But I have read other article on the subject that claimed there were unlocking action going on. I threw those up because I had been called on it, and spent less than 5 minutes searching.

Truth, it doesn't matter to me, unless the end of the world comes and I need a sex change. Given the other enormous differences between anatomies and skeletal structure I had no problem accepting it.

When reading these articles it is important to remember some of the writers writing them know less than we do. :D

While I mostly agree with Brooke's description of an SRS... there are a few minor details I would quibble about. For the most part, her article is well written though... so rather than writing another description from scratch, I think I will instead write a "critique" of her work -- please think of this as more intended as a supplement to her article, rather than any real attempt to contradict her...

Brooke's "lower temp is needed for sperm production" statement is quite accurate... and all I will add to it is that sperm production is part of a complex biochemical process that also produces hormones. [Both the testosterone most people think of when they think of "male sex organs"... and also smaller amounts of estrogen, which is actually needed for part of the sperm cell formation cycle.] Disrupting the sperm production (by putting the testes up inside the body, surgically or otherwise), would not just lower the sperm count -- it also would lower the hormone production. Not completely stop it... but lower it. In males were, through various birth defects, the testes do not descend as normal, there is usually an associated low androgen level as well. [I say "androgen" instead of "testosterone"... as testosterone is merely the "best known" of the androgens in a male. Just as there are actually three different estrogens in humans... estrone (E1), estradiol (E2), and estriol (E3). E2 is the most chemically active, by the way... which is why estradiol (or more formally 17-beta-estradiol, also called oestradiol in the UK) is the most common "human bioequivalent" HRT component, these days. The numbers in the E1, E2, and E3 thing just indicate how many hydroxyl groups are in the chemical structure... which also by the way is almost identical to testosterone -- there has just been a few carbon groups knocked off the end of the molecule, in making estrogen from testosterone. Which is why excess testosterone is easily converted by the human body to estrogen, but estrogen can not be converted back into testosterone -- it is a lot easier for enzymes to remove some carbon groups from a cholesterol molecule (via some intermediate steps) to make testosterone, than it is to try to reattach more carbon groups onto the structure... but I digress...]

The "double orchiectomy" "[often] performed months before the rest"... is a true enough statement, but the second part of it is more true in Thailand than elsewhere. It is sort of "old school", procedure wise... and these days more and more SRS surgeons are refusing to operate on (or at least charging more for) patients who have the double orchiectomy done ahead of time. As Brooke noted, doing the two procedures separately carries the risk of the scrotum shrinking -- and there is also another problem, which she did not mention. Namely, in all too many cases the surgeon doing the double orchiectomy (unless they are also a SRS surgeon) is not careful enough about preserving all of the scrotal tissue (they have no need to, for a "normal" double orchiectomy)... and they also often leave a scar in the scrotal tissue that has to be cut out before the vaginoplasty -- further reducing a limited supply of very valuable, "primary donor material".

These days, the most common recommendation for transitioners is to *not* have a double orchiectomy ahead of time, but rather to rely on androgen blocker medications...

Regarding Brooke's statement about "'[scraping]' off the layer of skin that had the hair follicles as part of the surgery"... that is only sort of true. Some do that... some use electrocautery on all the pores... some "punch out" little holes around each of the pores... there are various surgical ways to deal with the problem. She is more or less right, though...

Regarding the removal of the scrotal skin... that also varies a little, depending on the surgical technique used. Depending on how much "donor material" is available, it is quite common to detach only part of the scrotal skin, while retaining part of it "in place" to form the outer sides of the labia majora -- which is a natural "hair bearing" skin surface on females, so there is no need to detach it or remove the follicles from it, in that particular part of the reconstruction. She is right about what is done with the part that is detached, though...

Regarding the "corpus cavernosa (erectile tissues in the shaft)"... she is again only partially right. *Most* of the corpus cavernosa is currently removed -- the part that is inside the penis shaft. The corpus cavernosa, however, extends into the body a ways (necessary to provide the required "base" for the remainder to do its job correctly)... and often that internal part is left alone, as there would be too much risk of damaging other tissues in removing it. This is why, by the way, some post op TS still feel a slight sensation of "having an erection" when aroused. They actually *are* having an erection -- there is just nothing visible, as only the internal parts of the corpus cavernosa are still present...

[That is not necessarily a bad thing, by the way. Actually, the corpus cavernosa is discarded more for the psychological benefit of the patients, than the medical necessity. (Many TS really hate that "erection" sensation...). In female anatomy, the corpus cavernosa is also present -- the homologous tissue is just arranged a little differently, with very little "external" (in the clitoris), and the internal part enlarged (extending back parallel to the labia, inside the labia majora... where it functions to "spread" the labia, exposing the vaginal entrance, when a female is aroused. Shrug. Sometimes I wish they did not routinely discard that part... I ended up having a purely cosmetic SRS revision, years later, in which I asked a surgeon to transplant some of my body fat into my labia majora, to give them a much more realistic look and feel. Something that would have been completely unnecessary, had the original surgeon just repositioned the corpus cavernosa into its normal female location -- discarding merely the "excess" material, rather than "most of" the available tissue. Smile. Having said the above, though... I suppose I should add that the "normal" result is not really all that bad. I was having body fat harvested and transplanted anyway (as part of BFS, "Body Feminizing Surgery"), and just asked the BFS surgeon (who I knew also did gynaecological "cosmetic" surgery on natal females) if he could also improve on my labia appearance while he was operating on me anyway. Which he did, quite well, by the way].

When Brooke mentioned shortening and repositioning the urethra... she neglected to say what they do with the part of the urethra that is removed. To elaborate on that, it varies a bit from surgeon to surgeon, but the most common technique is to "salvage" that useful material. It is a completely hair-free, mucosal tissue (where the mucosal part means that it tends to produce a "natural lubricant" -- making it extremely valuable for normal post op sexual function)... so it generally gets reused somewhere, although again, exactly where varies with the surgeon. Most commonly (I think), it is used on the labia minora -- the "inner lips" -- either for the whole surface, or just part of it (depending on the surgeon...).

Brooke said she was not sure where they take extra skin from... and she is right that it varies with the surgeon. The most common areas, though, are by "stretching" the skin of the inner thigh upwards a bit and salvaging some from there (often done by Dr Suporn), or taking it from anywhere on the body that has an excess. [Sometimes the "belly"... sometimes the buttocks... rarely elsewhere... it depends more on the patient's unique body than the surgeon involved...].

Brooke noted that the glans (the "head" of the penis) is "trimmed down to a smaller size to become the clitoris"... but did not specify what happens to the "excess" glans material. With most surgeons, it is simply discarded... but some (Dr Suporn) keep it intact, flattening it out to become his "Chonburi Flap" -- a region of high sensitivity (since it is made from the intact nerve endings of most of the glans) around the clitoris, which he uses to increase the "sexual sensitivity" of his patients. [Or so I have read from his published medical papers... I have never actually met that surgeon, since he lives on the opposite end of the planet from me...]. While on the topic of sensation... it is perhaps interesting to note that most natal females have few nerve endings within their vagina's (an evolutionary trait, since otherwise the childbirth process would be even more painful than it already is). With "penile inversion" vaginoplasty, the clitoris ends up "less sensitive" -- since it is only made from part of the glans (whereas in natal females *all* of the nerve endings of what would have formed the entire glans "had things been different", end up in the clitoris). But to partially compensate for this reduced clitoral sensation, the surgeons preserve the nerve endings to much of the tissue they used to line the neo-vagina, resulting in TS having much more sensation "inside" than a natal female.

As a trivial aside... I just used the term "neo-vagina", regarding the same piece of anatomy I more frequently refer to as just a "vagina". "Neo" is Latin for "new"... and is used in a hyphenated word with "vagina" during and shortly after vaginoplastic surgery. After that, the organ in question is no longer "new"... and is just referred to as a "vagina". Shrug. Pedantic, I know. It is just that I sometimes read folks writing about *any* vagina in a TS, no matter how many years post op, as a "neo-vagina"... as if that term were a special label unique to a "manufactured" vagina... which is incorrect, and just bugs me. Smile. "Neo-vagina" can also be used for natal's, folks, if they have any sort of repairs done down there. It is not unique to trans-women... and it is only a temporary label...

Regarding the "I think they sometimes have a sort of 'framework' in there as well to help maintain the shape" comment, which Brooke made in reference to packing the neo-vagina with gauze... that is a new one to me, if true. I *have* heard of using non-lubricated, non-latex condoms *densely* pre-packed with gauze, to provide a bit more "firmness", when required... which perhaps is all that she is talking about... but no actual medical devices being inserted. I am not saying it definitely never happens, though. There are literally hundreds of SRS surgeons on the planet these days (although far fewer than that are famous for doing that procedure), and it is quite possible someone, somewhere, does something like that. It isn't a "mainstream" procedure, though. Shrug. Whatever...

As for Brooke's comments about the necessity of dilating... I mostly agree with her, but I would add a caveat. I had my ears pierced so long ago that I could not even guess when it was anymore... more decades ago than I want to admit, anyway... and my body has adjusted to that. Where once, I vaguely remember, I had to wear earrings fairly regularly -- or the holes would start to close up -- these days I can go for many months, without it being a problem -- possibly longer, although I have never tried. Similarly... when a patient is a "recent" post op, the surgeon gives a quite frequent dilation schedule to the patient -- several times a day, and if you miss, you will regret it when you next try. After a while (a few months, varying with the surgeon), that frequency goes down to once a day (often with several intermediate steps, first). After six months to a year, that can go down to once a week... and I have heard from many "long term" post ops that after many years, they have "gotten away with" skipping for many months at a time.

Actually, I know someone who hated dilation... never intended to use her vagina sexually... and went for close to forty years without dilating. [An intersexed person, surgically assigned female at birth, which was the source of the "unwanted SRS"... who eventually transitioned FtM -- although she was still living female at the time I am writing about, so I will refer to "her" with female pronouns]. Her vagina never completely went away, but it did atrophy down to something so small that I believe (if I am remembering correctly -- this was quite a few years back) she once described it as "too small to slip even a pencil into". So... I won't say I disagree with Brooke about the necessity of dilation... but I will say that it may not "heal shut" if you don't. It will, however, probably close up to "so small" that for most practical purposes, it becomes useless. "Use it or lose it", folks.

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Not something Brooke really touched on... but something I think I will mention due to Extravagance's earlier (unrelated) comments in this thread... is the "limiting factors" on post surgical vaginal size. Smile. And no, Extravagance, a "huge cock" does not mean "a huge, cavernous vagina". LOL. In another comment I am also posting to this thread today, you will find a diagram of the human pelvis -- the female pelvis, but that is not important. Look at the "android" image in that diagram for a moment... as that is essentially the most common pelvic shape in males. [Although the other, "female" shapes *do* occur in some males too -- genetics is a mixed up mess, with just about any rule having exceptions to it. Part of how living organisms evolve... the "copying" process for DNA has evolved to deliberately have "accidental cross-overs" in it, in higher life forms. This produces variations in the genetics of offspring... which sometimes is tragic, but occasionally results in a new trait that turns out to give the "birth defect" offspring an evolutionary advantage... but that is straying from the topic...].

Anyway, assuming for the moment an "android" pelvic shape in the SRS patient, that shape provides some limitations. As you can see in the lower part of that diagram, the shape of the "big hole" through the pelvis -- the size of which being a limiting factor in how big a baby's head can be and survive a "natural" birth -- is slightly different in android pelvic bones than in the gynecoid pelvis... and it is a bit smaller, assuming equal sized pelvic bones. [I added that last part as pelvic bones are *not* all the same size. Like every other bone in the body, it depends on how big the person is... which means that, since females are smaller "on average" than males, the pelvic bone of a typical female is actually smaller than the usual male's pelvis. It may *look* bigger... especially considering how much body fat many females carry over their hips... at least relative to the rest of her body... but in absolute terms, because her whole body is smaller, her hip bone averages smaller, too]. The size of that birth canal opening through the pelvis is one of the limiting factors.

Shrug. Most post op TS... and most natal women... usually do not attempt to stick really big things in their vagina's. But, as anyone who has spent times on one of the binary newsgroups knows (especially the groups that occasionally get flooded with a lot of pornographic spam), "usually" is not always. "Fisting", or inserting of other unusual objects, is a reality... and one which just might show up in someone's stories... so I will *very briefly* touch on that. Shrug. There is a medical term for a woman who has never given birth -- it is called being "nulliparous". That is relevant, as the cartilage joining the symphysis pubis (the middle of the pelvis "arch" above the genitals) is often "stretched" by childbirth... and all TS are obviously "nulliparous", without that stretched symphysis pubis. Add in the smaller dimensions of the opening in android pelvis... and there are limits to just what a TS vagina can do, "girth" wise.

Shrug, again. I have seen pictures of natal females (where it is not specified... but I strongly suspect they are *not* nulliparous), where some really big things get inserted in their vagina's. (Beer cans... bowling pins... I have seen some really strange pictures, on occasion]. Sorry, that is not possible for a "realistic" TS character... although I suppose anything is possible in fiction. Most TS dilate with stents that average about 38 mm (1.5 inches) in diameter... but that is just the size their surgeons typically provide -- it is not a medical limitation. I know some TS who have used "after market accessories" to stretch that up to comfortably dilating with up to 52 mm objects (a little over 2 inches)... but I do not think I have heard of anyone going larger than that. At that size, the vaginal walls are being pressed up against the sides of the opening through the pelvis... which becomes a limitation.

Natal females typically dilate to around 10 cm (4 inches) during the birth process, but their symphysis pubis has to "split" for them to do it. (Which is extremely painful... please do not think that I am saying natal females can handle something that big "normally". They can't... at least, not usually). Again, as mentioned in my other reply, some women *do* have android pelvic bones -- so I have no reason to believe that the presence of one is necessarily a limitation on giving birth, as in theory the same split should happen to a "male" pelvis after months of being exposed to the mix of hormones present during pregnancy. But so long as the character remains nulliparous, there would be a limit on how large a "huge cock" that Extravagance's hypothetical character could handle, girth wise.

As for depth... the limiting factor for most SRS surgeons is not the amount of "donor material", but rather the exact pelvic configuration of the individual patient, as well as something known as the "peritoneal reflection", or sometimes called the "Douglas Pouch". Basically, it is the bottom of the lining of the abdominal cavity... the "sack" that contains all the stomach, intestines, et cetera. That is a fairly strong barrier, and punching a whole through it is usually not surgically recommended. [Some SRS surgeons, notably Dr Suporn, routinely do so... but he was an abdominal surgeon before taking up cosmetic surgery -- and he uses a unique technique, which carries a small element of risk to it... although so far at least, he seems to be successful with it. I am not certain of it, but I think I have also heard of a couple other surgeons (possibly Dr Brassard, although my source was questionable) that have also started extending past that limit in recent years].

For the majority of SRS patients, that peritoneal reflection poses a depth limitation that averages somewhere around 13 to 15 cm (5.5 - 6 inches). Some patients get less than that... some a little more, depending on their unique anatomy. But that is the average post op SRS "depth"... and unlike "girth", which can be increased (to the maximum limited by the pelvis birth canal size) by simple dilation... the amount of depth you can get is usually no more than your surgeon gives you -- no matter how much you try. As it is usually possible (via a combination of "penile inversion", with the addition of skin from the scrotum and occasionally other sources, as needed) to get that much depth... the size of the original "donor material" does not really matter all that much. Unless, of course, you are going to surgically alter the peritoneal reflection... extending it inwards a bit locally, as a couple surgeons do. In that case, the maximum I have ever heard reported (long term) was 22.6 cm depth (8.5 inches). (Some get more than that initially... but that is the most I have heard of "long term", after things are fully healed...).

This is not particularly unique to "formerly male" TS anatomy, by the way. The same limitation exists in a natal female. The depth of the natal vagina also varies (and actually only averages about 8 cm -- a little over 3 inches), depending on the position of the peritoneal reflection in the particular, unique, female in question. The difference is, a natal woman has a cervix located at that depth... and on the other side of it is the uterus -- which is *inside* the abdominal lining. This creates a hollow within the body, immediately adjoining onto the natal vagina... which gives it somewhere to "stretch into", inwards, if necessary. A uterus which medical science can not, yet, duplicate... although if you are writing "magical" fiction, or science fiction from the "not too distant" future, it is not that unreasonable to imagine a procedure in which that extra organ *can* be duplicated. Medical science is not that far from routinely doing so now... and some experimental work has already been done along those lines...

This is a public forum... but this is also a fairly "adult only" topic of discussion... so I will add one other detail. Shrug. I am heterosexually married, to a male who is "longer" than I am "deep". It is not usually a problem. I won't go into details publicly... but essentially, there are sexual techniques by which you can "control" the depth to which someone penetrates -- without discomfort, and without really limiting the "fun" (although it does limit the use of some positions). Mostly, it just involves using your thigh muscles to exert a little pressure on the male's legs, "gripping" him... and limiting how deep you allow him to thrust. This is not unique to TS, by the way. I learned of it from post hysterectomy women... who have the exact same problem, since they no longer have a uterus for their cervix to "stretch into" when dealing with a "too large" male...

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Sigh. And once again, this is getting way too long. Part of many reasons why I have been trying (with mixed results) to stay out of discussions like this, in recent years. I just know way too much about all this stuff... and when I get started, I tend to ramble on for *hours*. Oh well, hubby went to some tradeshow today, so I had the time to kill, anyway. I just hope I have not bored too many people to death. Just curious... did anyone actually read *all* of the above? Or did you start skimming ahead, partway through? Grin. I know I would have, if I ran into something like this in a thread, written by someone else. But then... obviously, I already know all this trivia...