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Sex Reassignment Surgery (SRS)

The Nuts and Bolts

by Melanie Anne

In truth, there is much more to sex reassignment surgery than the surgery itself. Still, the nuts and bolts of the actual procedure seems to be a topic which most piques the interest. In deference to this interest, I'm putting a description of the specific of the surgery right up front. With that out of the way, we can continue or exploration into the whole phenomenon, including it's personal, social, financial, and legal ramifications.

What is Actually Done?

Technically, you cannot truly change one's sex. That's why the procedure is not really called "sex change surgery" but "sex reassignment surgery". The idea is to alter the physical appearance of a person's anatomy to approximate as nearly as possible the anatomic arrangement of the other sex.

Part of this procedure involves extended hormone therapy, which alters secondary sexual characteristics. In male to female transsexuals, it leads to the growth of breasts and the build up of body fat in particular areas. In female to male transsexuals it lowers the voice and causes body hair and beard to grow. (It should be noted that the male to female transsexual's voice is not changed by taking estrogen.) We shall fully explore the purpose and effects of hormone therapy later in this book, but for now we shall ignore this aspect in favor of a blow by blow description of the surgery.

The Long and the Short of it

Contrary to popular belief, the penis is not amputated during SRS. Rather, the internal penile tissue is mostly removed, but the outer skin is left attached, inverted and inserted into the body inside out as the new vagina. The testicles are removed, but the scrotal tissue is also left attached and used to fashion the vaginal lips or labia through standard plastic surgery procedures.

Here is how it happens. Once the patient has been prepped, sedated, wheeled into the operating room and anesthetized, the doctor slits the skin of the penis lengthwise from the head or glans down to the base on the underside. The skin is then peeled away from around the penis, but since the slit only opened the penis, the base of the skin is still attached.

The penile skin is then turned inside out, much like one might turn a sock inside out. When this is done, the slit is stitched back together, creating an inverted penis, which will ultimately form the new vagina.

Before this occurs, a rather miraculous, yet simple procedure is performed. Earlier, when the internal penile tissue was removed, a small stub of tissue was left behind, still attached. This is erectile tissue, which becomes stiff when stimulated, and also carries sexual sensation.

A tiny slit, perhaps a half-inch in length, is made in the new, inverted penis near the base where it is still attached. The stub of erectile tissue is pushed through the slit, forming the equivalent of a clitoris, and providing the opportunity for complete orgasm and sexual satisfaction after surgery. In addition, a second tiny slit is made below the one for the clitoris. The urinary tube is rerouted to this second slit to create a typical female urinary opening.

Once this procedure has been accomplished, the skin and muscles of the lower abdomen are lifted up with surgical instruments, providing a gap near the pelvic bone. The inverted penis is pushed into the gap, still attached at the base, so that it hinges down and into the proper location for a vagina.

To allow for proper vaginal contractions later, some of the abdominal muscles are repositions around to new vagina so that they can squeeze in on it, both by conscious control and also automatically during orgasm.

The new vagina is filled with surgical gauze to maintain shape, and then anchored in place with a thin surgical wire which enters the abdomen from the outside, runs under the pelvic bone, through the new vagina, back up around the pelvic bone and out the abdomen again. Once the vagina has healed in place, which takes approximately seven days, the wire is removed by the surgeon, who simply slips it out.

Post Op Information

The post op patient will remain in bed for seven to eight days. The pain of surgery is not at all as bad as one might expect. The only real pain comes if one sneezes, coughs, or laughs. The procedure does take a lot out of one's reserves, so that the patient drifts in and out of sleep and is too weak to roll over unassisted for the first day or so.

For the first three or four days, the patient is on a catheter for urinary purposes, which allows urine to drain through a tube to a bag on the side of the hospital bed. This is standard medical procedure for all urinary surgeries. In addition, any use of general anesthetic usually causes a shut down of bowel function for three or four days. Many post op patients require an enema to get the system flushed out and working again.

Urination after the catheter is removed is painful and difficult at first, but not to the point one cannot bear it. Over the course of the first few post op weeks, urination becomes increasingly easier, and the bladder is able to hold more and more until pre-surgical bladder capacity is usually recovered.

Most patients are back at work two to three weeks after surgery. The area of surgery will be sore for more than a month. Sexual sensation may return in as little as two weeks. Sexual intercourse can be allowed six weeks after surgery.

Requirements for Surgery

There are several reputable sex reassignment surgeons in the world today, and none of them will perform the procedure without sufficient proof that an individual has met the requirements. These requirements are not law, but are based on a set of Guidelines originally proposed by a Dr. Harry Benjamin.

As applied today, these guidelines require that a person seeking SRS must meet the following specifications:

  1. Live for at least one year full-time in the new gender role (called Real Life Training or RLT)

  2. Engage in hormone therapy for at least one year (which can be simultaneous with the full-time experience)

  3. Gain the recommendation of a psychologist or therapist after an appropriate series of sessions.

  4. Gain a recommendation of a psychiatrist that surgery is not contrary to the mental health of the patient.

When all these qualifications have been met, each surgeon also requires an HIV test to read negative (which they have performed at their facilities) and a personal interview so that they may verify your mental and physical condition personally.

These guidelines are not arbitrary, yet often seem so to those who are so motivated and sure of their feelings. But the surgery is not the big issue in the long run. The real issue is the kind of life you will have to lead afterward. If you were to have surgery before RLT only to discover that you really hated the new role, well that would be a life disaster.

On the other hand, it should be kept in mind that even if one were to have surgery, the option always remains to continue to live in the original role, since exposing one's genitals publicly can usually be avoided, therefore no one would have to know. In fact, I have met one such person who felt a deep personal need to change his physical sex, while continuing to live in the old role. For him, it works just fine.



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