Gender reassignment surgery, also called gender-affirming genital surgery, is performed to change the physical characteristics of the genitals. The goal is to help a person’s body better align with their gender identity.
Gender reassignment surgery may be performed for people assigned female or male at birth. It can involve complex, lengthy procedures, such as creating a new genital organ, called a neophallus or neovagina, and removing other organs, such as the testicles, breasts, uterus, or ovaries.
Before having this type of surgery, medical follow-up is recommended to begin hormone therapy when indicated. Psychological follow-up is also important to help determine whether the new physical characteristics are appropriate for the person’s needs and transition goals.
Where it is done
In the US, gender reassignment surgery is usually performed by specialized surgeons, such as plastic surgeons, urologists, gynecologic surgeons, or other surgeons with training in gender-affirming procedures. These procedures are typically done in hospitals or accredited surgical centers.
Access to gender reassignment surgery may depend on factors such as insurance coverage, state regulations, surgeon availability, medical eligibility, and required preoperative evaluations. Some people may also need documentation from qualified healthcare professionals before surgery, depending on the surgeon, insurance plan, or clinic policy.
Before seeing a surgeon, it is recommended to consult an endocrinologist or another clinician experienced in gender-affirming care. This specialist can evaluate whether hormone therapy is appropriate and help coordinate care before surgery.
In addition, follow-up with a mental health professional may be recommended or required. This can help support the person throughout the transition process and prepare them for the physical and emotional aspects of surgery.
How it is done
Before gender reassignment surgery is performed, some important steps should be followed:
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Medical follow-up with a psychologist, psychiatrist, and social worker;
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Socially living as the gender the person wishes to adopt;
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Hormone therapy to develop feminine or masculine characteristics, guided by an endocrinologist for each case.
These steps before surgery last about 2 years. They are very important because they support the person’s physical, social, and emotional adaptation.
1. Female-to-male transition
There are 2 types of surgical techniques used to transform female genitalia into male genitalia:
Metoidioplasty
This is the most commonly used and available technique, and consists of:
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Testosterone hormone therapy causes the clitoris to grow, making it larger than a typical clitoris;
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Incisions are made around the clitoris, which is released from the pubis, allowing it to move more freely;
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Vaginal tissue is used to increase the length of the urethra, which will remain inside the neophallus;
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Tissue from the vagina and labia minora is also used to cover and shape the neophallus;
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The scrotum is made from the labia majora, and silicone implants are placed to simulate the testicles.
The resulting penis is small, reaching about 6 to 8 cm. However, this method is faster and can preserve the natural sensitivity of the genitals.
Phalloplasty
This is a more complex, expensive, and less widely available method. For this reason, many people seeking this procedure look for specialists abroad.
In this technique, skin grafts, muscles, blood vessels, and nerves from another area of the body, such as the forearm or thigh, are used to create a new genital organ with greater size and volume.
Care after surgery: To complete the masculinization process, removal of the uterus, ovaries, and breasts is necessary. This may be done during the same procedure or scheduled for another time. In general, sensitivity in the area is preserved, and intimate contact is allowed after about 3 months.
2. Male-to-female transition
To transform male genitalia into female genitalia, the most commonly used technique is modified penile inversion, which consists of:
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Incisions are made around the penis and scrotum to define the area where the neovagina will be created;
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Part of the penis is removed, while preserving the urethra, skin, and nerves that provide sensitivity to the area;
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The testicles are removed, while preserving the skin of the scrotal sac;
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A space is opened to house the neovagina, measuring about 12 to 15 cm, using skin from the penis and scrotum to line the area. Hair follicles are cauterized so that hair does not grow in the area;
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The remaining skin from the scrotum and foreskin is used to form the vaginal labia;
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The urethra and urinary tract are adapted so that urine leaves through an opening and the person can urinate while sitting;
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The glans is used to form the clitoris, so that the sensation of pleasure can be maintained.
To help the new vaginal canal remain open and viable, a vaginal mold is used. This mold can be changed to larger sizes over the following weeks to dilate the neovagina.
Care after surgery: Physical activity and sexual activity are generally allowed about 3 to 4 months after surgery. Usually, lubricants made for the genital area are needed during sexual intercourse. In addition, the person may have follow-up with a gynecologist for guidance and evaluation of the skin of the neovagina and urethra. However, because the prostate remains, appointments with a urologist may also be necessary.
In addition, after any surgery, it is recommended to eat light meals, follow the rest period recommended by the doctor, and use prescribed medications to relieve pain, such as anti-inflammatory drugs or pain relievers, to support recovery.