Picture: Youtube screengrab Surgeons don’t remove the genitalia, but reconstruct it.

Gender affirmation surgery is not a new phenomenon and has been undertaken by numerous people around the world.

Here's a breakdown of what a sex change entails:

Hormone therapy

Once the assessment has been done the correct hormones can be started. At this stage, the patient (in a case of a male to female gender reassignment) is counselled about sperm donation, should they wish to have their own genetic children at some point in the future.

Depending on the effect of the hormones, the patient may choose to have a breast augmentation if their breast development is not sufficient.

Surgery of male changing to female

Surgeons don’t remove the genitalia, but reconstruct it.

“Transwomen will need to have hair removal of the beard and genital area, which will be involved in the surgery. During this phase, it is also important to expand the penile skin by stretching. Once the foreskin can reach above the umbilicus there is sufficient length for a vaginoplasty,” said Dr Kevin Adams.

During the surgery breast implants are put in as for any other breast augmentation.

* Removal of the testicles is sometimes done much earlier to facilitate breast growth ahead of sex reassignment. Any extra skin from the scrotum is trimmed to create the labia (lips of the vagina).

* For the penile surgery, an incision is made around the glans (tip) of the penis and the penis skin is removed from the body of the penis.

* The clitoris is formed by keeping part of the glans of the penis which has erogenous sensation.

* The skin is then turned inside out and inserted into a space made between the rectum and urethra (urinary tube). The urethra is then shortened to the appropriate length and stitched to its new position in the skin.

* The erectile tissue of the penis is discarded as it is not needed for the vagina.

Once the operation has been done, the patient stays in hospital for five days until the catheter can be removed. They then come to the outpatients to check that everything settles down adequately.

Surgery of female changing to male

For transgender men, the most important operation is usually removal of the breast tissue (Mastectomy). If a penis is needed there are two options.

“We can either use the skin from the forearm and turn that into a penis, but this leaves a big scar. The other alternative is to convert the clitoris into a penis, known as a metoidioplasty which looks much more like a penis but is too small to have sex with,” said Adams.