Once you are anesthetized in the operating room surgery begins by incising the skin of the penis around the glans. A flap is created based just above the anal opening and extending upward into the midline of the scrotum. This is preserved for later use to widen the penile skin tube. The penile skin is then dissected away from the deeper structures of the penis but remains attached at the base. The urethra is freed and shortened and the spongy tissue associated with erections is removed as well as the testicles.
Skin is lifted from the fascia on the lower abdomen.
After a vaginal opening is created it is lined with the outer layer of penile skin. A small opening is made in the skin near the base and the preserved portion of glans and the urethra are brought through this opening to form a neoclitoris and new urethral opening. Scrotal sac tissue is formed into inner and outer labia. The shortened urethra has been moved to a proper location and sutured into place. A clitoris is made from nerve bearing tissue and a portion of the penile glans taken in the first part of the procedure.