A Guide to Understanding Gender Reassignment Surgery

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Most people feel comfortable with the genitals and gender identity they were born with, and never have to think about the question of what gender they are. They take for granted the fact that they are a female person or a male person.

For some people, however, physical gender and emotional or psychological gender are not the same. For example, a person might have been born a female, with female genitalia, but feel as though she is living in a body that is the wrong gender. She might feel that for her, a body of the right gender would be the body of a man, with male genitalia. This disparity between physical gender and innate emotional and psychological gender can lead to an exceptionally profound feeling of dissonance that can be isolating and debilitating.

Sometimes, a person with this type of gender dissonance chooses to undergo gender reassignment surgery. In this surgery, the person’s genitalia are altered to match his or her innate emotional and psychological gender.

Requirements for Gender Reassignment Surgery

Before undergoing this surgery, a transgender person must meet several criteria. These guidelines are in place to ensure that the transgender person will be able to adjust to a new life after surgery.

The four criteria are:

  • The person must live for at least one year in his or her desired gender role. This is called real life training.
  • He or she must have hormone therapy for at least one year prior to surgery. This hormone therapy alters secondary sex characteristics such as body fat, breast growth, and hair growth.
  • The person must have therapy or psychological counseling, and obtain a recommendation from the therapist or counselor confirming that the person is psychologically ready for surgery.
  • He or she must gain a psychiatrist’s recommendation which confirms that surgery will not have a negative effect on mental health.

Once these four criteria are met, the transgender person must undergo an HIV test, which must be negative for the surgery to be performed. Finally, the surgeon will request a personal interview to discuss the procedure.

Male-to-Female Gender Reassignment

In male-to-female (MTF) reassignment surgery, the internal tissue of the penis is removed. The outer skin of the penis remains attached, but is inverted and inserted into the body cavity between the legs. This inverted penile tissue then becomes the vagina.

Similarly, the testicles are removed from the scrotum, and used to form the vulva and labia.

A clitoris is constructed using erectile tissue from the penis. This clitoris can be sexually stimulated and is capable of orgasm.

Female-to-Male Gender Reassignment

Female-to-male (FTM) reassignment surgery is considerably more difficult than MTF surgery. This is because it is more difficult to create a working penis from female genital tissue, because the clitoris is so much smaller than the penis.

This surgery is typically carried out as a series of procedures. The female reproductive organs are generally removed first, and penis construction surgery is carried out in a later procedure. This procedure involves modifying and extending the clitoris to create a penis. The new organ often becomes larger as a result of testosterone therapy as well as the surgery itself. Penile implants can also be used to achieve greater length.

The person undergoing FTM surgery can also opt for testicular implants, which are inserted into the reshaped labia.


Lynn Conway, 2006. Basic TG/TS/IS Information, Part I: Gender Basics & Transgenderism

Melanie Anne Phillips. The Transgender Support Site. Sex Reassignment Surgery, The Nuts and Bolts.

Paula’s Personal Diary: Gender Reassignment, 1998.

The Reed Centre for Genital Surgery and Sex Change Surgery: Description of Sexual Reassignment Surgery (Sex Change) Procedures Performed