What is feminizing surgery?

Feminizing Surgery

Feminizing genital surgery: Overview

Feminizing genital surgery changes the look and function of your genitals so they align with your gender identity. This is also called "bottom surgery." There are different types of surgery that you may have.

You may have vulvoplasty. This surgery creates a vulva. The vulva includes the labia, clitoris, and urethra. The scrotum is often used to form the labia. The head of the penis is used to create a clitoris. The urethra is shortened and placed below the clitoris.

You may have vaginoplasty. This surgery creates a vulva just like vulvoplasty. And it creates a vagina. The doctor will use skin from the penis to form the vaginal wall. Sometimes extra skin is needed. It may come from the lower belly, hip, or scrotum.

Doctors can use different methods to do the surgery. One is robotic surgery. You and your doctor can discuss ahead of time which method is right for you.

You will be asleep during surgery. You will stay in the hospital for about 2 to 5 days after surgery. Your recovery will depend on the type of surgery you had. Most people can go back to work or their normal routine in 6 to 8 weeks.

What are the types of feminizing surgery for gender affirmation?

There are different types of surgery that can help you have a more feminine body. Most fit into two groups: top surgery and bottom surgery.

Top surgery

Top surgery is also called breast augmentation. You and your surgeon can work together to choose your breast size, shape, and positioning.

Bottom surgeries

The types of bottom surgeries include:

  • Orchiectomy. It removes the testicles. The scrotum may be left behind to create the labia.
  • Penectomy. It removes the penis.
  • Vaginoplasty. It creates a vagina.
  • Labioplasty. It creates the labia.
  • Clitoroplasty. It creates a clitoris.

Other surgeries

These include surgery to:

  • Reduce the Adam's apple.
  • Change the pitch of your voice.
  • Make your face look more feminine.
  • Take fat cells from another part of your body and use them someplace else. This is called lipofilling.
  • Remove fat from your body (liposuction).

How do you prepare for feminizing genital surgery?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

  • Arrange for the care and support you'll need after surgery. Be sure you have someone to take you home. At home, you'll need help with many things, including wound care and showering. Your doctor can tell you how long you'll need this help. Having the support of people who care about you is important to your recovery.
  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
  • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
  • If you are taking hormones, your doctor will tell you whether to keep taking them or stop before your surgery.
  • If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
  • If you smoke, try to quit. Smoking slows healing and increases surgery risks. Your doctor may require that you quit for a period of time before and after surgery. You have the best chance for a healthy recovery if you quit smoking completely. If you need help quitting, talk to your doctor.
  • Be sure to tell your doctor if you have any changes in your physical or mental health that might affect the surgery or your recovery.
  • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

What are the risks of feminizing surgery for gender affirmation?

The risks of top surgery include implants that leak or rupture and changes in how the nipple feels. The risks of bottom surgery include bladder problems and narrowing or closure of the vagina or urethra. With both surgeries, there's a risk of infection and the chance that surgery may need to be redone.

What can you expect as you recover from feminizing surgery for gender affirmation?

Your recovery will depend on the type of surgery you had.

Top surgery

After breast augmentation:

  • Your breasts may look or feel different. They may be firmer and rounder.
  • You may lose feeling in your nipples. This may be short-term. But it may not.

Bottom surgeries

If you have surgery to remove the penis and testes:

  • Your body will no longer make testosterone. So you may be able to reduce the amount of estrogen that you take.
  • You'll sit down to urinate.

If you have surgery to create a vagina:

  • You'll need to use a dilator every day to maintain the depth and width of your vagina.
  • You'll need to use a lubricant if you have vaginal sex.

What happens on the day of feminizing genital surgery?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
  • Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do not shave the surgical site yourself.
  • Take off all jewelry and piercings. And take out contact lenses, if you wear them. If you're not able to remove jewelry, let your surgical team know as soon as possible.

At the hospital or surgery center

  • Bring a picture ID.
  • You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
  • How long surgery takes will depend on what type or types of surgery you have. Your doctor will tell you what to expect.

How is feminizing surgery for gender affirmation done?

Top surgery

During breast augmentation, the surgeon makes small cuts (incisions) to place silicone or saline implants in the chest. The cuts may be under the breast, in the armpit, or around the nipple.

Bottom surgeries

  • Orchiectomy and penectomy are often done together.
    • Orchiectomy. The testicles are removed. The scrotal skin may or may not be removed and used to form the labia.
    • Penectomy. The penis is removed. If you're not having vaginoplasty, the surgeon creates a shallow vaginal dimple. This lets you urinate while sitting down.
  • Vaginoplasty, labioplasty, and clitoroplasty. These are often done together.
    • Most surgeons use the skin of the penis to form the vaginal wall. Sometimes extra skin is needed. It may come from the lower belly, intestine, or scrotum.
    • The scrotum is often used to form the labia.
    • The nerve-sensitive head of the penis is used to create a clitoris.
    • The urethra is shortened and repositioned.

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