History of Genital Gender Affirming Surgery from a Patient Perspective
This history was compiled by Rabbit Rabbit Studio in 2022 for TRANS-ARC with input, editing, and guidance from Geolani Dy, Gaines Blasdel, Meg Langford, Finn Gornick, and Polina Reyblat.
People have been modifying genitalia through surgery for thousands of years across the globe. Some of these surgical practices, examples of which we have highlighted here, might be understood as people seeking to align their bodies with a social or spiritual gender expression. In the 20th century in Germany, Western scientific tradition began to codify concepts of trans-ness, and surgeries began being offered in the context of treatment.
Beginning in the 1990s, options for genital gender affirming surgery have become far more widespread, so for the purposes of this section we will focus on examples before that period.
If you would like to suggest edits, additions, or corrections, please email us.
Beginning in the 1990s, options for genital gender affirming surgery have become far more widespread, so for the purposes of this section we will focus on examples before that period.
If you would like to suggest edits, additions, or corrections, please email us.
Some starting points
~ 500 BCE - present
Hijra
Hijra
Where? South Asia including India, Pakistan, and Bangladesh
Who? Hijra are a third gender community recorded in the Kamastura in 500 BCE. In the 1200s during the Mughal Empire Hijra held positions in prominent households. Practices that continue today include offering blessings at celebratory events. The British, during their colonization of India, listed Hijra as a “criminal caste”. Only recently have countries solidified citizenship status for Hijra residents.
Surgical details: Hijra communities practice Nirvan, usually a penectomy and orchiectomy, a ritual genital surgery.
Who? Hijra are a third gender community recorded in the Kamastura in 500 BCE. In the 1200s during the Mughal Empire Hijra held positions in prominent households. Practices that continue today include offering blessings at celebratory events. The British, during their colonization of India, listed Hijra as a “criminal caste”. Only recently have countries solidified citizenship status for Hijra residents.
Surgical details: Hijra communities practice Nirvan, usually a penectomy and orchiectomy, a ritual genital surgery.
~ 300s BCE
Galli
Galli
Where? The cult likely originated in Mesopotamia, held important religious sites in modern day Turkey, came to Greece in the 300s BCE, and an ornamental clamp used in their surgical rituals was found in the 1840s in the Thames.
Who? Galli are priests of the cult of Cybele (a mother goddess). The priests adopted women’s clothing, wore makeup and their hair long. They were sometimes referred to with she and her pronouns.
Surgical details: The priests performed ritual penectomies and orchiectomies.
Who? Galli are priests of the cult of Cybele (a mother goddess). The priests adopted women’s clothing, wore makeup and their hair long. They were sometimes referred to with she and her pronouns.
Surgical details: The priests performed ritual penectomies and orchiectomies.
200s
Marcus Aurelius Antoninus (Elagabalus )
~203-222
Marcus Aurelius Antoninus (Elagabalus )
~203-222
Where? Elagabalus was from a prominent Arab family in Emesa (modern day Homs, Syria)
Who? Elagabalus was head priest of the sun god Elagaba and teenage emperor of the Roman empire from 218-222. Elagabalus broke many Roman gender and marriage norms, wore make-up and dresses, and preferred being referred to as a “lady”.
Surgical details: Elagabalus reached out to many physicians in search of someone who could surgically create a vagina, offering large sums of money. Elagabalus also had a circumcision, likely for religious reasons.
Who? Elagabalus was head priest of the sun god Elagaba and teenage emperor of the Roman empire from 218-222. Elagabalus broke many Roman gender and marriage norms, wore make-up and dresses, and preferred being referred to as a “lady”.
Surgical details: Elagabalus reached out to many physicians in search of someone who could surgically create a vagina, offering large sums of money. Elagabalus also had a circumcision, likely for religious reasons.
early 1900s in the United States
1902
Jennie June /Ralph Werther/ Earl Lind
1874 - ?
Jennie June /Ralph Werther/ Earl Lind
1874 - ?
Where? June was born in Connecticut and lived extensively in New York
Who? Jennie June was perhaps the first trans autobiographer in the US. Growing up June attended a boys school, struggled with mental health, and later found a safe haven in Columbia “Paresis” Hall with the Cercle Hermaphroditos. June also used the names Ralph Werther and Earl Lind.
Surgical details: June put much effort into an orchiectomy June had done in 1902, out of a desire for an altered appearance and a decreased desire for sex.
Who? Jennie June was perhaps the first trans autobiographer in the US. Growing up June attended a boys school, struggled with mental health, and later found a safe haven in Columbia “Paresis” Hall with the Cercle Hermaphroditos. June also used the names Ralph Werther and Earl Lind.
Surgical details: June put much effort into an orchiectomy June had done in 1902, out of a desire for an altered appearance and a decreased desire for sex.
1917
Alan Hart
1890-1962
Alan Hart
1890-1962
Where? Alan Hart was born in Kansas and received his surgery in Oregon.
Who? Alan Hart was born in 1890. He was an author, researcher and physician who attended the University of Oregon Medical School (now Oregon Health & Science University School of Medicine). When they became available, Hart took synthetic hormones. Hart practiced medicine and moved regularly whenever he was outed. He married twice.
Surgical details: At his University, Hart received psychological and surgical care for his transition. At first attempting something that might be considered “conversion therapy” but deciding in the end to change his name and appearance, receive a hysterectomy, and live as a man. He cited eugenicist logic for this surgery - arguing that people such as himself should be sterilized.
Who? Alan Hart was born in 1890. He was an author, researcher and physician who attended the University of Oregon Medical School (now Oregon Health & Science University School of Medicine). When they became available, Hart took synthetic hormones. Hart practiced medicine and moved regularly whenever he was outed. He married twice.
Surgical details: At his University, Hart received psychological and surgical care for his transition. At first attempting something that might be considered “conversion therapy” but deciding in the end to change his name and appearance, receive a hysterectomy, and live as a man. He cited eugenicist logic for this surgery - arguing that people such as himself should be sterilized.
Pre-WWII at the Institute for Sexual Research in Germany
1906
Karl M. Baer
1885-1956
Karl M. Baer
1885-1956
Where? Germany
Who? Karl M. Baer, who may have been intersex, was an author, accountant, and activist in lesbian, feminist, and Jewish spaces. Baer emigrated to Palestine in the late 30s after being attacked by Nazis. Baer’s burial site is in Tel Aviv-Yafo.
Surgical details: Baer, in his early 20’s, received surgical care and support securing new documentation from Dr. Magnus Hirschfeld, a Jewish doctor and the head of the Institute for Sexual Research. Surgical specifics do not remain, likely due to the May 1933 burning of the Institute’s papers by the Sturmabteilung, a wing of the Nazi party.
Who? Karl M. Baer, who may have been intersex, was an author, accountant, and activist in lesbian, feminist, and Jewish spaces. Baer emigrated to Palestine in the late 30s after being attacked by Nazis. Baer’s burial site is in Tel Aviv-Yafo.
Surgical details: Baer, in his early 20’s, received surgical care and support securing new documentation from Dr. Magnus Hirschfeld, a Jewish doctor and the head of the Institute for Sexual Research. Surgical specifics do not remain, likely due to the May 1933 burning of the Institute’s papers by the Sturmabteilung, a wing of the Nazi party.
1922
Dora Richter
1891 - ?
Dora Richter
1891 - ?
Where? Germany
Who? Dora Richter, whose parents were farmers, wore dresses from a young age. She found her way to the Institute for Sexual research, where she worked for a decade, when a judge released her into the care of Magnus Hirschfeld (after her arrest for her attire). As a result of the 1933 Nazis attack on the Institute, Richter may have been killed or died. While no records of what happened to her have been found, one hopeful account suggests that Richter survived to open a restaurant in her hometown.
Surgical details: Richter received an orchiectomy in 1922 at the Institute for Sexual Research. She received a penectomy and vaginoplasty in the 30s.
Who? Dora Richter, whose parents were farmers, wore dresses from a young age. She found her way to the Institute for Sexual research, where she worked for a decade, when a judge released her into the care of Magnus Hirschfeld (after her arrest for her attire). As a result of the 1933 Nazis attack on the Institute, Richter may have been killed or died. While no records of what happened to her have been found, one hopeful account suggests that Richter survived to open a restaurant in her hometown.
Surgical details: Richter received an orchiectomy in 1922 at the Institute for Sexual Research. She received a penectomy and vaginoplasty in the 30s.
1931
Lili Ilse Elvenes (Lili Elbe)
1882 - 1931
Lili Ilse Elvenes (Lili Elbe)
1882 - 1931
Where? Elvenes was born in Denmark, lived in Paris, and received surgical care in Germany.
Who? Lili Ilse Elvenes (popularly known as Lili Elbe) was an impressionist painter. She and her wife Gerda Gottlieb, who she met at the Royal Danish Academy of Fine Arts in Copenhagen, traveled together, painting and illustrating.
Surgical details: Elvenes received her vaginoplasty from Kurt Warnekros, who later sterilized people for the Nazi Party, at the Women’s Clinic in Dresden in 1931. Charlotte Charlaque received her vaginoplasty that same year. Elvenes also received a uterine and ovarian transplant. She died shortly after her fifth surgery due to complications. Before her first surgery she was diagnosed with a hormonal condition that may have been Klinefelter syndrome.
Who? Lili Ilse Elvenes (popularly known as Lili Elbe) was an impressionist painter. She and her wife Gerda Gottlieb, who she met at the Royal Danish Academy of Fine Arts in Copenhagen, traveled together, painting and illustrating.
Surgical details: Elvenes received her vaginoplasty from Kurt Warnekros, who later sterilized people for the Nazi Party, at the Women’s Clinic in Dresden in 1931. Charlotte Charlaque received her vaginoplasty that same year. Elvenes also received a uterine and ovarian transplant. She died shortly after her fifth surgery due to complications. Before her first surgery she was diagnosed with a hormonal condition that may have been Klinefelter syndrome.
A halting expansion of surgical opportunity in the mid-late 20th century
1939-1949
Michael Dillon / Lobzang Jivaka 1915-1962
Michael Dillon / Lobzang Jivaka 1915-1962
Where? England
Who? Michael Dillon, a Navy doctor, author, and rower was born to an aristocratic Anglo-Irish family. He bound from a young age and sought out testosterone pills in the 30s. He worked in a garage and later as a doctor until an international scandal outed him and he fled to India and Tibet where he tried to become a buddhist monk, with mixed success. He died in a hospital in India in 1962.
Surgical details: Suffering from hypoglycemia, Dillon was hospitalized for fainting. After one episode, he awoke to a doctor who offered him a double mastectomy, help with changing his documented sex (achieved in 1944), and a connection to Dr. Harold Gillies. Gillies had performed phalloplasties on soldiers who had been injured. From 1946-1949 Dillon received surgical care from Gillies under the guise of an intersex condition. Common law made it illegal to perform phalloplasty otherwise, as this care in any other context was considered “mayhem”, a crime of impeding someone’s ability to be a soldier.
Who? Michael Dillon, a Navy doctor, author, and rower was born to an aristocratic Anglo-Irish family. He bound from a young age and sought out testosterone pills in the 30s. He worked in a garage and later as a doctor until an international scandal outed him and he fled to India and Tibet where he tried to become a buddhist monk, with mixed success. He died in a hospital in India in 1962.
Surgical details: Suffering from hypoglycemia, Dillon was hospitalized for fainting. After one episode, he awoke to a doctor who offered him a double mastectomy, help with changing his documented sex (achieved in 1944), and a connection to Dr. Harold Gillies. Gillies had performed phalloplasties on soldiers who had been injured. From 1946-1949 Dillon received surgical care from Gillies under the guise of an intersex condition. Common law made it illegal to perform phalloplasty otherwise, as this care in any other context was considered “mayhem”, a crime of impeding someone’s ability to be a soldier.
1950
Roberta Cowell
1918 - 2011
Roberta Cowell
1918 - 2011
Where? England
Who? Roberta Cowell, a race car driver, pilot, and engineer, was born to a wealthy, religious family in London. During WWII she crash landed and was captured, becoming a prisoner of war until 1945. In 1948, severely depressed and recently divorced, she sought out therapy. Cowell published the story of her life and transition in the 50s before withdrawing from public life.
Surgical details: Cowell began hormone therapy, read Michael Dillon’s book Self, and got in contact with him. In 1950 Dillon, who was in unreciprocated love with Cowell, performed a secret orchiectomy on her, risking his ability to practice medicine in the process. Cowell could then seek out an intersex diagnosis and received a legal vaginoplasty from Dr. Harold Gillies in 1951.
Who? Roberta Cowell, a race car driver, pilot, and engineer, was born to a wealthy, religious family in London. During WWII she crash landed and was captured, becoming a prisoner of war until 1945. In 1948, severely depressed and recently divorced, she sought out therapy. Cowell published the story of her life and transition in the 50s before withdrawing from public life.
Surgical details: Cowell began hormone therapy, read Michael Dillon’s book Self, and got in contact with him. In 1950 Dillon, who was in unreciprocated love with Cowell, performed a secret orchiectomy on her, risking his ability to practice medicine in the process. Cowell could then seek out an intersex diagnosis and received a legal vaginoplasty from Dr. Harold Gillies in 1951.
1958
Jacqueline Charlotte Dufresnoy (Cocinelle)
1931 - 2006
Jacqueline Charlotte Dufresnoy (Cocinelle)
1931 - 2006
Where? Dufresnoy lived in France and received surgical care in Casablanca, Morocco
Who? Jacqueline Charlotte Dufresnoy, an activist and performer best known by her stage name Cocinelle, was born in Paris. She debuted at trans cabaret Chez Madame Arthur in 1953, continuing to perform at other venues, on stage and in movies. Her widely publicized surgery elevated her fame and career. She married three times, in 1944 founding Association Devenir Femme with her third husband and drag performer Thierry Wilson. Dufresnoy died in 2006 following a stroke.
Surgical details: In 1958 Dufresnoy received a vaginoplasty from Dr. George Burou, a French surgeon trained in Algiers, at his Clinique du Parc in Morocco. Burou performed hundreds if not thousands of surgeries at his clinic, and published his procedure in 1974.
Who? Jacqueline Charlotte Dufresnoy, an activist and performer best known by her stage name Cocinelle, was born in Paris. She debuted at trans cabaret Chez Madame Arthur in 1953, continuing to perform at other venues, on stage and in movies. Her widely publicized surgery elevated her fame and career. She married three times, in 1944 founding Association Devenir Femme with her third husband and drag performer Thierry Wilson. Dufresnoy died in 2006 following a stroke.
Surgical details: In 1958 Dufresnoy received a vaginoplasty from Dr. George Burou, a French surgeon trained in Algiers, at his Clinique du Parc in Morocco. Burou performed hundreds if not thousands of surgeries at his clinic, and published his procedure in 1974.
1970
Innokenty (a pseudonym)
1939 - ?
Innokenty (a pseudonym)
1939 - ?
Where? Innokenty was living in Moscow, and received surgical care in Riga.
Who? Innokenty was Soviet engineer who, after being turned away from doctors in Moscow, received surgical care from Dr. Victor Kalnberz in Riga, modern day Latvia. Kalnberz was experienced with genital reconstructive surgery for injured and intersex patients. Innokenty advocated for his surgery by describing feeling like a boy from childhood and his attraction to women. His mother also spoke on his behalf, citing suicide attempts. After the surgeries, he kept in contact with Kalnberz, sharing some about his life in Riga and later Siberia.
Surgical Details: Innokenty received 9 surgeries between September 1970 and April 1972. He also underwent hormone therapy and acquired new documentation. Kalnberz’ surgeries were discovered by the Health Minister of the Soviet Union and he was reprimanded, threatened with jailtime, forbidden to do any further similar surgeries, and his work with Innokenty was classified for two decades.
Who? Innokenty was Soviet engineer who, after being turned away from doctors in Moscow, received surgical care from Dr. Victor Kalnberz in Riga, modern day Latvia. Kalnberz was experienced with genital reconstructive surgery for injured and intersex patients. Innokenty advocated for his surgery by describing feeling like a boy from childhood and his attraction to women. His mother also spoke on his behalf, citing suicide attempts. After the surgeries, he kept in contact with Kalnberz, sharing some about his life in Riga and later Siberia.
Surgical Details: Innokenty received 9 surgeries between September 1970 and April 1972. He also underwent hormone therapy and acquired new documentation. Kalnberz’ surgeries were discovered by the Health Minister of the Soviet Union and he was reprimanded, threatened with jailtime, forbidden to do any further similar surgeries, and his work with Innokenty was classified for two decades.
1971
Shonna
1947 - ?
Shonna
1947 - ?
Where? Singapore
Who? Shonna, a Singaporean citizen of Chinese descent, raised by her grandmother, dressed as a girl from a young age. She found community at Bugis Street, a trans scene while coping with severe depression. She was persistent in her efforts to convince Professor S. S. Ratnam at the University of Singapore’s Department of Obstetrics and Gynaecology, to perform a vaginoplasty.
Surgical details: Shonna, at 24, received surgery in July 1971, the first in Singapore, at Kendang Kerbau Hospital.
Who? Shonna, a Singaporean citizen of Chinese descent, raised by her grandmother, dressed as a girl from a young age. She found community at Bugis Street, a trans scene while coping with severe depression. She was persistent in her efforts to convince Professor S. S. Ratnam at the University of Singapore’s Department of Obstetrics and Gynaecology, to perform a vaginoplasty.
Surgical details: Shonna, at 24, received surgery in July 1971, the first in Singapore, at Kendang Kerbau Hospital.
1973
Vivian Rubianti
1944 - present
Vivian Rubianti
1944 - present
Where? Rubianti lived primarily in Jakarta, and received surgical care in Singapore
Who? Vivian Rubianti, who worked in the beauty industry as a salon owner and in cosmetic sales, was born in 1944 with Chinese citizenship which she later renounced for her Indonesian citizenship. After receiving surgery, she petitioned to have her gender legally recognized, which was successful. This was important to securing travel documents, as she knew of other post-op women who could not travel. Press reported Rubianti as a former wadam, or member of the waria community; it has also been suggested that Rubianti differentiates herself from the waria community.
Surgical details: In 1973, Rubianti traveled to Singapore to receive genital gender affirming surgery at Kandang Kerbau Hospital in Singapore.
Who? Vivian Rubianti, who worked in the beauty industry as a salon owner and in cosmetic sales, was born in 1944 with Chinese citizenship which she later renounced for her Indonesian citizenship. After receiving surgery, she petitioned to have her gender legally recognized, which was successful. This was important to securing travel documents, as she knew of other post-op women who could not travel. Press reported Rubianti as a former wadam, or member of the waria community; it has also been suggested that Rubianti differentiates herself from the waria community.
Surgical details: In 1973, Rubianti traveled to Singapore to receive genital gender affirming surgery at Kandang Kerbau Hospital in Singapore.
1985
Maryam Khatoon Molkara
1950-2012
Maryam Khatoon Molkara
1950-2012
Where? Molkara is from Iran and had her surgical care in both Iran and Thailand.
Who? Maryam Khatoon Molkara, active in Tehran’s LGBTQ scene, had been taking hormones, but wanted to pursue surgery. She began a relentless campaign, experiencing violent pushpack, advocating to religious leaders, including Ayatollah Ruhollah Khomeini, for a fatwa that might protect her in receiving surgery. Khomeini finally agreed to issue a fatwa determining that gender affirming surgery was not against Islamic law. In 2007 Molkara founded the Iranian Society to Support Individuals with Gender Identity Disorder.
Surgical details: Molkara was dissatisfied with the results of her 1985 surgery in Iran, and completed her surgeries in 1997 in Thailand. Thailand continues to be a center for genital gender affirming surgery due to relative low cost and high levels of care, availability, and expertise. Molkara’s surgery was paid for by the Iranian government, as were those of many other trans people after her.
Who? Maryam Khatoon Molkara, active in Tehran’s LGBTQ scene, had been taking hormones, but wanted to pursue surgery. She began a relentless campaign, experiencing violent pushpack, advocating to religious leaders, including Ayatollah Ruhollah Khomeini, for a fatwa that might protect her in receiving surgery. Khomeini finally agreed to issue a fatwa determining that gender affirming surgery was not against Islamic law. In 2007 Molkara founded the Iranian Society to Support Individuals with Gender Identity Disorder.
Surgical details: Molkara was dissatisfied with the results of her 1985 surgery in Iran, and completed her surgeries in 1997 in Thailand. Thailand continues to be a center for genital gender affirming surgery due to relative low cost and high levels of care, availability, and expertise. Molkara’s surgery was paid for by the Iranian government, as were those of many other trans people after her.