Vaginoplasty

This is the complete surgical procedure (including Orchiectomy) to remove the penis, testicles and construct a neo-vagina using the Perineum to line the vaginal canal. The perineum is the space between the anus and scrotum in the male.

For perspective the dilators mentioned are inserted from the bottom (anus) and out from the cavity opened between the patients' legs by the surgeon to work on the internal structures.

What you see is a closeup which doesn't really let you see the extremely intrusive nature of this procedure. The opening is from where the penis/scrotum were to near the top of the anus.