Wednesday, October 21, 2015


Dear Patrick: I am a trans woman who wants SRS. It’s been a long wait while I saved money. There just never seemed to be enough. But I have a sugar daddy now who promises he will make me a real woman so we can get married. I am going to see a surgeon in a few months. Can you tell me what to ask for when I talk to the doctor?


For readers who are not trans, let me explain that SRS stands for “sex reassignment surgery.” Many different surgeries exist to help trans people to change their bodies so they can live in their genuine, deeply felt identities. Not all transgender people want medical intervention, but for those who do, access is very important. Of course, the surgeries are different, depending on what each person needs, wants, or can afford. For a trans woman, the term “SRS” usually refers to a surgery that uses tissue from the genitals she was born with to create a vagina. Sometimes tissue is salvaged from the “penile” head to construct a clitoris, and sometimes, depending on the amount of tissue the surgeon has to work with, additional plastic surgery can be done to create the inner labia.

When surgeons first became willing to help trans women, the only focus was on creating a vagina. Her ability to become a “real” woman was defined by her ability to have intercourse with a cis-gender (non-trans) man. This is problematic, as we can see today, because not all trans women are heterosexual. Even if they are straight or bisexual, they may not want to have intercourse. A woman’s sexuality should not be defined by her ability to give a man pleasure, or by the ability to be penetrated. But back in the 1950s, there was little discussion of the clitoris or any sort of orgasm, even for cis women. The end result of these surgeries made a lot of trans women happy, but they sometimes did not look or feel likea cis woman’s genitals, and the ability to have an orgasm was often compromised or absent. Of course, many men then (and now, to my complete astonishment) don’t look at their female partners’ genitals and so have little or no idea how much variety there is in the size, color, and shape of the clitoris and labia.

Today, you have a much higher chance of being able to function sexually after surgery and have a pussy that looks pretty. We are aware that a woman’s sexual response relies on many different parts of her anatomy. The primary organ of sexual response is the clitoris, a small bundle of nerves and sensitive tissue located at the top of the inner lips. Because some of the erectile tissue of the clitoris is under the surface and not visible, pressure against the vulva or the entire external genitals is also sometimes effective to create arousal or intensify orgasm. The inner lips can be sensitive enough to respond to touch. So can the vaginal opening. Many cis women have orgasms as a result of penetration or pressure inside the vagina, especially if it is combined with clitoral stimulation.

Anal sex has been part of human sexuality as far back as we can trace our own behavior. There are pictures of men and women having anal sex (and, of course, older men with younger men) on drinking vessels from ancient Greece. Many women like anal sex and find that they have a more reliable sexual response to stroking, pressure, or fullness in the bonus orifice. Luckily, you have the additional sex organ of the prostate, which makes anal sex more easy to eroticize and intensifies orgasms from this type of intercourse. So even if you find that after surgery, it takes a long time for your nerve endings to connect up and allow you to feel sexual excitement from touching your new vulva, you have other options. Don’t ignore your nipples and your whole body—for most women, sex doesn’t happen simply between the legs. It starts in the imagination and the heart and then spreads throughout the body, gradually becoming more and more focused on the genitals.

Some questions to ask your doctor would be where they got their medical training, why they work with transgender patients, how many people they have operated on, and how the process is done. Check to see if the doctor understands the interplay between the vagina and clitoris as part of a woman’s sexual response. Ask if you can get references from previous patients or talk to them about their results. Most surgeons keep scrapbooks so you can look at what they are able to do. Before you go see the doctor, look at pictures of women’s vulvas. Joni Blank’s book Femalia includes a diverse range of photos of beautiful cunts, and there’s always porn, although it may not be as respectful or acurate as the work of a feminist artist. If you see a photo that you like, bring it to the consultation with you. See what the doctor says about whether he or she can create something like that genital configuration for you.

Please learn as much as you can about female sexuality before getting SRS. Loni Garfield Barbach has written some great books and so has Betty Dodson. These books advocate women learning how to masturbate in order to teach their bodies how to have orgasms. After surgery, you may find that it is much easier for you to enjoy sex if you practice alone as well as with a partner. It’s a matter of training new nerve endings and tissue to be able to work together. Many transwomen feel so much relief and such a sense of “rightness” after SRS that they get a sexual boost from looking at and feeling their new bodies. A fantastic new book that is very inclusive of all women's bodies is Girl Sex 101 by Allison Moon!

I do want to also add, however, that I don’t think people’s gender should be defined by their genitals. I have many trans women as acquaintances, colleagues, or close friends who have not had SRS, and I don’t see any issue with validating them as women. (There are also many trans women in my life who haven’t shared the status of their genitals with me, and I don’t think it’s necessarily any of my business!) One of my oldest and dearest friends never had SRS because she and her female lovers were happy with the body that she had, after hormone treatment, and she wanted to be absolutely sure she could enjoy orgasms with her lovers. There is always a risk with surgery that you may lose that ability. You are a woman, and the only yardstick about how much medical treatment you should get is your own needs and beliefs.

If you know other T-girls who have had the surgery, talk to them about it! Get honest feedback about how they felt before and after. I know it is a major status symbol, and for many trans women, there is no question that you must get this done. Just remember that nobody is physically perfect, and we all struggle with some aspect of living in our mortal bodies. One things that trans people can offer their friends and lovers is compassion for the ways in which our bodies are both amazing and difficult. We know, first-hand, that who you are and how you look can be worlds apart. But it’s who you are that is most important.

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