Feminizing: Vaginoplasty
Vaginoplasty is the creation of a vagina, clitoris, and labia for trans feminine individuals. The most common method is the penile inversion vaginoplasty. In this procedure, the skin of the penis is inverted to line the new vaginal canal. The glans of the penis, which is rich in nerve endings, is used to create a sensate clitoris. The scrotal skin is used to create the labia majora. The procedure is highly complex, aiming to create genitals that are both aesthetically and functionally female, including the potential for sexual sensation and orgasm.
Vaginoplasty Variants and Dilation
Alternative techniques exist for vaginoplasty, such as using a section of the colon (colovaginoplasty) or peritoneum to create the vaginal canal, which can be options for patients with insufficient penile tissue or who desire self-lubrication. Regardless of the technique, a crucial part of recovery is a lifelong regimen of vaginal dilation. Dilation involves using a set of medical dilators for a prescribed amount of time each day to prevent the vaginal canal from closing or shrinking. This is non-negotiable for maintaining the surgical result.
Feminizing: Orchiectomy
An orchiectomy is the surgical removal of the testes. It can be performed as a standalone procedure or as part of a full vaginoplasty. As a standalone surgery, it is a much simpler, lower-risk procedure. Its primary benefit is that it removes the body's main source of testosterone production, eliminating the need for anti-androgen medications. For many, it provides significant dysphoria relief and is a major step in their transition.
Masculinizing: Metoidioplasty
Metoidioplasty is a masculinizing bottom surgery that uses the existing genital tissue, which has been enlarged by testosterone, to create a small phallus (a 'meta-penis'). The surgeon 'releases' the clitoris from its hood and may perform a urethral lengthening to allow for urination through the tip. Often, a scrotoplasty is also performed, creating a scrotum from the labia majora where testicular implants can be placed. Metoidioplasty is a less complex surgery than phalloplasty, with fewer stages and lower complication rates, and it preserves natal erectile sensation.
Masculinizing: Phalloplasty
Phalloplasty is a multi-stage, highly complex procedure that constructs a larger, more anatomically typical phallus. It requires taking a large tissue graft, complete with its own artery, vein, and nerve supply, from a donor site on the body. The most common donor sites are the radial forearm (RFF) or the anterolateral thigh (ALT). The surgeon shapes this graft into a phallus and connects the blood vessels and nerves using microsurgery. Subsequent stages can include urethral lengthening, scrotoplasty, and the insertion of testicular and erectile implants. Phalloplasty aims to provide a result that is aesthetically male and allows for standing urination and penetrative sex (with an implant).
Masculinizing: Hysterectomy
A hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) are often performed for trans masculine individuals, either before or during genital reconstruction. This eliminates the risk of uterine or ovarian cancer, stops menstruation if it hasn't ceased with testosterone, and removes the body's primary source of estrogen. For many, it is a key step in alleviating dysphoria related to internal reproductive organs.