There are multiple ways to approach gender reassignment surgery, all procedures are viable, and each has their own set of complications, which depending on the patient's particular medical history can make one method preferable over the other. The most common is through a method known as penile inversion vaginoplasty (PIV), which basically means cutting open the penis and turning it inside out. This procedure removes the erectile tissue, testicles and much of the scrotum, but preserves the glans, penile skin and urethra to fashion the clitoris and vaginal cavity. As you might imagine, patients with small penises often find they have insufficient material for PIV and have to resort to alternate vaginoplasty techniques.

PIV requires four to five hours of intense surgery and multiple stages. In order to perform the operation the surgeon first must dissect the scrotum along the midline and dispose of the testes, careful to ligate the spermatic cords. Next the penile skin can be separated from the shaft by cutting two round incisions around the gland, making way for access to the foreskin, which will be carefully dissected away from the shaft. The unskinned shaft is then dissected to remove erectile tissue and the glans reduced to about half its original size. Finally the skin is folded inward and reconnected at its base with the two ends of the uncircumcised foreskin and urethra, creating a natural-looking vaginal canal and hood around the reduced glans, now clitoris. The scrotal skin can be stitched together and adjusted to form an aesthetically pleasing result.

If performed properly, these methods provide near 100% sexual satisfaction to most who go under the knife. Tom knew these steps nearly as well as a seasoned surgeon, he had fantasized about them for years after finding out a surgery existed that could fix him. For years he dreamt about waking up after surgery and taking off the dressings, peeling back the bandages to discover the pink interior of a perfect vagina. Now the fantasy was finally coming true. Already unconscious from the pain, he was wheeled into the emergency OR, and anesthesia was started. Dr. Stoll, assisted by Dr. Davis, prepared the instruments of his impending transformation, this was it! The day when he would lose his dick and gain something else so much better. Something that no matter what happened, made him the man he was meant to be.

They lifted Tom's legs into the stirrups and began attaching monitors to check on his vital signs. The operation itself would be fairly uneventful, Dr. Stoll had done many before. Seeing such a masculine young football player in this situation was still alien to Dr. Stoll, he felt like he should be more scared than this. However, fear never stopped him from doing his job, nor did it stop him from performing the transformation that Tom needed.

Part of his job as a plastic surgeon was to make whatever augmentations he did look natural on his patients’ bodies. He wanted everything to fit perfectly; there should be no scars, or any other visual reminders that anything had been changed, and the style should match the person he was operating on. Well how do you make a natural looking vagina on a massive hairy hunk of a football jock? In truth, it wasn't easy, but there were options. Dr. Stoll and Dr. Davis agreed on the best course of action. They made quick work of his male genitalia and then went to work, mapping out where to make the incisions for his new vulva. After some consideration on how to give Tom the most masculine vagina possible, they decided to preserve the entirety of Tom’s glans. He had a Prince Albert and the doctors made sure he could still wear it like before. Since he didn’t have the largest penis, his new clit didn’t even look out of the ordinary. They gave him especially big, but still natural looking labia majora. From the top of his groin, down to his mons veneris they left no trace of his cock, balls, or any sign they were once there. With an entire package that matched the rest of his body and a face it looked like it had always been a part of him. In truth it had, this would just be the first time everyone else could see it too.

Tom would be wheeled into the recovery room where a worried and confused Luke would be waiting. As soon as they placed him on the bed Luke rushed over to examine his friend and teammate. It had been nearly twelve hours since he’d come in here and Luke had only gotten about five minutes sleep himself. Just as he suspected, Tom was hooked up to every kind of monitor imaginable. Luke had done this to poor Tom, what kind of man deserves such a cruel fate?

"Is he alright?" asked Luke anxiously. "I hope he’s ok."

Dr. Stoll smiled gently. "He'll be fine, I promise," said Dr. Stoll reassuringly. "As far as we can tell everything went exactly according to plan. There are no complications, the operation was successful. Right now he's unconscious and resting comfortably."

Luke nodded, unsure of what to make of this. “It is a highly unusual situation, though, and after some discussion with my colleagues we are willing to excuse the self harm and allow him to leave as long as he can stay with a loved one or relative for the next three to six months. If you're not comfortable with that, we will have him transferred to the county mental hospital where he will receive adequate care."

“Are you fucking kidding me?! You want to stick him in a mental hospital because of what he’s gone through?” yelled Luke angrily. “What does he need help for? This is all a terrible accident, and really it’s my fault. How can you say that it’s self harm? ”

"Self harm is when someone does something to themselves with intent, whether that be harming their body. In this case, him pulling his catheter was a mistake and although it may seem harsh, it’s plenty a good reason for us to believe it was intentional."

"But, but why do you think it was intentional?" cried Luke.

"We don’t know exactly. But, based on the degree of the mutilation we’ve determined it is either a psychotic episode or sexual frustration. We suspect the latter but want to rule out the former. Regardless, it is very important to ensure he has access to medical attention and the support of others during this period. A condition of leaving is a pledge from you or another close relative that they can take him in and be responsible for him.”

“Why me though? We’re not related?”

“Really? The nurses told me the two of you were lovers?“

Luke hesitated, not knowing what to say. He knew Tom’s parents were dead and he would almost definitely end up staying here if he didn’t lie and say Tom was his boyfriend. Truth be told he had always kinda had a crush on Tom. Even though he knew it was impossible, and completely unrealistic he found himself imagining what it might be like to be with him. What would Tom feel like in his arms? How hard would his chest muscles be? How big would his… dick get? Not that the last one was a question anymore thanks to him. Damn, this was worse than he thought. But, there was nothing else he could do.

"Yes... well..." he lied.

"Good. Now, go home, get the place ready for your boyfriend, enjoy the fresh air and sunlight, and come pick him up in the morning.”

The doctor left the room, leaving Luke to contemplate the situation and sit by his sleeping friend.