Converting male to female anatomy requires removal of the penis, reshaping genital tissue to appear more female, and constructing a vagina. A vagina can be successfully formed from a skin graft or an isolated loop of intestine. Following the surgery, female hormones (estrogen) will reshape the body's contours and grow satisfactory breasts.
Female to male surgery has achieved lesser success, due to the difficulty of building a functioning penis from the much smaller clitoral tissue available in the female genitals. Penis construction is not attempted less than a year after the preliminary surgery to remove the female organs. One study in Singapore found that a third of the patients would not undergo the surgery again. Nevertheless, they were all pleased with the change of sex. Besides the genital organs, the breasts need to be surgically altered for a more male appearance. This can be done quite successfully.
Orgasm, or at least "a reasonable degree of erogenous sensitivity," can be experienced by patients after surgery.
Social support, particularly from the family, is important for readjustment as a member of the opposite sex. If patients were socially or emotionally unstable before the operation, over 30, or had an unsuitable body build for the new sex, they tend to do poorly. In no case studied did the procedure diminish their ability to work.
All surgery runs the risk of infection, bleeding, and a need to return for repairs. This surgery is irreversible, so the patient must have no doubts about the results.
The most common complication of the male to female surgery is narrowing of the new vagina.
J. Ricker Polsdorfer MD, The Gale Group Inc., Gale, Detroit,