What Genital Surgery Can and Can't Do

by norrie mAy welby

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

Let's assume we've resolved any other underlying issues, such as child abuse, parental or societal disapproval of and taboos on genitals or sexuality, poor self esteem, drug dependency, the general dehumanising effects of "male role conditioning" internalised homophobia, social stereotypes, lack of acceptance of sexual/gender diversity, and lack of transgender pride.

Let's assume we've accepted ourselves as we are, as the transgender person we'll always be, but we just want to have our genitals configure like most other women's. It's important for a decision like this to be made with all the available information. We have the right to make our own decisions about our bodies and our lives. And to know that at any time we have the right to change our minds, as many times as we want to.

It's also important to note that most transgender people who live full-time as women do so without genital restructure. And to note that of those who do have genital restructure surgery, few are fully satisfied with the results.

It's important to go into this with much more in mind than the glossy sales spiel the surgeon may give us, or the glamourous impressions popular media give about "sex transformations". It's important for us to be aware of exactly what genital restructure surgery can and can't do.

Our Identity

Genital restructure will not change our sex. We may be allowed to alter a piece of paper (our birth certificate) as a result of it, but we do not legally become female for all purposes. Nor do we become biologically female. In terms of our reproductive sex, this procedure removes it.

Genital restructure will not change our identity much. Apart from the piece of paper mentioned above, we can change almost every other document to our chosen identity; which includes our gender identity, without having to have any medical alterations.

Some of us wanted genital restructure because we thought it would make us more of a woman. This procedure changes our bodies, and our experience of our bodies, but not who we are. If you ain't a woman before the op, you won't be one afterwards.

Our identity is pretty much who we think we are, how we interact with other people, and what they think of us as a result of this interaction. Most of the time social interaction will not involve what's between our legs. And even then, a lady with a little extra is still a lady.

Some of us may think, as I thought, that genital restructure would at least remove the sexual rejection we experience from some guys because, although they've found us attractive, they can't deal with our having a penis. Personally, I found that the sort of guys who reject us before genital restructure for having male parts are usually the same sort of guys who reject us after genital restructure for having a male past. Homophobia knows no fairness or sanity.

I now believe there are decent human beings who will accept us as we are. The less room we make in our lives for the sort of people who just want us on their own terms, the more room we make for those who will accept and love us as we are.

Physical Results

We may know all this, but still choose to have things rearranged within our body, as is generally our right.

However, all major surgery, such as this is, carries a risk to our health, and this risk may be greater because of such health-affecting conditions as age, heart disease, H.I.V., hepatitis, or other impairments. We should take these factors into account in making our choice, but the surgical team is also bound by medical ethics to consider these factors in reaching a decision to operate or not.

These factors aside, it's important that we are aware of the physical limitations of the medical technology. It's not a simple foolproof procedure. And regardless of advances in techniques, the result is still very dependent on the material being worked with. In other words, even with a perfect surgical team using the most advanced techniques, the quality of results will vary because of differences between individual bodies.

Different people have different pelvic structures, for example, and such factors affect the possible depth of the constructed vagina. Such factors are often unknowable until surgery is in process, so the patient should be aware of risks such as this beforehand.

Different people have different healing rates and their bodies will recover from surgery in different ways. The external appearance will also vary between individuals.

Some people have the idea that all pudenda look like an air-brushed picture from "Hustler". Actually, every woman's crotch is as unique as her face. The appearance of our surgically created pudenda may well be within the "normal" range, but it may well not look like what a standard porn shot would have us expect.

There is always the possibility that the result will look obviously surgically constructed, but most wouldn't draw attention from a quick glance in a change room. Of course, what people see depends on what they're looking for.

Surgeons may tell candidates for transgender genital surgery that the results will be indistinguishable from non-surgically created genitals. Well, this may be true if our sex partners don't examine us too closely, and it may often be the case that in the heat of the moment, they don't.

But of course a close examination will reveal differences between an organic and a surgical construction.

They may be getting high tech, fashioning "convincing" inner labia and so on, but there are always scars. These scars may be superficially invisible, or hidden under pubic hair, but a close examination will reveal them.

We have no cervix. We have "male" bone structure. There are a thousand things not changed by a change in our hormones or the arrangement of our genitals. Genital restructure surgery changes nothing but the structure of our genitals. It does not make us indistinguishable from biologically female people.

The effect on our experience of sex

Most people who have this surgery will experience a great change in the quality of sex. In my experience, post-restructure euphoria aside, this is not a change for better or worse. Post-restructure sex has a totally different quality. To compare it to before is like comparing trees and comic books. One is made out of the other, and both can be pleasant to look at, but how we experience each is totally different.

An intact boy can have sex with a watermelon and experience great sexual pleasure. Post-restructure, I find that I can't rely on physical stimulation. My mind has to be in the right place, my emotions have to be fully engaged.

Perhaps nerves are damaged in the process of surgery too. I have learned a lot from women who survive genital mutilation, such as happens with so-called "female circumcision" in some other cultures. I can still experience fully satisfying sexual pleasure in my dreams, for the nerve endings in my brain are undamaged. And I find that other parts of my body are more erogenous than I would have suspected. (Either some kind of body compensation has happened, or I just hadn't discovered the g-spot on my scalp before).

Post-restructure, some of us may experience total loss of sexuality. Some may be euphorically orgasmic. And probably most of us will move back and forth between these extremes.

Taking care of a neo-vagina

Many post-surgical complications can be avoided by carefully following the proper procedures. Don't have (anal or vaginal) penetrative sex until the surgeon gives you the all clear. Breaking this rule is one of the major reasons for pro-lapse (where the vagina more or less caves in), or rupture. It's also very important to carefully follow the instructions for dilation to keep the vagina open. This must be done more frequently at first, but must be kept up even years afterwards (for as long as we want to have a functional vagina, basically). Surgeons quite often give us a boring test tube to use, but we may find a vibrator does a better job, since it makes relaxing the muscles easier. And we'll probably do a better job of maintaining the routine if it's enjoyable!

Many of us are overwhelmed by excitement when we finally get to the surgeons' office to book our operation, and may miss the instructions given. Make sure you have the instructions in writing. It's a very good idea to take a friend with you who can remind us of them.

Acknowledging loss

I was initially ecstatic about the removal of my penis, and am now very happy with my body as it is, but there came a time when I had to process the loss of my penis.

Having genital restructure means not only losing a penis, but all that went with it, such as (in my case) the ability to achieve sexual satisfaction with purely physical stimulation. Acknowledging these losses is not a symptom of regret for a "wrong" decision. It is a healthy way of adapting to change.

When we lose something that's been a major part of our lives (and frankly, if we go to all that trouble to have something removed, then it meant a lot, good or bad, to us), there's a natural grieving process to go through. This may not strike us till years later, but if we allow the process and acknowledge the loss, we'll be a lot happier in the long run. Staying in denial of our feelings or stopping a normal emotional process may add complications of substance addiction, compulsive behaviour or depression, and sooner or later we still have to be honest with ourselves.

When I asked for help to process my loss, I was advised to make a shrine to my "former self", to help me fully acknowledge, accept and then let go of my former experience of myself, I made this "shrine" by pasting up by "boy" and "pre-op" photos on my wall. Allowing this process has allowed me greater self acceptance as I am now, my experience of my body as different from my post-puberty adolescence as that was different from my infancy.

What if we choose the wrong answer?

No one is born knowing all the right answers. And no one even dies having learned all the right answers, what's "right" one year may not be the next. We simply do the best we know how at the time, The more we allow ourselves to adapt to different circumstances, and not give ourselves a hard time for not knowing "then" what we know "now", the more happiness and fulfillment we will experience.

There are no ultimately "right" or "wrong" answers to the question of surgery. We simply do the best we know how at the time. What more would we ask of anyone else?

Even if we discover afterwards that we wish we hadn't chosen as we did, we don't need to be unhappy forever. We humans have the abilities to adapt to what may initially seem to be the worst situations. If we are open to the widest possible range of things and willing to let go of limitations, we find happiness and fulfillment no matter what.

No matter what decisions you may make or made about genital surgery or other alterations, may happiness and wholeness be yours.

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