The first sex change man to woman surgery was performed in 1930 in Germany. The patient, Lili Elbe, underwent five different surgeries during her transformation including a vaginoplasty and a surgery meant to transplant ovaries that failed. Sadly, Elbe died soon after the completion of her fifth procedure. Since 1930 major strides have been made in the sex reassignment field. In the 1970's sex change surgery become a hot topic in the United States with successful completion of tennis player Renee Richards's surgery. To anatomically change the penis and give a man the appearance of a vagina requires several steps. First, the testicles are removed and skin from the penis area is used to structure the vagina. This surgery is called a vaginoplasty and when successful results in a sensate vagina. A part of the penis is used to shape the clitoris. The results of this type of surgery vary due to each patient's skin and other factors. In addition, vaginoplasty is only one part of the entire reassignment process which includes therapy, other surgeries, hormonal treatment, and more.