the woman can control the speed, rhythm and angle of penetration in a way that arouses her most. She can move her pelvis against her partner's so that her clitoris rubs against his pubic bone (and pressure can be applied to her aroused corpora stumps, inside her and just behind the clitoris), which is an effective way to trigger an orgasm in many cases. At the same time, either the woman or her man can play with her breasts, adding to the erotic sensations she feels. If kneeling all the way down doesn't quite work, the woman can raise her torso slightly so that either she or her man can play with her clitoris by hand even while he is still inside her. In order to develop some insight into these possibilities, watch how "Leticia" (Halle Berry) reaches for her orgasm in the final lovemaking session of her academy award-winning performance in the movie "Monster's Ball".
 
Instead of trying to "both come at once", as if that were some sort of ideal goal, it is usually best for the woman to come first. That way she can be sure to come even if it takes some time. Playfully and lovingly swapping back and forth between penetration and then manual or oral stimulation of the girl's clitoris and vulva can help her get really hot and reach orgasm. Whatever works, works. Then, once the woman has had her orgasm, she can flip over and wrap her legs firmly around her man's back, and let him enjoy mounting her from above and thrusting hard into her while he approaches his orgasm and ejaculation.
 
Note: If the man has difficulty "staying up" long enough for the woman to reach orgasm, the solution is simple: Viagra! With Viagra almost any man can get good firm erections, and many healthy men can easily "stay up" for an hour or more by using it. Women should not hesitate to suggest Viagra to their men, because it can be a wonderful lovemaking enhancer. Since Viagra helps their men stay excited longer and takes pressure off their men, it can help women reach orgasms who otherwise can't reach orgasm soon enough - by giving them plenty of time to reach a climax.
 
These same concerns arise if your partner is a woman. There is a need to explore for positions and methods that work, and for signaling about things such as shifting positions, who should come first this time, etc. The shared experiences of developing really satisfying lovemaking skills together is an important part of falling deeply in love and fully emotionally bonding with your partner.
 
Once you are comfortable making love and reaching orgasm in basic sex-positions, you and your partner may want to explore more advanced techniques in order to keep your love-life fun and exciting. There is a wide variety of excellent books and videos available to help you in this. For starters, you could check out books like How to Be a Great Lover: Girlfriend-to-Girlfriend Time-Tested Techniques That Will Blow His Mind and The Good Girl's Guide to Bad Girl Sex. Also, take a look at videos like The Guide to Advanced Sexual Positions. Such books and videos can also help a woman get over various hang-ups and become more comfortable thinking about and then enjoying lovemaking.
 
 
Some differences between earlier male vs later female genital experiences, arousals and orgasms
 
The results of SRS are made immediately obvious to the postop woman by one important effect: She now has to "sit down to pee". Peeing isn't as easy as before, and every time you pee you are reminded that you are now a girl, reminded in the same way that all the other girls are.
 
On the other hand, there is a really great advantage to having female genitals that soon becomes obvious too: Your sexual arousals are no longer "visible to others". Just as for any other woman, the postop woman does not have to constantly suppress her arousals like men do. She can let herself get aroused any time she wants to, and can stay aroused for long periods of time without others "seeing anything", just as many other women do (this is another reason so many women smile a lot!).
 
It's great to be able to engage in fantasies and visualizations and get aroused at any time you want to. This freedom can help a woman create and firmly establish a healthy libido. She can hook-up her brain with her genitals without much "censorship" going on. Even though her libido is not as heavily stimulated by the large doses of testosterone that men have, neither does she have to tame and control her libido like men do theirs. Therefore, on balance, a woman can generally feel "sexy" much more of the time than a man can.
 
Lynn speculates that a lot of men have problems with getting erections simply because they have to constantly avoid having erections. In other words, they get much more practice in avoiding erections than they do in getting them! Women do not need to "censor" their arousals in that way. If they have no religious or other types of hang-ups about sex and lovemaking, they can easily practice and enjoy getting aroused as much as they like, and can develop very healthy libidos as a result. This advantage can help the postop woman get into her sexuality fairly quickly and help her learn a lot in just the first year or two postop.
 
Once she begins experiencing arousals and engaging in sexual activities, one major thing becomes immediately obvious. Orgasm feels really different as a woman. It may not be quite as easy to achieve and may take longer to achieve, but it can be a much more powerful sensation than any she ever experienced before as a boy.
 
Following SRS, the perfunctory feeling of male ejaculation during orgasm is gone forever. Instead, you can build up your sexual arousal to a much higher level without ejaculation bringing things to a halt. It may take more time to reach it, but you can now experience a more powerful orgasm - with the old male ejaculation feeling now replaced by an intense neural discharge and spasm throughout the entire genital area during orgasm. It feels kind of like you are being gently stimulated with electricity inside and throughout your entire genital region. The experience can vary a lot from orgasm to orgasm in the way in which the "neural halo and spasmodic colors" of the orgasm develop, spread, and feel. It seems almost as if most men so easily and quickly reach ejaculation that they never manage to get "high enough" sexually to trigger this more powerful form of orgasm.
 
In addition, there are real differences in "body feelings" during lovemaking between the male and female experience (although many of these feelings will be "female" in form for preop TS women too). Most males are usually stimulated visually by their partner's body-appearance. Once aroused, they usually feel a growing "tightness inside" and a desire to "grab and hold and thrust and penetrate". This desire comes on suddenly, and quickly becomes quite overpowering, with most of the sexual sensations coming only from within the penis itself. However, when the release of orgasm occurs, it is usually much more perfunctory than for a woman, being accompanied by a few spurts of semen and a few grunts and that's it. The ejaculation is then followed by quite a sudden letdown and loss of any interest in sexual activity.
 
The sexual experience for the postop woman is much more "internal" within and throughout her whole body than for a male. The arousal may start in her genitals, but then can spread all through her lower body, especially inside the muscles, and her skin all over her body becomes more sensitized to caressing and touching. Instead of sexual arousal being just in the genitals as in a male, the estrogen seems to also enable a powerful "heat" to fill the woman's whole body once she is aroused - and especially once she is being penetrated. Having this heat come over her in the absence of a partner, and without any satisfaction, can make her feel like "climbing the walls" or "thrashing around in her bed".
 
Since her whole body becomes much more sensitive to touch as she get fully aroused, she is not stimulated so much by her partner's appearance as by the way he (or she) touches her and manipulates her body and the way his (or her) voice sounds. She doesn't feel the hard focused drive to quickly achieve orgasm as do males, but instead feels a desire to let go and thrash around and be "handled" and gradually heighten her erotic feelings. It isn't what she is seeing that counts as much as what she is feeling and hearing and how her body is being manipulated by her partner, as she yields to the wonders of sexual heat and lovemaking. And usually she'll like to take some time to do this and enjoy this, instead of just "rushing for ejaculation" like most guys do.
 
Finally, she will get up on a "plateau" and realize that an orgasm is going to come. This is a truly wonderful feeling. At some point, the orgasm starts and spreads throughout her genital area, with the genital nerves becoming tremendously sensitized as it spreads. The sensation of the orgasm will vary a lot from orgasm to orgasm (more variably than in the male). Sometimes it will be weak, but sometimes it can be amazingly intense, and the feeling varies a lot in form and "color" from orgasm to orgasm.
 
Just like natal women, trans women often experience a strong urge to "vocalize" just before and during orgasm - moaning, squealing, screaming and making other loud noises while they come. The sound and internal body sensation of these vocalizations can greatly heighten the intensity of the orgasmic experience for many women. Postop women shouldn't be afraid to let out loud moans or screams when they come. It is perfectly natural, and can help transform ordinary orgasms into ecstatic ones. In contrast, very few men vocalize when they ejaculate, other than making a few grunts. Perhaps the difference is hormonal, with testosterone blocking these emotional vocalizations, just as it blocks emotions such as "crying" in males.
 
After climax the trans woman feels a sudden relaxing and calming effect that is somewhat similar to what it is like for boys. But unlike when she was a boy, she may often feel aroused and sexy again rather soon after having sex, often getting firm internal erections again soon after her orgasms. Even though it may be difficult for her to achieve orgasm again until some time has passed (a few hours to a day or so), she may feel a desire for sex again right away anyways. These re-arousals are a really wonderful feeling, and can enable sweet sessions of touching and snuggling with a loving partner after intercourse.
 
 
Measuring and documenting postop orgasmic response in TS women
 
As part of an effort to better measure and document postop women's sexual capabilities, Lynn participated in first scientific physiologic study of orgasm in postop TS women, in June 1999. This research was conducted by Rom Birnbaum, as part of her Ph.D. studies at the Institute for the Advanced Study of Human Sexuality in San Francisco, CA. Space was provided space for Rom's equipment and for conducting the research studies by Club Eros, a gay men's club in San Francisco. Although seemingly a strange place to conduct research studies on women, this "sex-friendly" site in the Castro Area was a good place for accommodating a wide range of research subjects and control subjects, during daytime "off-hours" at the club.
 
Research subjects were instrumented with electronic sensors (using measurement techniques evolved from the pioneering work of Masters and Johnson in their early studies of orgasm), and then engaged in masturbation in a comfortable, private environment in an effort to achieve orgasm. A number of the postop TS women, including Lynn, achieved orgasm as measured directly by Rom's instrumentation. Lynn's case was particularly important, since she demonstrated that the capacity for very intense orgasms can endure for many decades after SRS (Lynn was 31 years postop at the time of this research). Dr. Birnbaum's work demonstrated scientifically for the first time what many postop women and their lovers have known all along, namely that strong orgasms can be fully enjoyed by many TS women. Rom published her Ph.D. thesis results in 2000 (see following abstract).
 
 
Abstract: First physiologic study of orgasm in postoperative male-to-female transsexuals.
Birnbaum, R.
 
Ph.D. dissertation, The Institute for Advanced Study of Human Sexuality, San Francisco (Oct. 18, 2000).
Contact: poststudy@aol.com
 
Objective: To determine whether data generated by a physiological sex research study would support the hypothesis that orgasmic capacity can be retained and/or gained after sex reassignment surgery in the postoperative male-to-female transsexual. Design: Controlled laboratory-based analysis of responses to masturbation to orgasm(s). Setting: A mobile sex research laboratory setup predominately in two central San Francisco locations. Participants: A volunteer sample of eleven postoperative male-to-female transsexuals as well as twenty-nine control group participants divided into five groups: eleven nontranssexual males, nine nontranssexual females, five preoperative male-to-female transsexuals, two intersexual people and two female-to-male transsexuals. These totals include one participant who joined the study first as a preoperative male-to-female participant, and returned again later as a postoperative male-to-female participant. Intervention: One protocol including measurements of preorgasmic, orgasmic, and postorgasmic responses; response time determined per individual. Dependent variables: Pressure waveform patterns produced by involuntary contractions of the anal musculature, heart rate, and blood pressure. Results: Of the eleven postoperative male-to-female study group participants, eight self-reported orgasm and three of these eight produced orgasmic contraction episodes similar to those produced by control group participants in this study and subjects in previous physiological studies of orgasm. Furthermore, no statistically significant differences were found between contraction patterns produced by study and control groups in terms of duration of orgasmic contractions, intraorgasmic amplitude changes, number of orgasmic contractions per series, mean intervals between the first four contractions, mean intervals between all contractions, or orgasmic heart rates. Conclusions: Data from this study strongly support the hypothesis that orgasmic capacity can be retained and/or gained after sex reassignment surgery in the postoperative male-to-female transsexual. However, given the limited sample sizes, projected percentages of orgasmic capacity in the postoperative male-to-female transsexual population are unavailable.
 
 

 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.

 
 
The range of experiences of many postop women - - effects on sexual orientation and the moderate unpredictability of postop sexual orientation - - long-term effects - - some of Lynn's own experiences - - [ to be completed] - -
 
 
 
Who are the most active, prominent surgeons doing vaginoplasty (SRS) now?

The most prominent SRS surgeons in the U.S. today are Toby Meltzer, M. D. of Scottsdale, Arizona and Eugene Schrang, M.D. of Neenah, Wisconsin. These surgeons are in their prime, are performing hundreds of SRS each year, and are achieving outstanding results in appearance, function and sensitivity. Marci Bowers, M.D., a surgeon who has worked closely with Dr. Biber, has recently taken over his practice in Trinidad, Colorado and is reported to be doing excellent SRS surgeries there (Dr. Biber is now retired). There are also other expert surgeons performing high-quality SRS's in various other countries around the world, most notably Yvon Ménard, M.D. and Pierre Brassard, M.D. ( en español ) in Montreal, Canada, and Suporn Watanyusakul, M.D. ("Dr. Suporn") in Chornburi, Thailand. 
 

Marci Bowers, M.D.

Toby Meltzer, M.D.

Eugene Schrang, M.D.

 

For information on many surgeons performing excellent vaginoplasty (SRS) operations both here and abroad, see Andrea's Vaginoplasty page and follow the many links there. See also the SRS section of TS Women's Support Site and The New Sex Change Indigo Pages for information and links to SRS surgeons in many countries. The new European TS Information pages provide information about many excellent European surgeons. There are also a number of surgeons in Thailand who are now performing good quality SRS's, and the costs of surgery there are much lower than for comparable work elsewhere in the world.
 
Important note: In past years, few surgeons would operate on girls who were HIV+. This compounded the tragedy of being TS for the small minority of women who had been forced to live "on the streets" and had contracted this dread disease. However, surgical techniques have improved to where SRS can now be done without risk to expert surgical teams, although extra procedures are required that may raise costs. For information about surgeons who accept HIV+ patients, contact Christine Beatty (christine@glamazon.net). Christine herself survived life on the streets, and went on to become a successful postop woman. She reports that the following expert surgeons now accept otherwise healthy HIV+ patients: Toby Meltzer, M.D.: Same price as HIV- ; Sanguan Kunaporn, M.D.: 30% price increase for HIV+ ; Preecha Tiewtranon, M.D.: $1000 extra from HIV+ ; Eugene Schrang, M.D.: Unspecified extra change.
 
 
 
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!]
 
The TS women's support site contains links to many photographs of SRS surgical results of many surgeons. One link contains a series of 25 photographs of an SRS performed by Toby Meltzer, M. D. of Scottsdale, AZ. Another link contains a detailed sequence of photos of a labiaplasty performed by Dr. Meltzer.
 
Spanish actress Carla Antonelli's website also contains a very detailed "still-frame-video" sequence of SRS. Another site contains a photo sequence of SRS performed in the UK.
 
And here is a link to a photo of an early surgery done by Dr. Biber in Trinidad, Colorado in 1976. Dr. Biber became justifiably famous among T-girls in the U.S. for such results, and they've flocked to him ever since. The early surgical technique and results are very similar to Lynn's sex reassignment surgery, which was performed by the famous Mexican plastic surgeon J. J. Barbosa, M.D. way back in 1968.
 
Lynn had follow-up surgery for vaginal deepening and labiaplasty performed by Dr. Schrang (in November 2000), in order to bring her results up to modern standards. Dr. Schrang also has extensive experience in successfully correcting SRS complications surgeries done elsewhere.  Gwendolyn Ann Smith has created a webpage, "Transsexual's Guide to Neenah", that provides a lot of practical information about undergoing SRS by Dr. Schrang at Theda Clark Regional Medical Center in Neenah, WI.
 
 
 
Options that can reduce costs and enable feminization and transition earlier in life
 
One of the greatest difficulties faced by young, intense transsexuals who are very certain of their need to undergo complete gender correction is the high cost of transition and the long time-period (several years) to get everything approved. The overall costs of counselling, hormones, electrolysis and surgeries is typically $30K to $40K in the U.S. Because of their gender condition, many younger transsexuals are unable to obtain good enough employment to save money fast enough to achieve a timely transition. Meantime, they are often doomed to watch as their bodies continue to masculinize (even if taking estrogen) which makes a successful and complete transition seem further and further out of reach.
 
Recent developments, including easier and earlier access to female hormones and antiandrogens (ordered from overseas pharmacy sites via the web). There are also several new sex-change surgery clinics in Thailand , where SRS costs only about $6000 to $8000 (see New York Times article of May 6, 2001). Easier access to hormones and surgery have made it much easier for young transsexual girls to feminize themselves while young and to achieve complete gender transition while in their twenties. The Thai surgeons do not insist on the full HBIGDA protocol (and instead make their own informed decision whether a patient is suitable for SRS), thus greatly reducing the financial burden and logistical complexities of having to go to two counselors or psychiatrists for several years in order to get the letters of approval for SRS required here in the U.S.
 
For more information about the Thai surgeons, see the TS Womens' Resources SRS page. See also Dr. Suporn Watanyusakul's website and photos of recent SRS at his clinic. For another recent example of Dr. Suporn's work (May 2002), see the webpage of a girl from Finland describing her SRS experiences and showing photos of her SRS results (in English).
 
 
Photos of recent vaginoplasty (SRS) results by Dr. Suporn on a girl from Finland (at 5 months postop)

 
 
Also see the websites for the Preecha Aesthetic Institute (Dr. Preecha Tiewtranon), the Aesthetic Plastic Surgery center in Bangkok (Dr. Pichet Rodchareon), and the Plastic Surgery Center in Phuket (Dr. Sanguan Kunaporn), including a sequence of photos of SRS surgery by Dr.Sanguan Kunaporn.
 
However, anyone going to Thailand for SRS should make very certain that they are going to one of the handful of reputable surgeons there who are doing high-quality SRS's using modern surgical techniques in the best hospitals. There has long been a tradition in Thailand of doing what superficial "Hijra-style" SRS's which do not create a full vagina. These are inexpensive surgeries (on the order of $1000 to $1500). Many Katheoy "working girls" undergo these surgeries, not being able to afford the full SRS surgeries (if someone does not need a full SRS, a Kathoey-type surgery might be an option to consider). Bottom line is that anyone going to Thailand should carefully research the latest information on Thai surgeons, and avoid going to the "lowest bidder" for such an important and life-changing surgery .
 
As an even less expensive alternative, transsexuals in the U.S. can now take advantage of fairly easy access to orchiectomy. After orchiectomy (castration) a T-girl's body will not be further maimed by testosterone, and the feminizing effect of female sex hormones is much more rapid and more pronounced (especially in younger girls). This option can enable younger T-girls to rapidly become feminized and passable, and to buy some time to save money for SRS without feeling such desperate urgency. For more information on this type of surgery, see this Orchiectomy page.
 
In the past, many T-girls went to Dr. Robert Barham in Portland Oregon for orchiectomies, who charged about $1000 for the surgery. Although Dr. Barham is no longer doing these surgeries, his protocols are worth documenting as being what you might expect elsewhere:  Dr. Barham required that you had transgender counseling for one year and been on hormone replacement therapy for one year and had passed a recent HIV status test. His protocol involved seeing you at least one day before the procedure to discuss the procedure, the implications and the risks. The procedure was then generally done on the following day in his office. He used bilateral spermatic cord blocks for anesthesia. The procedure itself took approximately one hour. Following the procedure it was best if you can remained in bed with ice packs for 12 to 24 hours. He also asked that you stay in town for 48 hours, to take care of any problems that might arise, and also to give you a chance to begin healing before returning home.
 
For more detailed information about orchiectomy, see Sherry's website. Sherry is a transgender girl who underwent orchiectomy in 1999 as part of her preparation for gender transition. In her website she describes her own experiences and provides a lot of up to date information about orchiectomy, including a list of surgeons. See in particular her pages entitled "Questions I am Often Asked About My Castration" and "Orchiectomy for Transsexuals". See also Andrea James' new Orchiectomy page.
 
 
 
Completion of transsexual body feminization by cosmetic surgeries
 
Many transsexual women also undergo breast augmentation surgery, facial feminization surgery and various cosmetic surgeries to further feminize their bodies. Anne Lawrence's site contains photos of recent breast augmentation surgery on transsexual women, and Lynn's FFS site contains information on facial feminization. To give you an idea of the wonderful results now achievable, here are some photos of breast augmentations performed on hormonally-feminized transsexual women (these were done by Dr. Suporn, in Thailand):
 

 
However, it is important to note that many TS women achieve very satisfactory breast development without augmentation, especially if they started their transitions while in their teens. For a discussion of breast development in TS women, along with many photos of unaugmented development, see this Breast Development webpage.
 
The decision of whether to augment or not is very similar for a TS women as for any other woman - a complex one with many tradeoffs of appearance vs sensation vs risks of complications. In many cases of small development, augmentation can bring a lot of satisfaction, but in many other cases it may be quite unnecessary and carry unwanted risks. For a discussion of breast augmentation with many photos, see this Breast Augmentation webpage.
 
Carla Antonelli's website contains a page of photos of pretty T-girls where you can see even more results of breast augmentation surgery. Perhaps even more importantly, her page conveys images of the wonderful results that these young women obtained from feminization early in their lives. The ongoing moral to the story is this: If a T-girl knows for sure that she inevitably must become a woman, she should immediately seek medical help to stop any further masculinization and begin her feminization as early in her life as possible - in her mid-teens if she can. Courage and decisiveness in seeking gender correction while still young will dramatically improve her chances for a full and complete life.
 
 
The joys and wonders of complete gender correction
 
Modern medical advances have brought us a long way from the ancient methods used in traditional "Hijra-style" surgical treatments of transsexualism. Modern sex hormone therapy, vaginoplasty (SRS) surgery, facial feminization surgery and cosmetic surgeries can substantially modify an MtF transsexual's body to properly match her innate gender, especially if treatment is started early enough in life. It is now possible for many postop women to feel totally gender-congruent in their transformed bodies, and to be able to very comfortably and passionately enter into loving relationships (either heterosexual or lesbian, as the case may be) as sensual, sexually responsive women.
 
The extent of body modification and feminization now possible by early medical intervention and lots of effort can be seen in many photos of young transsexual women (such as those of Amanda Lear (France), Roberta Close (Brazil), Carolyn Cossey (U.S.) and Julia Sommers (Australia)).
 
The joys and wonders of being able to resolve the transsexual condition and to then live a full life as a warm, loving woman in the resulting female body are suggested by the following beautiful photographs of Jenny Hiloudaki (Greece). Jenny started on female sex hormones at the age of 13 and underwent vaginoplasty (SRS) at the age of 20:

 
 

 
 

 

 

Reset on 7-15-06
V-1-05-05 + update of 10-14-05

Translation first posting 7-07-06

Translation updated posting of 4-05-09

 
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