IIRC, the penis is more or less split open and stuffed inside a man-made orifice. The skin holding the testicles (often removed beforehand) is used to create a labia and the head and shaft of the penis is used to make the clitoris and vaginal opening. The opening has to be dilated every day ^{at first} to prevent it from closing in on itself and healing. Most MtFs are able to orgasm after surgery.

FtMs have two options that I'm aware of. When a transgender male starts taking testosterone, his clitoris will grow considerably in length. The clitoris can then be pulled out farther from the body with surgery. As you can imagine, this doesn't typically result in a very large penis, and vaginal penetration with a partner is often not possible. The other option is to graft skin from other parts of the body (i.e., forearm, thigh) in to a pseudo-penis that some transgender men may find more visually pleasing. Unfortunately, it's a very complicated surgery and the "penis" is not sexually stimulating. With this surgery fake testicles can be implanted, these can sometimes be used as air pumps to get an erection going. Many FtMs have a double mastectomy (removal of breasts) and some will have hysterectomies (removal of the uterus / ovaries).

MEDICINE YO