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The long history of traditional 'Hijra-style' surgeries extends from ancient times right up to today, continuing onward in countries such as India and Bangladesh. The detailed knowledge of the postoperative effects of the Hijra-type emasculations provided an important empirical background for the development of modern transsexual surgeries.

The Development of Modern Sex Reassignment Surgery SRS [To be added here later: Discussion of advances in plastic surgery after WW I, and a discussion of the pioneering of vaginoplasty in TS women around by F. Abraham, M. During the 's, transsexual women began to benefit enormously from the newly available female sex hormones, which enable the development of breast, soften the skin and over time produce female body contours.

Also during the 's, a few surgeons began exploratory surgeries to construct vaginas in MtF transsexuals by using skin grafts taken from the thighs or buttocks, drawing upon then recently developed techniques for constructing vaginas in intersexed girls.

Christine Jorgensen, a U. citizen, was among the first small group of transsexuals to undergo such a surgical "change of sex". She was "outed" in by U. print media shortly after her initial surgery, and her story became a national sensation. Through her story, many transsexuals for the first time learned of the existence of the new hormonal and surgical treatments.

However, access to this new, experimental surgery was limited to a tiny handful of patients in Europe. At the time of Christine's surgery in the '50's, doctors first removed the transsexual's male organs in one or more surgeries. The patient then waited through an extended period for healing.

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Then, in a surgery similar to those done to create vaginas for intersexed patients, surgeons constructed the patient's vagina by using skin grafts taken from her thighs or buttocks Christine's vaginoplasty surgery was in Transsexual pioneer Christine Jorgensenwho underwent an early for of SRS in Although patients were extremely pleased with the results especially when compared to their previous situationsthere were major problems with this early method.

The skin grafts were unreliable, and sometimes partially failed to "take".

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The use of extensive grafts also left large disfiguring scars at the donor sites. In addition, a lot of sensitive genital tissue was forever lost in the first step, affecting patients' feelings of sexual arousal and capacity for orgasm.

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During the late 50's and into the 60's, several hundred transsexuals in the United States came under the care of Harry Benjamin, M. D, a compassionate physician and endocrinologist who had offices in New York, N. and San Francisco, CA. Instead of viewing transsexuals as mentally ill deviants as did most psychiatrists of the day, he began to visualize transsexuals as truly suffering from a genuine mis-gendering condition of unknown origins.

In efforts to ease their suffering, he began prescribing estrogen to selected patients in response their profound pleas for medical feminization. He also maintained close watch on the results of transsexual surgeries being performed, and began to refer his most intensely transsexual patients to those surgeons who were obtaining the best results. Then, in the late 50's, a french plastic surgeon named Georges Burou, M. invented the modern form of penile inversion MtF sex reassignment surgery for MtF transsexuals.

Variations of Dr. Burou's technique have been used ever since.

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Burou's classic innovation was to use the male genitalia as source of skin and sensitive erotic tissue to create the new female genitalia, including the vagina. Thanks to Pascale from France for finding these photos of Dr. men's magazine.

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Burou performed these surgeries in his clinic in Casablanca, Morocco. Inseveral famous and very beautiful young "female impersonators" from the club Le Carrousel in Paris, France, including Coccinelle more infoBambi and April Ashleywere successfully transformed into women by Dr.

Many of the young Le Carrousel girls had received female hormones as a side-benefit of working at the club, and as a result had become incredibly beautiful, feminine and sexy.

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Several returned to perform at the club after their genital surgery. Their successful "sex changes" became widely known about, and they became sought after as love objects by many prominent, wealthy men. Some very wealthy men including Aristotle Onassis would occasionally "sponsor" the sex change surgery of a Le Carrousel girl, who would then became their mistress for a while.

Among the keys to the success of these surgeries were i the use of the skin of the penis and scrotum to form the new labia and a sexually functional vagina thus avoiding the source area disfigurement caused in earlier operations by the use of large, deep skin graftsand ii the careful dissection and placement of the terminated corpora cavernosa and the saving and relocation of some of the sensitive nerves and a small amount of erectile tissue. If done properly, the post-operative patient can have powerful feelings of sexual arousal erection of the corpora stumps remaining inside her body and can easily be orgasmic the prostate is left intact, and can spasm during orgasm just as before SRS - while the nerve tissues throughout the corpora, the clitoris and the vulva spasm, throb and release at the same time, just as in any other woman.

Benjamin's practice grew rapidly as more and more transsexuals learned that they could obtain compassionate treatment from him.

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He began referring ever larger numbers of patients to surgeons, especially to Dr. Burou in Casablanca. By the mid 60's, several other top surgeons abroad began performing SRS surgeries on transsexuals using Dr.

Burou's techniques, and Dr. Benjamin referred patients to these surgeons too. The most notable of these was Jose Jesus Barbosa, M. Barbosa was Lynn's SRS surgeon, and had performed over SRS's by However, such surgeries were still virtually unheard in the U. even in the mid-to-late 60's.

The vaginoplasty surgery is often followed several months later by labiaplasty surgery to refine the external female genitalia (labia). Following are photographs of the details of the female genitalia created by modern vaginoplasty and labiaplasty. These photos clarify the remarkably advanced state of modern MtF sex reassignment surgery   Angelica, a year-old, from California, has been working as an operator at PHONE-SEX for four years. She tells Cosmopolitan UK what it's really like to have men   12 Photos Explore the Naked Male Body In Space. Alex Yocu explores the contrast of the naked male body in a geometric space. Read more below. We

Under intense pressure from religious groups following the publicity of the Jorgensen case inmost U. hospitals installed policies that explicitly forbade such operations, and religious strictures were frequently drawn upon to support the witholding of any hormonal or surgical treatments of transsexuals. Then too, the U. medical community in the 60's thought of transsexuals as "severely psychotic" rather than biologically mis-gendered.

Instead of receiving help for gender-transition from medical professionals, many transsexuals were forced into mental institutions, where psychiatrists tried to "cure them of their mental illness" by electroshock therapy and aversion therapy. During the late 50's and into the early 60's, a number of intensely transsexual girls in the U. resorted to castrating themselves in order to become more feminine and to bypass hospital restrictions on removal of testicles from "intact males" during SRS.

Once no longer intact, the girl might hope to obtain complete SRS in some hospitals here - if she had the money to pay for it. See for example, the story of transsexual pioneer Aleshia Brevard.

At a young age and feminized on estrogen, Aleshia became a star performer at Finocchio's, the world famous "female impersonator" nightclub in San Francisco. After a self-castration to further feminize herself, Aleshia was able to undergo SRS in the U. in with the help of Dr. As did so many postop transsexual women in the 's including Lynn Aleshia left her past life behind and entered stealth mode.

She went on to become a showgirl, a "Playboy Bunny" a hostess at one of the famous "Playboy" clubsa widely recognized actress in movies, on stage and on TV, and got married three times!

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Aleshia only recently came out to tell her story in a wonderful book about her amazing life. Aleshia pre-op as the star "Lee Shaw" at Finocchio's in Aleshia Brevar shortly after her SRS in Aleshia as an actress in stealth mode, in the early 's Early Sex Reassignment Surgeries in the U. Finally, insurgeons at the John Hopkins Medical Center began performing a limited number of MtF SRS operations in effort to help some intensely transsexual patients under care of Hopkins' new gender identity clinic.

The Hopkin's staff believed that transsexuals were mentally ill, but they also believed that there was no psychological method for reversing the "incorrectly formed gender identity".

In an experimental program they began to explore the possibility of helping patients via surgery, as was being recommended by Dr. The Hopkins' Surgeons used a variant of Dr. Burou's method. In the fall ofnewspapers around the country propagated the following item from a column in the New York Daily News: "Making the rounds of Manhattan clubs these nights is a stunning girl who admits she was a male less than one year ago and that she underwent a sex change operation at, of all places, Johns Hopkins Hospital in Baltimore.

Surprisingly, the hospital confirms the case, saying surgery followed psychotherapy. Such operations, although rare in this country, are neither illegal nor unethical, according to a Johns Hopkins spokesman.

Officials at a number of major hospitals here agreed with Johns Hopkins on the legality and ethics of the operations but none could recall such an operation ever having been performed in New York.

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The Times article provided extensive information on the surgical and hormonal treatments then being done abroad, and on the new program at John's Hopkins University Medical Center, where several surgeries had recently been done.

The article also identified Dr. Benjamin as being the world's leading authority on transsexualism, and as author of a new textbook on the subject entitled The Transsexual Phenomenon see this link for an online version of the original text.

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Harry Benjamin, M. The great medical pioneer and compassionate physician [photo taken by Lynn Conway in ] Dr. Benjamin was the pioneer of the whole new area of medical knowledge of transsexualism. His paradigm-shifting medical text described his experiences with many patients over several decades. He was the first researcher to recognize how gender identity and sexual orientation are two independent dimensions of each person's human nature.

Benjamin recommend how "intense transsexuals" could and really should be treated, in order to enable them to live in the gender they sought. His book documented the results of the new, innovative surgical and hormonal treatments and put those treatments into a rational context as therapy for transsexualism. This book gave fresh hope to many transsexuals, and opened the door for the modern medical approaches that we now take for granted.

At the same time, the fact that Johns Hopkins was actually doing transsexual surgeries greatly enhanced the visibility of Dr. Benjamin's theories and the attention that his research results received from the medical community. Diagrams of the early John's Hopkins MtF SRS Procedure Following are illustrations that sketch the basic steps in the early Hopkins surgical method, which is a variation on Georges Burou's method.

These figures are taken from Chapter 22, by Howard W. Jones, Jr. in Transsexualism and Sex ReassignmentRichard Green, M. and John Money, Ph. By this time it was common to refer to this type of surgery as "sex reassignment surgery" SRS. The illustrations were reproduced from an original article by Howard W. Schirmer, and John E. Hoopes, " A Sex Conversion Operation for Males with Transsexualism", American Journal of Obstetrics and Gynecology : Figure 1. A sketch of the perineum showing the line of primary incision.

Figure 2.

The right spermatic cord is clamped and ligated. Figure 3. The primary incision is continued up the ventral side of the shaft of the penis. Figure 4.

The anterior flap is developed from the skin of the penis. Figure 5.

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The urethra is dissected from the shaft of the penis. Figure 6.

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The corpora cavernosa are separated to assure a minimal stump. Figure 7. The perineal dissection. Figure 8. The perineal dissection has been completed and the anterior flap perforated to position the urethral meatus. Figure 9. The skin flaps are sutured and placed in position in the vaginal cavity. Figure The preservation of the vaginal cavity is assured by use of a suitable vaginal form. Note 1: Figure 10 is quite misleading and does not correspond to the anatomy the should result from this procedure.

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In figure 10, the vaginal opening is way too far forward from the anal opening, and the vaginal entry is shown going first in horizontally and then turning upwards after passing a large web of skin in front of the anus. Compare this sketch with the later photos of the details of modern SRS results, especially the one showing the entry of a vaginal stent into a postop's vagina. This very poorly conceived sketch has likely been the source of many botched surgeries in the early days, as surgeons copying the Hopkins procedure may have thought that a thick web of skin was needed in order to prevent tears into the rectum.

Note 2: Over the years, the techniques for doing SRS have been steadily refined. It has also became common for post-op MtF's to have additional genital surgery called "labiaplasty" that construct further details of the external female genitalia.

For more information on modern SRS surgeries, see the links and the " Photo Details of Modern SRS Results " below.

SRS Becomes an Accepted Treatment for Transsexualism in the U. The early Johns Hopkins announcement and publications coincided with the publication of The Transsexual Phenomenonby Harry Benjamin, M. in late The result of many years of research observations and clinical practice by Dr.

Benjamin became the seminal text on transsexualism. The book finally identified transsexualism as a distinct, major medical affliction in which patients have an innate gender identity opposite to the genital sex of their bodies.

These theories and results obtained considerable attention within the U. medical community over the next several years - but most of it was highly skeptical. Then, following interactions with Dr. Benjamin and some of his patients, physicians at the Stanford Medical Center started a exploratory gender clinic inled by Norman Fisk, M.

and Donald Laub, M. SRS operations were undertaken on selected MtF patients, and the Stanford clinical and surgical results further validated the concept of SRS as treatment for those suffering from intense transsexualism. Acceptance of SRS as a serious and valid treatment for transsexualism began to slowly spread among thought leaders in the U.

medical community. Hospitals around the country began gradually lifting their bans on transsexual surgeries, and surgeons at various locations began performing these surgeries on small numbers of selected patients in the U. In Stanley Biber, M. The excellent successes of his surgeries became widely known, and patients streamed to him. For a detailed report from one of Dr. Biber's surgeries, see this Operative Report.

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For many years Dr. Biber performed over MtF SRS's per year, and by the year had performed over of them. A USA Today article told Dr. Biber's story, as follows: 4A -WEDNESDAY MAY 24, - USA TODAY. Sex-Change nickname makes Colo.

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