This fascinating video reveals exactly how surgeons perform a male to female sex change.

The animation, uploaded by the European Society of Urology, shows how a penis and testicles are removed and a vagina is formed.

The new genitalia even has a clitoris capable of orgasm.

It begins by making clear men who seek to become women must meet certain criteria.

The patient must have already had two psychological approvals - where experts deem they should have the surgery - before an assessment by surgeons to ensure they are fit and well.

They must also have lived as a woman for at least 18 months, had hormone therapy for 12 months, and changed their first name legally by deed poll.

Surgeons make a cut in the scrotum, the flap of skin is pulled back, and both testicles are removed

The penile skin is cut circumferentially around the glans (head of the penis) and pushed to the penile base

By sharp dissection, the dorsal nerve bundle (a nerve that gives the penis feeling) the glans (the head of the penis) and the urethra (the pipe through which urine and semen flows) with the corpora cavernosa - the main fleshy bits of the penis cut away - right up to the the pubic bone as possible

The video shows how the patient is first put in a position in which they are lying on the operating table, their knees bent and their feet flat and turned outwards.

A catheter is placed in their urethra to drain urine and collect the fluid.

Surgeons make a cut in the scrotum, the flap of skin is pulled back, and both testicles are removed.

Next, the dorsal nerve bundle (a nerve that gives the penis feeling) the glans (the head of the penis) and the urethra (the pipe through which urine and semen flows) are separated from the corpus cavernosum, the main 'shaft' of the penis.

Now, the patient's legs are raised and the penis is further dissected - with the corpora cavernosa - the main fleshy bits of the penis cut away - right up to the the pubic bone as possible.

With this cut away only the urethra, the central pipe, is left.

This is cut shorter, and is later put into a different place in the vagina, comparable to where a naturally-born woman would have her urethra, the outlet from which urine will flow.

The excess skin of the penis and foreskin is used to make a long flaccid tube of skin, which is inverted to become vaginal canal, known as a ‘neo-meatus’.

The rest of the urethra is stitched into it to make the canal slightly wider in circumference, so the woman will be able to have sex.

Next, incisions are made in the genitals where women normally have a clitoris and a urethra.

A male to female sex change involves removing the penis testicles, creating the vagina - including a working clitoris - and making labia, the vaginal lips (file photo)

A clitoris is formed through cutting the glans, the head of the penis, to a smaller size. It is then attached to the genitals with fine stitches.

Surgeons then cut further down what was the scrotum, towards the anus, and cut away the anus’ main tendon, the centrum tendineum.

The space between the rectum and the base of the prostate is roughly developed to make space for the new vagina, and the area is stitched up.

For the outer female genitals, each half of the skin of the scrotum is tailored to become the labia minora and majora – the inner and outer ‘lips’ of the vagina’.

The incisions are strategically placed to look like natural skin closes in the vaginal lips.

Research has shown that after surgery many patients are able to enjoy a satisfying sex life.

In one study, carried out on 24 patients at the University of Tuebingen, Germany, it was reported that all patients were able to have an orgasm.

After surgery, research has shown that many patients are able to enjoy a satisfying sex life. In one German study it was reported that all patients were able to have an orgasm after the operation

Marc Pacifico, consultant plastic surgeon and member of the British Association of Aesthetic Plastic Surgeons (BAAPS), said the psychological aspects of the operation are 'hugely important'.

He told MailOnline: 'This is an irreversible operation so the decision to go through with it has to be as concrete from the patient and from their doctors.

'There are thorough psychiatric pathways that all the patients have to go down prior to even entering the surgical route.

'The operation is not straightforward. 'There are risks, as with any operation, but the genitals are not a clean area - so there is there is a risk of infection and delayed healing.

'You can get stenosis, tightening of the vagina. Many people undergoing the surgery will need dilaters to open it up.

'There's a risk of bleeding, or the skin - such as the new clitoris - dying.'

He added that sex change surgery is only one part of the gender reassignment process.

He said: 'The genitals are only one part of it; lots of people have surgery to feminise their nose and their voice box.'



