Bottom surgery for a trans woman, also known as male-to-female (MTF) genital reconstruction surgery or vaginoplasty, involves creating a vagina, clitoris, and labia by using tissue from the existing genitals.

Here’s a simplified overview of the process:

  1. Penectomy: The penis is removed, with some of the skin set aside to be used in the construction of the vagina.
  2. Orchiectomy: The testes are removed.
  3. Vaginoplasty: A vaginal canal and opening is created between the urethra and rectum. The skin of the penis and sometimes part of the scrotum is used to create the vaginal lining.
  4. Clitoroplasty: A clitoris is formed from parts of the glans of the penis, preserving nerve endings to maintain sexual sensation.
  5. Labiaplasty: The labia (vaginal lips) are created, usually from scrotal skin.

The goal is to create a functional and aesthetically typical vagina. Depth and sensation are important considerations. The neoclitoris usually has sensibility since it’s made from the sensitive tissue of the glans penis, which allows for sexual stimulation. The neo-vagina is also typically self-lubricating to some degree, depending on the surgical technique used and individual patient variation.

After the surgery, dilation of the neo-vagina must be performed regularly to prevent the body from healing the new vaginal cavity closed. Over time, dilation frequency can be reduced, but it is usually continued on a regular basis for life.

Surgery can be a critical step for many trans women in their transition. However, like all surgeries, it comes with risks such as complications from anesthesia, infection, changes in sexual function, and the need for further surgeries.

In terms of cost, vaginoplasty can range from $10,000 to $30,000 or more, depending on the surgeon and specific procedures performed.

Consultation with a knowledgeable healthcare provider is crucial for anyone considering this surgery, as is psychological preparation and support.