Gender-affirming surgery (male-to-female)

Often used to refer to vaginoplasty, sex reassignment surgery can also more broadly refer to other gender-affirming procedures an individual may have, such as permanent reduction or removal of body or facial hair through laser hair removal or electrolysis, facial feminization surgery, tracheal shave, vulvoplasty, orchiectomy, voice surgery, or breast augmentation.^[1] Sex reassignment surgery is usually preceded by beginning feminizing hormone therapy. Some surgeries can reduce the need for hormone therapy.^[2][3][4]


Gender-affirming surgeries for transgender women have taken place since the 16th century, though they became more notable in the 20th century.^[5] Most patients report greater quality of life and sexual health outcomes postoperatively.^[6][7][8]

History[edit]

Lili Elbe was the first well-known recipient of male-to-female sex reassignment surgery, in Germany in 1930, the first being Dora Richter. She was the subject of four surgeries: one for orchiectomy, one to transplant an ovary, one for penectomy, and one for vaginoplasty and a uterus transplant. However, she died three months after her last operation.


Christine Jorgensen was likely the most famous recipient of sex reassignment surgery, having her surgery done in Denmark in late 1952 and being outed right afterwards. She was a strong advocate for the rights of transgender people.


French actress and singer Coccinelle travelled to Casablanca in 1958 to undergo a vaginoplasty by Georges Burou. She said later, "Dr Burou rectified the mistake nature had made and I became a real woman, on the inside as well as the outside. After the operation, the doctor just said, 'Bonjour, Mademoiselle', and I knew it had been a success."


Another famous person to undergo male-to-female sex reassignment surgery was Renée Richards. She transitioned and had surgery in the mid-1970s, and successfully advocated to have transgender people recognized in U.S. sports.


The first physician to perform sex reassignment surgery in the United States was Los Angeles-based urologist Elmer Belt, who quietly performed operations from the early 1950s until 1968. In 1966, Johns Hopkins University opened the first sex reassignment surgery clinic in America. The Hopkins Gender Identity Clinic was made up of two plastic surgeons, two psychiatrists, two psychologists, a gynecologist, a urologist, and a pediatrician.


In 1997, Sergeant Sylvia Durand became the first serving member of the Canadian Forces to transition from male to female, and became the first member of any military worldwide to transition openly while serving under the Flag. On Canada Day of 1998, the military changed her legal name to Sylvia and changed her sex designation on all of her personal file documents. In 1999, the military paid for her sex reassignment surgery. Durand continued to serve and was promoted to the rank of Warrant Officer. When she retired in 2012, after more than 31 years of service, she was the assistant to the Canadian Forces Chief Communications Operator.


In 2017, for the first time, the United States Defense Health Agency approved payment for sex reassignment surgery for an active-duty U.S. military service member. The patient, an infantry soldier who identifies as a woman, had already begun a course of treatment for gender reassignment. The procedure, which the treating doctor deemed medically necessary, was performed on November 14 at a private hospital, since U.S. military hospitals lack the requisite surgical expertise.^[38]