Part I: 1906 -1965
Part II: 1966 -1975
Part III: untruths and unknowns
Both vaginoplasty and phalloplasty were first developed for cis persons: either because the organ was missing at birth (agenesis) or had been lost/damaged in battle, in crime or in an accident. Secondly the operations were applied to intersex persons to normalize their bodies. This was sometimes, against the wishes of adults, but sometimes perceived as correction surgery and welcomed. However it was also done to children when they were unable to consent, and many later, as adults, inevitably resented what had been done. This article is primarily about the development of surgery for transsexuals, that is, those who wanted such surgery. The development of surgery on cis and intersex persons is recounted in that it came first.
Entries in blue pertain to operations on cis and intersex persons.
There are ancient traditions of transgender surgery by transgender communities, without the assistance of doctors, without anaesthetics, without antibiotics. However that is another story.
Part I: 1906 to 1965
1832 Jean Zuléma Amussat, ParisThe first known vaginal reconstruction. Amussat used ‘progressive perineal dilation’ (a condom packed with iodoform gauze). This was mainly a making of an opening in the cellular tissue between the bladder and the rectum, and attempting to maintain it by the wearing of some form of tampon or plug. No skin grafting.
1872 HeppnerHeppner improved on what Amussat did : a vaginal reconstruction using the labia, and split thickness skin grafting.
1890-1914 Franciszek Neugebauer, WarsawLike most doctors of his generation Neugebauer was very concerned to establish a person's 'true sex' for otherwise “disastrous consequences may follow an erroneous declaration of sex, and that not merely for the individuals immediately concerned, their families and connections, but for others besides". The 'true sex' of course was established by finding hidden testicles or ovaries, not by asking the person which sex they felt that they were. His major work is Hermaphroditismus beim Menschen, 1908, which summarizes 2000 cases of hermaphroditism across history and around the world. He had observed forty or so of the cases first hand.
1892 WF Sneguireff, ParisSneguireff was the first surgeon to use a segment of the rectum to build a vagina.
1898 R. Abbe, New YorkAbbe dissected a canal and lined it with split-thickness skin grafts. These non-genital skin grafts were placed over a rubber stent packed with gauze. After 10 days, the stent was removed, and the skin grafts were completely vascularized. The patient was asked to wear a vaginal conformer postoperatively, and intercourse was possible. However, Abbe’s report of the operation was lost for almost 40 years.
1900 Beck, New YorkBeck made a vagina using an internal downward incision next to the bladder to the space between the bladder and rectum which was met by an upward cut from the peritoneum in the usual way, which was then lined with skin flaps from the thigh and stuffed with gauze.
1902 A. Geijl, AmsterdamGeijl operated on a 20-year-old ‘male hermaphrodite’ who had been raised as a girl, and was about to marry as a woman. He removed the penis and created a vagina. Against the practice of the time he did not define sex as determined by gonads; rather he was led by the patient’s sense of self.
1903 J. Riddle Goffe, PolyClinic Hospital, New York‘A pseudohermaphrodite, in which the female characteristics predominated. Operation for removal of the penis and the utilization of the skin covering it for formation of a vaginal canal’. This seems to be the first report of a penile-inversion vaginoplasty – 50 years before those done by Fogh-Anderson and Burou.
1904 James F Baldwin, Grant Hospital, ColumbusBaldwin used the ileal segment from the small intestine to create a vagina, but he also suggested that the sigmoid colon might be used for the same purpose. However difficulties were reported with bowel transposition such as necrosis, infection, and abscess formation.
1906 Georg Merzbach, BerlinKarl Baer, raised as female but living as male, went to hospital after being hit by a tram. His body incongruity was discovered, his body was corrected as far as possible to male, and he was released with a medical certificate confirming his male identity, and an endorsement by Magnus Hirschfeld.
1912-1921 Richard Mühsam, BerlinMühsam did a series of partial operations, orchiectomy, mastectomy, hysterectomy, on trans men and trans women, one at the request of Magnus Hirschfeld. Most of them were tentative.
1918 J Allen Gilbert, Portland, OregonAt the request of his patient, Alan Hart, Gilbert did a hysterectomy. This is an early cooperation of a doctor to supply as much of a sex change operation as then technically feasible. Dr Gilbert published an account of his patient, referred to as 'H' in Journal of Nervous and Mental Disease in 1920.
1926 Il’ia Golianitski, MoscowProfessor Il’ia Golianitskii, well-known for his work on plastic surgery and tissue transplantations, successfully performed sex-change operations on both men and women. Entitled “Underdeveloped people” and illustrated by a photograph of one of the patients, the reportage described five successful sex-change operations: “four on women and one on a man." However this did not continue.
1922-1933 Institut für Sexualwissenschaft, BerlinUnder the aegis of Magnus Hirschfeld, a few surgical operations for trans women were performed, using a similar technique to that of Abbe and non-genital skin grafts, The operations were mainly done by Drs Erwin Gohrbandt, Felix Abraham and Ludwig L. Lenz. Dörchen Richter was operated on in 1922 and 1931; Charlotte Charlaque in 1929-1930; Toni Ebel 1930-1931. Abraham published a paper giving the details of the operations on Richter and Ebel in Zeitschrift für Sexualwissenschaft und Sexualpolitik in 1931 Translation.
1927 G.A. WagnerVery similar to what Baldwin had done, except that Wagner used the sigmoid colon to create a vagina.
1930-1931 Kurt Warnekros, Staatliche Frauenklinik, DresdenOn a visit to Paris, Warnekros, who had operated on Charlotte Charlaque for Magnus Hirschfeld, was consulted by a 48-year-old married man, who was concerned that he was being taken over by a female personality. Warnekros arranged for the patient to have an orchiectomy in Berlin and then admitted her to the Staatliche Frauenklinik. He performed genital surgery on her and transformed her into Lili Elvenes (Elbe). An extra operation, possibly an ovary or uterus transplant, was performed. Lili died a few months later.
1930-1945 Hugh Hampton Young, Johns Hopkins Hospital, BaltimoreYoung pioneered genital reconstruction surgery, but not on transsexuals.
1930s-1940s Lennox Broster, Charing Cross Hospital, LondonBroster did pioneer research and provided hormonal therapy and surgery for intersex patients, especially those with adreno-genital syndrome (now known as Congenital adrenal hyperplasia). His work on intersex patients was reported in The News of the World, in 1943, which attracted patients who would now be regarded as transsexual. However there is no evidence that he operated on any such person, and Clifford Allen, the psychiatrist who worked with him, specifically rejected surgical treatment for ‘transvestites’ (the term then in use). His most notable patient was 1935 Mark Weston, who did change gender but was not regarded as a ‘transvestite’.
1936 Nikolaj Bogoraz, MoscowBogoraz did the first phalloplasty. He reconstructed a total penis using a rib cartilage within a reconstructed tubed abdominal flap.
1938 JB Banister and Archibald H McIndoe, LondonAbbe’s 1898 report was re-discovered, and his surgery replicated by Bannister and McIndoe (cousin to Harold Gilles), albeit modified by using a rigid plastic mould. This approach came to referred to as the McIndoe technique. McIndoe reported 63 repairs.
From this point on, external hormones are available, but still not used for all transsexual transitions.
1939-1965 Ludwig Levy-Lenz, CairoPreviously a surgeon at the Institut für Sexualwissenschaft, Levy-Lenz settled in Cairo after being driven out of Germany by the Nazis. He did transgender and other surgery and was very successful, and had a villa near the Giza pyramids. After WWII he also practiced in Baden-Baden.
1941-1942 Charles Wolf, La Chaux-de-Fonds, SwitzerlandArlette-Irène Leber had a series of operations including vaginoplasty following Sneguireff's method using part of the intestine. In 1944 a Cantonal Court approved her change of civic status to female.
194? Josef Mengele, Auschwitz“I met another boy whom the scientists of Auschwitz, after several operations, had successfully turned into a woman. He was then thirteen years old. After the war, a complicated operation was performed on him in a West German clinic. The doctors restored the man's physical masculinity, but they couldn't give him back his emotional equilibrium.”
1942-1957 Harold Gillies, Ralph Millard & Patrick Clarkson, Harley Street, London