After gender-affirming surgery, the method and experience of urination change. The specifics depend on the type of surgery:

1. Male-to-Female (MTF) Gender-Affirming Surgery (Vaginoplasty):
   • After vaginoplasty, the individual will urinate through a newly constructed vaginal opening, which is positioned anatomically in a location similar to cisgender women.
   • Initially, there might be swelling and discomfort. A catheter is often placed during surgery to drain urine and is typically kept in place for about a week or as advised by the surgeon.
   • After the catheter is removed, there might be a period of adjustment as the individual gets used to the new sensation and direction of urine flow. Some people might experience a downward or slightly forward direction of flow, especially at first. With time, the direction usually settles into a more typical pattern.
   • It’s essential to maintain cleanliness around the surgical site to prevent infections, especially since the area will be healing and may have sutures.
2. Female-to-Male (FTM) Gender-Affirming Surgery:
   • If an individual undergoes metoidioplasty with urethral lengthening, the enlarged clitoris (neophallus) is used to create a new urethra that allows for urination through the tip of the neophallus.
   • Phalloplasty, another FTM surgery, creates a penis using grafts from other parts of the body, and urethral lengthening is often part of this procedure. After surgery, the person can urinate through the neophallus.
   • As with MTF surgeries, a catheter is typically placed post-operatively and remains in place until initial healing occurs.
   • Once the catheter is removed, urination might require some adjustment, especially if there is swelling. Some individuals may initially need to sit to urinate until they become accustomed to the new anatomy and until healing is more complete.
   • Again, maintaining cleanliness is crucial, especially given the complexity of the surgical site.

For both MTF and FTM surgeries, it’s essential to follow post-operative instructions closely, keep follow-up appointments, and report any issues like prolonged pain, difficulties with urination, or signs of infection to the surgeon or medical team. Over time, as healing progresses, the experience of urination will become more routine and familiar.