Although it was given as approximately 3: Create a space for the neovagina between the rectum and urethra or prostate the prostate is left intact. However, she died three months after her last operation. This means that they are unable to bear children or menstruate until a uterus transplant is performed, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status. Prevalence No official figures are available on the prevalence of transgender or gender-nonconforming individuals, and it is very difficult to arrive at a realistic estimate. Plastic surgery , since it involves skin, is never an exact procedure, and cosmetic refining to the outer vulva is sometimes required. Supporters of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, whereas skin is not. The most common minor complication were bleeding and infection. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability which is affected by age, nutrition, physical activity and smoking , any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. In the medium and long term there is a risk of loss of depth 23 , 24 , 30 , e15 , e23 , e25 or breadth 24 , 30 , e11 , e19 , e25 of the neovagina in particular. Garrels 12 found a gradual decrease in the difference between the two figures in Germany, with the ratio decreasing from 3. Gender reassignment surgery GRS is a complex surgical undertaking. If the patient has been circumcised removal of the foreskin , or if the surgeon's technique uses more skin in the formation of the labia minora , the pubic hair follicles are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Weitze and Osburg estimate prevalence in Germany at 1 per 42 8. Separate the neurovascular bundle from the erectile tissue.