Lili Elbe and the First Attempts at Vaginoplasty

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 26 September 2026· How this site is researched

In 1930 a Danish painter travelled from Paris to Germany and began a series of operations that nobody had done before, in an order nobody had worked out, with no way of knowing what any of them would do to her. Her name was Lili Elbe. Roughly a year later she was dead, at 48 or thereabouts, after the last of them.

Hers is the story usually given as the beginning of vaginoplasty, and it is worth saying at the outset that the record is thin. Much of what is repeated about Elbe comes from one heavily edited book, and the clinical notes that would settle the details are gone. So this is the story as far as it can honestly be told, with the holes marked as holes.

Lili Elbe

She was born in Denmark in 1882 and trained as a painter, exhibiting and selling work under the name Einar Wegener. She married another artist, Gerda Gottlieb, who became well known for elegant, faintly scandalous paintings of a dark-haired woman. The model was Lili. The arrangement is often told as an accident, with Gerda short of a sitter one afternoon, though that tidy origin comes to us through the same unreliable book as everything else.

What is clear is that across the 1920s, living largely in Paris, Lili appeared in public more and more, and that by the end of the decade the strain of the double life had become unbearable. Doctors she consulted offered nothing useful. There was no endocrinology worth the name for this, no diagnosis on any list, no other patient she could write to. What she had was an idea that surgery might do it, and the money and nerve to go looking for a surgeon who agreed.

Germany, and the doctors she found

She went first to Berlin, to Magnus Hirschfeld's Institut für Sexualwissenschaft. The institute was the only place in the world then doing serious work on trans patients, combining research, hormones, legal advocacy and, cautiously, surgery. Her first operation, the removal of the testicles, is generally placed in Berlin in 1930.

The operations after that were carried out in Dresden, at the municipal women's clinic, under a gynaecologist named Kurt Warnekros. Accounts of him vary and very little survives in his own words. What can be said is that he took her on when almost nobody would have, and that his plan went well beyond what any surgeon could reasonably expect to achieve in 1930.

The operations, 1930 and 1931

The number is usually given as four, sometimes five. The sequence, as far as it can be reconstructed, ran roughly like this: the testicles removed, then the penis removed, then an attempt to transplant ovarian tissue, and finally an operation intended to give her a uterus so that she might carry a child.

That last ambition is the part modern readers stumble over, and it deserves to be said plainly. Nothing about it was achievable. Tissue typing did not exist, immunosuppression did not exist, and the concept of rejection was barely understood. A transplant between unrelated people in 1931 was going to fail, and there was no drug on earth that could have stopped it. Whether the surgeon genuinely believed otherwise, or whether he was carried along by his patient's hope, the record does not tell us.

Elbe died in September 1931, a few months after the final operation. Cause of death is usually given as heart failure following complications from the transplant, and rejection and infection both appear in later accounts. I would not put more weight on any one version than the evidence can carry.

Two other things happened in that year that were, in their way, as remarkable as the surgery. Her Danish passport and papers were altered, reportedly with the king's involvement, and her marriage to Gerda was annulled because the state no longer recognised her as a man. Legal recognition, in other words, arrived first, and by a route that had nothing to do with any of the systems we argue about now.

Why the record is so poor

Almost everything popularly known about Elbe comes from Man into Woman, published in 1933 and assembled from her letters and diaries by an editor writing as Niels Hoyer. The names in it are changed, including the surgeon's. Material was cut, shaped and in places written over, and it was compiled after her death by somebody with a narrative in mind. It is evidence, but it is not testimony.

The clinical records are another matter. Dresden was bombed flat in 1945. Hirschfeld's institute was destroyed by the Nazis in May 1933, its library burned in the street, and the patient files with it. The two places that held the documentation were both erased inside fifteen years.

There is a second name that belongs here, and an honest amount of uncertainty attached to it. Dora Richter worked at the Berlin institute and is generally described as having had genital surgery there in the early 1930s, possibly ahead of Elbe's. For decades she was assumed to have been killed when the institute was attacked. More recent archival work has suggested she may in fact have survived some years longer. I mention her because the popular version of this history has one protagonist, and the real version almost certainly had several whose names went into the fire.

What changed after that

The next chapter most people know is Christine Jorgensen, an American who travelled to Denmark and was treated there by an endocrinologist, Christian Hamburger, with hormones and then surgery around 1951 and 1952. Her vaginoplasty came later, in the United States. What made her story different was not the medicine. It was that an American newspaper got hold of it in December 1952 and the coverage went round the world, which meant that for the first time enormous numbers of people learned the thing was possible at all. Letters reportedly reached her by the thousand.

The technique that actually works is usually credited to Georges Burou, a French surgeon practising in Casablanca from the 1950s. His approach was penile inversion: rather than removing tissue and hoping to build something in its place, he used the penile and scrotal skin, with its own blood supply, turned inside out to line a canal made between the bladder and the rectum. It is essentially still what most surgeons do. Burou published little and presented the method to an international audience only in the 1970s, by which point he had a great deal of experience behind him.

Everything since has been refinement. Better attention to the urethra and the nerve supply to the clitoris, which is what makes sensation reliable rather than lucky. Depth taken from a graft or, more recently, from the peritoneal lining when there is not enough skin. Vulvoplasty as a considered option for people who do not want a canal or the dilation that keeps one. Hair removal done properly beforehand, which sounds trivial and is not.

Why it matters

The distance is enormous and it is worth measuring honestly. The people I sit with in Bangkok consultations are asking about depth, sensation, dilation schedules and when they can fly home. They are asking because the operation has a known shape, a known complication rate and a known recovery. None of that existed for Lili Elbe. She agreed to procedures nobody could explain to her, from a surgeon who could not have known what he was doing, because the alternative was going on as she was.

She was not a case study and she did not volunteer to become one. She was a painter who wanted to live, and contemporary reporting treated her as a curiosity and her name as a headline. What she got was the best available answer in 1930, which was not good enough and killed her. What is on offer now is not a different degree of the same thing. It is a different thing, built over ninety years by people who mostly went unrecorded.

This is history, not medical advice. For the procedure as it stands now, its stages, risks and costs, see vaginoplasty and the bottom surgery hub.