Sex reassignment surgery, known as SRS, for male-to-female transgender women involves reshaping the male genitals into a form with the appearance of and, as far as possible, the function of female genitalia. Prior to any surgeries, trans women usually undergo hormone replacement therapy and depending on the age at which HRT begins, facial hair removal.
Other surgeries undergone by trans women may include facial feminization surgery, breast augmentation, and various other procedures.
Male To Female SRS
Sex Reassignment Surgery can be categorized into 3 methods in accordance with the construction procedures of the new vagina and clitoris as follows:
Penile Inversion Vaginoplasty
Penile inversion vaginoplasty is a MTF surgical procedure in which the male genitalia is reconstructed into that of a female’s.
In the penile inversion vaginoplasty the testicles are removed (orchiectomy) and the scrotal skin is used to make labia majora (labiaplasty). The nerves to the the sensitive glans penis and the corresponding skin is preserved and used to make a clitoris. The skin of the penis and, in most cases, skin grafts from the scrotum are used to make a vaginal vault. The urethra is shortened and placed in the female position. Sensitive urethral mucosa is placed in between the labia minora.
Penile inversion vaginoplasty is typically a one stage procedure, however, occasionally secondary procedures are preferred to maximize the aesthetic appearance of the vulva.
The advantage is that this method is relatively simple, not complicated. For experienced and specialized surgeons, this technique of sex reassignment surgery lasts about 4 hours.
The disadvantage is that it is not suitable for men with penises shorter than 4 inches because this will result in a vagina that is not deep enough (in general, the vagina depth is equivalent to the length of the skin covering the penis minus one inch (this includes skin required to construct the Minor Labia).
Scrotal Skin Graft
This technique involves using the skin covering the penis to construct the vagina, as well as the skin covering the scrotal. This results in a sufficiently deep and functional vagina as required by the patient. If after the scrotal skin graft, the vagina depth is still not satisfactory to the patient and then the plastic surgeon will consider using skin graft from other areas such as the upper limbs, the stomach to further increase the depth of the vagina.
The advantage is that this technique helps patients with short penises, and enables them to possess the desired deep vagina.
The disadvantage is that the surgery is difficult and complex, and surgery time will be longer. For this technique, experienced and specialized plastic surgeons in sex reassignment surgery will take about 6 hours to complete.
The Sigmoid Colon Vaginoplasty
This technique is used in the case where patients have short penises, or to assist patients whose vaginas have become obstructed. This can also be used in patients who have never undergone sex reassignment surgery. The vagina which is part of the colon will have good lubricant.
1. This technique helps patients who have previously undergone sex reassignment surgery, whose
vaginas have become obstructed, and are unable to perform sexual intercourse.
2. It also helps patients with very short penises. In this regard, the surgeon will have already
decided that the surgery types SRS 1 and SRS 2 cannot be performed.
3. The vagina has a natural lubricant.
4. It is possible to determine the depth of the newly constructed vagina.
1. A scar of approximately 7 cm long will be visible above the left side of the pubis.
2. The surgery is difficult to complete, with preparation procedures required such as cutting off
parts of the colon, and the colon must be thoroughly cleansed (by an enema) 1 day prior to the
3. The patient may experience dyspepsia/indigestion symptoms 2-3 days after the surgery.
Popular Transgender Surgery
Some transgender choose to do the following procedures prior to a sex change while some never perform srs. The choice is up to the individual. Although most cases require the surgeries to be performed in stages, an affordable treatment plan can be customized to meet your transformation goals.
Facial feminization surgery
Occasionally these basic procedures are complemented further with feminizing cosmetic surgeries or procedures that modify bone or cartilage structures, typically in the jaw, brow, forehead, nose and cheek areas (facial feminization surgery or FFS).
Breast augmentation is the enlargement of the breasts. Some trans women choose to undergo this procedure if hormone therapy does not yield satisfactory results. Usually typical growth for trans women is one to two cup sizes below closely related females such as the mother or sisters. Estrogen is responsible for fat distribution to the breasts, hips and buttocks, while progesterone is responsible for developing the actual milk glands. Progesterone also rounds out the breast to an adult tanner stage 5 shape and matures and darkens the areola.
Voice feminization surgery
Some MTF individuals may elect to have voice surgery altering the range or pitch of the person’s vocal cords. However, this procedure carries the risk of impairing a trans woman’s voice forever, as happened to transsexual economist and author Deirdre McCloskey. Because estrogens by themselves are not able to alter a person’s voice range or pitch, some people proceed to seek treatment. Other options are available to people wishing to speak in a less masculine tone. Voice feminization lessons are available to train trans women to practice feminization of their speech.
Tracheal shave is also sometimes used to reduce the cartilage in the area of the throat to conform to more feminine dimensions, to greatly reduce the appearance of an Adam’s apple.
Because male hips and buttocks are generally smaller than those of a female, some MTF individuals will choose to undergo buttock augmentation. If however efficient hormone therapy is conducted before the patient is past puberty, the pelvis will broaden slightly and even if the patient is past their teen years a layer of subcutaneous fat will be distributed over the body rounding contours. Trans women usually end up with a waist to hip ratio of around 0.8 and if estrogen is administered at a young enough age “before the bone plates close” some trans women may achieve a waist to hip ratio of 0.7 or lower. The pubescent pelvis will broaden under estrogen therapy even if the skeleton is physically male.