with functioning testicles it is better to leave them as they can continue to manufacture hormones and other substances while implant- ed in the abdomen. Next, the erectile tissue of the penis is re- moved, including that which lies within the body in the perineum (the space between the legs). The urinary duct (urethra) is short- ened and its orifice placed right at the body surface. The skin previously covering the penis is removed. Then a space is made in the perineum just in front of the rectal wall. This space is then lined with a skin graft taken from the thigh. The raw cut surface forms the outside of this new "vaginal" canal and it is formed around a mold which keeps the raw surfaces of the graft and of the receiving site in firm contact with each other so that the graft will "take" at all points. This mold must be worn continually for at least 6 weeks after the operation and intermittantly for 6 mon- ths in order to allow complete healing, prevent constriction and maintain position and shape. The inside of this canal being made of outside skin does not form mucous membrane as in a normal vag- ina. Consequently, there is no lubrication present. It is simply a blind-end pouch simulating the vaginal canal. Due to the anatomy of the male this pouch cannot be located exactly in the same place or take the same direction as the normal female vagina, but it does simulate it pretty well. Finally the scrotal sac is divided in half and out and sewn so as to simulate the vaginal lips--the lab- ia majora. It should be emphasized that since there are no fun- ctional nerve centers remaining to approximate the female clitoris, such sexual pleasure as may result in the future is entirely de- pendent on "psychic" sex---that is, the idea that "I am a woman.

The doctor whom I interviewed indicated that although the fin- al appearance is a reasonable facsimile of the normal female gen- itals and, except for close inspection, would pass for same, almost invariably the patient is not pleased. "She" had an idealized con- ception in mind or she wants the area to look like "Mary's" or "Helen's" etc. This in itself indicates that in most such cases the absence of male genitals and the appearance of "female" struct- ures is primarily a sort of "status" symbol.

I believe that FPs should realize that they have the best of two worlds and should consider the masculine advantages they would sacrifice as well as the feminine drawbacks economically and other- wise that they would acquire...unless, of course, they plan to make their living as prostitutes which they could only bring them- selves to do if they had been homosexual to start.

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