Feminizing Bottom (Genital) Surgery

What is feminizing bottom surgery?

Feminizing "bottom" surgery is a gender-affirming surgical procedure that involves removal of the male genital organs, with or without creation of female genitals. The decision to pursue feminizing genital surgery is highly personal; the procedure may not be for all people who experience gender dysphoria.

If you are a transgender or gender-expansive person who desires feminizing genital surgery, there are options to consider based on your goals for surgery. It is important to discuss your specific goals with a surgeon trained in feminizing bottom surgery techniques.

Orchiectomy

Orchiectomy is surgical removal of the testicles. Because the testicles produce sperm and the hormone testosterone, an orchiectomy may eliminate the need to use testosterone blockers and may reduce the amount of estrogen needed to achieve and maintain the desired feminine appearance.

Orchiectomy can be performed as part of a vaginoplasty or vulvoplasty, as described below. However, some transgender and gender-expansive people prefer to have orchiectomy alone without further genital surgery. In this case, orchiectomy can be combined with scrotal skin reduction (scrotectomy) if desired.

Vaginoplasty

Vaginoplasty is the surgical creation of the external female genitals (vulva) and a vagina. Vaginoplasty is usually a one-stage procedure that involves four surgical steps:

• Removing the male genital organs (penis, scrotum, and testicles)
• Creating the vulva (labia minora, labia majora, clitoris, and clitoral hood)
• Shortening and repositioning the urethra to allow urination in a seated position
• Creating a vaginal canal

The most common way to create a vaginal canal is by using skin from the penis and scrotum. As such, the length of the vaginal canal is determined by the amount of skin available. Some people seeking feminizing genital surgery may need a different technique that involves robotic-assisted surgery.

Hair removal from the penis and scrotum usually is required before surgery to prevent complications in the vaginal canal. This process can take up to 6 months. After vaginoplasty, regular vaginal dilations are required to maintain vaginal length and size. Your surgeon may refer you to a pelvic floor physical therapist to help with your recovery.

Vulvoplasty

Like vaginoplasty, vulvoplasty involves surgically removing the male genitals, creating the external vulva, and shortening/repositioning the urethra to allow urination in a seated position. Unlike vaginoplasty, vulvoplasty does not include the creation of a vaginal canal. As such, hair removal and vaginal dilations are not required.

Preoperative and postsurgical considerations

It may be necessary to pause hormone therapy prior to surgery to decrease the risk of blood clots. Additionally, because the prostate gland is not removed during feminizing bottom surgery, age-appropriate screening for prostate cancer is needed after surgery. It is also possible to develop urinary symptoms associated with benign prostate enlargement as you get older.

Before requesting a consultation, we recommend that you review the eligibility criteria for feminizing bottom surgery.