Dear Alice,
If you were a woman, who wanted to be a man, could you get a penis? And once you got your penis, could you masturbate, ejaculate, and experience other male sexual behaviors?
And vice versa. If you were a man, who wanted to be a woman, could you then get your penis removed, and then masturbate?
Dear Reader,
You ask a complicated question, and in order to adequately answer, it's key to understand sex, gender, and gender identity. Sex and gender are often conflated — sex is what medical professionals assign at birth based on body parts, genes, and hormones. Gender, on the other hand, is a social construct based on what Western society has designated into the categories of men and women, though many people acknowledge that this binary doesn't recognize those who feel their gender identity doesn't align with those categories. Gender identity is the gender that people feel they are inside regardless of their sex assigned at birth. Many people feel that their sex assigned at birth matches their gender identity; cisgender is a term that indicates this experience. While society may view gender as binary, the idea of gender has evolved to be more expansive and is often described as a spectrum on which individuals may identify (inclusive of those who identify as trans, gender non-binary, genderqueer, or intersex among others), or they may identify outside of the gender binary entirely. Some people with these experiences may choose to make changes to their body to better reflect their identity; one way to do this is through surgery, often referred to as gender-affirming surgeries. Depending on the individual, they may seek to undergo top or bottom surgery, or both. Top surgery involves either removal or augmentation of breasts. Bottom surgery may involve the modification of genitalia or body parts associated with reproduction. Once an individual has recovered from these surgeries it’s possible for them to experience sexual behaviors, such as masturbation, but likely not possible to ejaculate. However, not all people will opt for these surgeries, and that doesn’t make their gender identity any less valid. Read on for more information about the types of surgery, the counseling and diagnostic requirements, and what can be expected following the various procedures.
People vary tremendously about how they feel their body aligns with their desire to express their gender, whether or not they choose to seek gender-affirming surgeries, and if so, which ones they elect to undergo. For those whose gender identity is different from the sex they were assigned at birth, they may want to make their body more like what society considers masculine or feminine. They also could be intersex, having been born with genitalia that may not fit neatly into the gender binary. Many intersex people were subject to surgery on their genitalia as infants, during which their genitalia was surgically altered to fit societal norms. Some intersex folks may seek out gender-affirming surgery in order to address problems or distress resulting from early surgeries or simply to feel more comfortable in their bodies. It's also the case that many people choose to affirm their gender through dress, name changes, pronoun changes, and other non-medical methods and some folks choose to take hormones (such as testosterone or estrogen) to express their gender in ways that feel more true to themselves.
For those opting for gender-affirming surgery, there are a number of steps they’re required to complete. In order to proceed, the person has to be diagnosed with gender dysphoria, which, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), refers to distress associated with feeling that they don't identify with the sex they were assigned at birth. As a side note, this is separate from gender nonconformity (which isn't a diagnosis), in which someone's gender expression, role, or identity doesn't align with the social expectations or norms of the sex they were assigned at birth; not every gender non-conforming person experiences gender dysphoria. Currently, surgeons in the United States generally follow the World Professional Association for Transgender Health (WPATH) Standards of Care. These standards and the requirements for those seeking surgery continue to shift over time and could vary based on the procedure being sought. That being said, some of the requirements may include referrals from a mental health professional, hormone therapy, and living according to their gender identity for at least a year.
Before getting into the logistics of the procedures and genital functioning as a result, it may be helpful to think about why you’re asking this question. If this is something you’re learning about because you’re considering these procedures for yourself, it can be helpful to think about all the ways in which these procedures would or wouldn’t change how you feel about your body and expressing your gender. If you’re asking out of curiosity, it may be helpful to remember that this is a private decision. Using tools such as Go Ask Alice! to educate yourself about these topics is a great way to learn more, especially if you're looking to support others in your life. However, when interacting with people in the real world, just as cisgender folks aren't often asked to describe the appearance and functioning of their genitals outside of a medical setting, asking trans, gender non-binary, or intersex folks about their genitals directly can be similarly invasive. Further, whether or not someone decides to have any of these procedures has no bearing on their gender identity. Many facets create a person's identity, and people live whole and fulfilling lives, regardless of what their genitals may look like.
All of that being said, some of the procedures that are used to construct a vagina and clitoris include:
Some people who go through these procedures may also be interested in other procedures that make their appearance more feminine, such as fuller breasts and changes in their voice. To enlarge breasts, the individuals may choose to take hormones to stimulate breast growth or undergo breast augmentation — both of which maintain some amount of nipple sensitivity. Some people are even able to breastfeed with careful administration of hormones and regular screenings. To increase the pitch of the voice, voice therapy, hormones, and surgical procedures are all methods that may help.
For those who are looking to construct the vulva, vagina, and clitoris into a penis, some of the options include:
Those who wish to construct a vulva and vagina into a penis and testes tend to have more associated complications, such as more trouble with scarring, blood clots, and loss of sensation or sexual pleasure. They’re also less likely to maintain sensation or ability to have penetrative sex with the penis. For both types of surgery, health care providers may recommend also removing the uterus, cervix, and ovaries. It’s also worth noting that neither procedure will result in a penis will be able to ejaculate. Some people may also opt to get a mastectomy or bind their breasts to flatten their shape. Binders require caution, as wearing them too tightly can cause chest pain, breathing difficulties, or rib fractures.
For those who desire surgery and aren't covered by health insurance, the out-of-pocket expense is, much like other surgeries, significant. For those who do have insurance, the cost will vary by person, depending on their plan and level of coverage. All of these surgeries require some time for healing before masturbation and sexual activity can safely (and enjoyably) be resumed. For more extensive information on transgender health, including information on gender presentation, hormones, identity documents, and much more check out the Center of Excellence for Transgender Health and the World Professional Association for Transgender Health.
If you’re feeling out of alignment with your gender identity and your body or considering gender-affirming surgery, it may be helpful to seek support from other lesbian, gay, bi, trans, queer (LGBTQ+) folks online, through student organizations (if you're a student), or at a local LGBTQ+ center. There are also health care centers that focus on providing care to those in LGBTQ+ communities, and for students, some campuses may have medical and mental health care that's specifically intended to meet the needs of trans students.
Take care,
Related Q&As:
Female masturbation is a very taboo topic in current cultures all aorund the world. This stems from the traditional role females play in sex: submissive, naive, and passive. If a woman doesn't have a partner, masturbation is seen as an act of lonliness. Talking about sex and masturbation is also taboo among women, but having these conversations about sex and orgasms can be mutually beneficial to both parties in intimate relationships. Statistically speaking, women masturbate much less than men do. (41.7% vs 63.3% of men)
This question speaks about taboo ideas over sex in a relationship, the importance of it, and potential alternatives to vaginal sex. If the person in this question is worried about sexual sensations after gender confirming surgery, it might be nice to read this question for reassurance and maybe some suggestions. using sex toys, oral or anal sex might are just some examples!
This question is very helpful since the person is intersex. It is directly correlated to this question since many people who have both male and female genitalia might undergo gender confirming surgery and are curious about the process and the results. The question also explores what it means to diclose such private information to the people close to and the discomfort that may come along with it. It takes a lot of courage to put yourself out there; if you decide disclosing is the choice you want to make, you may want to consider how you can cope with potentially negative reactions from friends.
This question looks to provide resources for information and support groups for students who identify as bigender. This question lists many good qualities to search for in schools and institutions like gender neutral, unisex, single-stall, or transgender accessible restrooms and locker rooms and policy statements about gender identity and sexual orientation-based harassment and bias violence. These might be useful resources for anyone a part of the LGBTQ+ community.
Definitions:
Source 1: Chest Binding and Care Seeking Among Transmasculine Adults: A Cross-Sectional Study
SUMMARY
There are about 0.6% of the United States population that identifies as transgender. Among transmasculine individuals, breasts can cause significant gender dysphoria, that is, “discomfort or distress [due to] a mismatch between biological sex and gender identity." To alleviate some of the discomfort, transmasculine individuals may practice chest binding, a method of compressing the chest tissue to achieve a flatter chest contour. Common methods for binding include wearing one or multiple sports bras to flatten the chest; wrapping the chest with elastic bandages; and wearing commercial binders, which are undergarments that are specially designed, ultra-tight, and often made of nylon and spandex. These could be potentially harmful to the body though- Peitzmeier et al. found that 97.2% of individuals who bound their chests experienced at least one negative physical symptom from binding, the most common of which were back pain (53.8%), overheating (53.5%), chest pain (48.8%), and shortness of breath (46.6%). Potentially severe symptoms such as scarring (7.7%) and rib fractures (2.8%) were also reported.
Although it comes with concerns, if surgery was not something they feel comfortable with but still struggle with body dismorphia, binding the chest might help alliviate some of that pressure.
Source 2: Sexual Orientation -- Research
SUMMARY
Sexual orientation develops at a young age. It begins as attracting emotions to a certain group of people that evolves into a sexual attraction. This attraction is very specific to the individual and may change over time. Importantly, people can not shape your sexual orientation. No one can "turn" you gay. Transgender is a non-medical term to describe people whose gender identity does not align with the one they were appointed to at birth. This has recently included people who do not identify with the gender binary, some may call themselves genderqueer or nonbinary.
Many straight and cisgendered people have false stereotypes around the LGBTQ+ community or just assume people are staright which may cause distress to someone who identifies LGBTQ+. Bullying does occur, but being a part of the LGBTQ+ community is something many people take great pride in and a big source of happiness. Talking to someone you can trust or someone who has been through similar things may help relieve discomfort, societal pressures, and anxiety around touchy subjects. Some resources include going to a Gay/Straight Alliance meeting at your school, visiting your local LGBTQ community center, checking with your nearest Planned Parenthood health center for other resources in your area, checking out LGBTQ organizations such as the Human Rights Campaign (HRC), The Trevor Project, and Parents and Friends of Lesbians and Gays (PFLAG) , and searching for online communities! The Trevor Project has a 24/7 helpline where people can talk about what is going on if they are having a hard time.
Definitions can also be a little confusing. Sex is what the doctors gives you at birth and it usually correlates with the hormones, genitalia, and genes you have. Gender is not provided by a medical professional and is what society tells you a man and a woman should look and act like. Gender identity is what you feel on the inside and how you demonstrate your gender using clothing, behavior and personal appearance. The term transsexual is a historic, medical term that refers to individuals who have undergone some form of medical and/or surgical treatment for gender reassignment (historically referred to as sex reassignment). Some transsexual individuals may identify as transgender, although others primarily identify as the male or female gender to which they have transitioned.
Source 3: Expert Q&A- American Psychiatric Association
SUMMARY
This source has a lot of good information about gender dysmorphia and speaks on the idea of surgery as very expensive and not necessary for some people. It is important to talk about the risks involved with sex confirming surgery with their physician before making the decision. Gender dysmorphia can happen at any age, and many adults who have diagnosed body dysmorphia often recall having these feelings as a child.
Not all individuals with gender dysphoria choose to undergo gender reassignment. For one, gender reassignment that includes surgery is very expensive and usually not covered by most insurance. Nor do all individuals with gender dysphoria desire a complete gender reassignment. Some are satisfied with taking hormones alone. Some are satisfied with no medical or surgical treatment but prefer to dress as the felt gender in public. Some people make use of trans-affirming social networks online and in local supportive communities to cope with gender dysphoria and claim a gender identity and forms of expression that do not require medical treatments. Some individuals choose to express their felt gender in private settings only because they are either uncomfortable or fearful of publicly expressing their felt gender. However some people who are denied or have no access to gender reassignment treatments can become anxious, depressed, socially withdrawn and suicidal.
Many transgender people who take feminizing or masculinizing hormones report improvement of emotions as their gender dysphoria lessens or resolves. A person transitioning from male to female (MTF, transwoman) takes feminizing hormones that may reduce libido. A person transitioning from female to male (FTM, transman) takes masculinizing hormones that may increase libido. Less commonly, masculinizing hormones may provoke hypomanic, manic, or psychotic symptoms in patients who have an underlying psychiatric disorder that include such symptoms. This adverse event appears to be associated with higher doses or greater than average blood levels of testosterone.
As with any medical treatment, the anticipated risks and benefits should be considered by a patient and prescribing doctor on an individual basis.
Source 4: Male to Female Surgery
SUMMARY
This website goes into depth on the process of transitioning from male to female.There are three surgeries that can help. They are:
orchiectomy,
This is where the surgeon removes the testicles by cutting the spermatic cord. It takes about 20 minutes and can be done under general or local anethesia. This could help alleviate the intense hormone regiments later on since the levels of testosterone after the testicles are removed drop significantly. This might lower the amount of estrogen needed which has many health benefits like reducing the risk of bloood clots.
vulvoplasty,
This is where the surgeon uses the skin and tissues of the penis to create the outside of the vagina. The surgeon creates a clitoris out of the glans (or head) of the penis, an inner and outer labia from skin on the penis and scrotum, creates the opening of the urethra so you can urinate, and creates the introitus (opening of the vagina). This excludes the internal part of the vaginal canal. In these cases, the person is incapable of having sexual intercourse or having a penis in their vagina, but they can still orgasm through clitoral stimulation. This procedure removes the need to stretch the vagina, there is a quick recovery time, and it avoids some health complications that are associated with vaginoplasty.
and vaginoplasty.
The procedure is the same as above however it includes the creation of the vaginal canal. During most vaginoplasties, your surgeon will use a skin graft to create a new vaginal canal (the inside wall of the vagina). To do this, your surgeon will take skin from your scrotum and thin it so it works well as a skin graft. After the graft is in, the surgeon will place a gauze in there for around five days so that theskin graft can grow like it should around the vaginal tissues. After two weeks of recovery, these women need to begin stretching the vagina 2-3 times a day for 6 weeks. Sexual penetration is possible after this surgery.
Source 5: Masculinizing Surgery- Mayo Clinic
SUMMARY
This source goes through all the possible surgical options for people who want to transition to male genitalia. Fertility can be heavily reduced or end. If that is a concern, people should think about freezing their eggs or embryos before getting a procedure. There can be top surgery which involves removing breast tissue (mastectomy). This may require the removal of the nipples and areolas, if so, there will be a loss of erotic sensation in the nipples. If they do not need to be removed, sensation is retained!
There is also bottom surgery which can be separated into three parts: Scrotoplasty, Metoidioplasty, and Phalloplasty. Scrotoplasty creates a scrotum using egg-shaped silicone testicular implants inserted into the labia. Metoidioplasty is expanding the length of the clitoris which will function as the penis. Your surgeon can also extend your urethra through your released clitoris using a graft typically taken from the lining of your mouth (urethral hookup). This will make standing urination possible.This procedure typically results in a penis with an unstimulated length of between 1 and 3 inches (3 and 8 centimeters). Typically, full sensation and orgasmic function are retained, but the vagina might not need to be closed, and penetration might not be possible. As a result, your surgeon might recommend removing your uterus, cervix and ovaries during metoidioplasty.
Phalloplasty is a little more risky and involves more surgeries. During phalloplasty, large amounts of donor skin will be taken from other areas of your body, such as your forearm, calf or lower abdomen. This can cause significant scarring. The skin will be rolled into the shape of a penis and anchored into position above your clitoris. Your new penis will not be able to become erect with sexual stimulation. A penile implant will be needed to allow penetrative sexual intercourse. There is a high risk of complications after this surgery.
OVERALL CONCLUSIONS:
The previous answer was correct about most of the information. I have laid it out in a more organized way. I think it is important to mention in the response how these surgeries might not be for everyone and that you can still feel a part of the trans/ LGBTQ+ community with or without the surgeries. There is a lot of stigma in the media nowadays against trans people who have not gotten the surgery, but that doesn't make them any less of the gender that they indentify with; gender is a social construct and may be able to fluctuate over time and takes no regard for genitalia or bodily organs. Surgery usually requires proof of diagnosed body dismorphia. (3)
Male to Female Surgeries
orchiectomy,
This is where the surgeon removes the testicles by cutting the spermatic cord. It takes about 20 minutes and can be done under general or local anethesia. This could help alleviate the intense hormone regiments later on since the levels of testosterone after the testicles are removed drop significantly. This might lower the amount of estrogen needed which has many health benefits like reducing the risk of blood clots.
vulvoplasty,
This is where the surgeon uses the skin and tissues of the penis to create the outside of the vagina. The surgeon creates a clitoris out of the glans (or head) of the penis, an inner and outer labia from skin on the penis and scrotum, creates the opening of the urethra so you can urinate, and creates the introitus (opening of the vagina). This excludes the internal part of the vaginal canal. In these cases, the person is incapable of having sexual intercourse or having a penis in their vagina, but they can still orgasm through clitoral stimulation. This procedure removes the need to stretch the vagina, there is a quick recovery time, and it avoids some health complications that are associated with vaginoplasty.
and vaginoplasty.
The procedure is the same as above however it includes the creation of the vaginal canal. During most vaginoplasties, your surgeon will use a skin graft to create a new vaginal canal (the inside wall of the vagina). To do this, your surgeon will take skin from your scrotum and thin it so it works well as a skin graft. After the graft is in, the surgeon will place a gauze in there for around five days so that theskin graft can grow like it should around the vaginal tissues. After two weeks of recovery, these women need to begin stretching the vagina 2-3 times a day for 6 weeks. Sexual penetration is possible after this surgery. (4)
Breast development and augmentation is also common and is available in a plastic surgeons office. It takes a special regiment of hormones and screenings to develop the ability to breastfeed, although it is possible! Erotic stimulation of the nipples is retained.
Female to Male Surgeries
Many transmen feel uncomfortable with their breasts due to body dysmorphia. Wearing a nylon or spandax chest binder is common to alleviate some of the anxieties around their breasts. If pressed too tightly, there may be chest pain, breathing difficulties, or even rib fractures (1).
Scrotoplasty creates a scrotum using egg-shaped silicone testicular implants inserted into the labia.
Metoidioplasty is expanding the clitoris which will function as the penis. The complete release of the clitoral ligaments places the clitoris in a more advanced position and gives the impression that it is longer. Your surgeon can also extend your urethra through your released clitoris using a graft typically taken from the lining of your mouth (urethral hookup). This will make standing urination possible.This procedure typically results in a penis with an unstimulated length of between 1 and 3 inches (3 and 8 centimeters). Typically, full sensation and orgasmic function of the clitoris are retained, but the vagina might not need to be closed, and penetration might not be possible. Therefore, masturbation can occur as clitoral stimulation, but erections and ejaculations are not possible. As a result, your surgeon might recommend removing your uterus, cervix and ovaries during metoidioplasty.
Phalloplasty is a little more risky and involves more surgeries. During phalloplasty, large amounts of donor skin will be taken from other areas of your body, such as your forearm, calf or lower abdomen. This can cause significant scarring. The skin will be rolled into the shape of a penis and anchored into position above your clitoris. Your new penis will not be able to become erect with sexual stimulation. A penile implant will be needed to allow penetrative sexual intercourse. This means they will not be able to masturbate or ejaculate. (5)
Resources (2)
Notes on research:
Male to Female surgeries seem to be more developed online. Female to Male surgeries seem to have more complications associated with them and a lot of erotic sensations are lost and penetrative sex with transmen seem to be more rare.