What is masculinizing surgery?

Masculinizing genital surgery: Overview

Masculinizing genital surgery changes the look and function of your genitals so they align with your gender identity. This is also called "bottom surgery." It may relieve gender dysphoria so you can feel more at ease in your body.

There are many types of bottom surgery. For example, you may have your uterus removed (hysterectomy). You may have your vagina removed (vaginectomy). The doctor can use your clitoris to create a small penis. This is called metoidioplasty. Or skin and tissue from other parts of your body can be used to create an average-sized penis. This is called phalloplasty. The urethra can be made longer so you can urinate while standing. You may also have surgery to create a scrotum (scrotoplasty).

Some of these surgeries can be done at the same time. Others may need to be done separately. Your doctor can discuss the best timing for the surgeries you want.

You may stay in the hospital for up to a few days after bottom surgery. Your recovery will depend on the type of surgery you had. Healing may take from a few weeks to several months.

What are the types of masculinizing surgery for gender affirmation?

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

Top surgery

Top surgery is also called chest reconstruction. The breasts are removed to flatten your chest.

Bottom surgeries

The types of bottom surgeries include:

  • Hysterectomy. It removes the uterus. Sometimes the ovaries are also removed.
  • Vaginectomy. It removes the vagina.
  • Metoidioplasty. It creates a small penis.
  • Phalloplasty. It creates a larger penis.
  • Penile implant. It allows the penis to be firm enough for sex.
  • Scrotoplasty. It creates a scrotum.
  • Testicular implants. They give shape to the scrotum.

How do you prepare for masculinizing 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 to 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 masculinizing surgery for gender affirmation?

The risks of top surgery include swelling and scarring. The risks of bottom surgery include urinary problems and a breakdown of the tissue used to create a penis. With both types of surgery, there's a risk of infection and the chance that the surgery may need to be redone.

After masculinizing genital surgery for gender affirmation: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have chest pain, are short of breath, or cough up blood.
  • You can't stop bleeding from the surgical site.
  • You have extreme weakness or fatigue (to the point where it's hard for you to function).

Call your doctor now or seek immediate medical care if:

  • You are sick to your stomach or cannot drink fluids.
  • You have pain that does not get better after you take pain medicine or pain that continues to get worse.
  • You cannot pass urine, or you have pain when urinating.
  • You have loose stitches, or your incision comes open.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
    • A fever.
  • You have signs of a blood clot in your leg (called deep vein thrombosis), such as:
    • Pain in your calf, back of the knee, thigh, or groin.
    • Swelling in the leg or groin.
    • A color change on the leg or groin. The skin may be reddish or purplish, depending on your usual skin color.
  • You have changes in the genital area, such as a change in color, temperature, or drainage.
  • You cannot pass stools or gas.
  • You have belly pain or bloating, or you have to strain to have a bowel movement.
  • Bright red blood has soaked through the bandage over the incision.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

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

After top surgery, you may have small scars or less sensitive nipples. If the uterus and ovaries are removed, you'll no longer have periods or make estrogen. Surgery to create a penis can have a long recovery.

How are masculinizing surgeries for gender affirmation done?

Top surgery

Top surgery can be done in a few different ways. You might have one or two cuts (incisions). The breast tissue is removed. And your nipples might be reshaped.

Bottom surgeries

These may include:

  • Hysterectomy. The uterus (and sometimes ovaries) are removed through a small cut in the belly or through the vagina.
  • Vaginectomy. The surgeon removes the vagina. Then the surgeon closes the vaginal opening.
  • Creation of a penis. Options include:
    • Metoidioplasty. The clitoris is used to form a small penis. Sometimes tissue from another part of the body is also used (skin graft).
    • Phalloplasty. A skin graft (often from the forearm, belly, or thigh) is used to form an average-sized penis. This often involves more than one surgery, especially if you want a penile implant.

Bottom surgery may or may not include the creation of a scrotum or the use of testicular implants.

What happens on the day of masculinizing 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 types of surgery you're having. Your doctor will tell you what to expect.

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