Male-to-female (MTF) bottom surgery, also known as vaginoplasty or gender confirmation surgery, is a procedure that transgender women might choose to undergo as part of their transition. This surgery involves the construction of a neovagina, clitoris, and labia by repurposing and reshaping existing genital tissue. Here’s a brief overview of the procedure and its components:

  1. Penile Inversion Technique: This is the most common method for MTF vaginoplasty.
    • The skin from the penile shaft is inverted to create the vaginal canal.
    • The glans (head) of the penis is used to create a neoclitoris, which often retains sensation.
    • Scrotal skin can be used to create labia majora and minora.
    • The urethra is shortened and repositioned.
  2. Depth Considerations: One challenge of the penile inversion technique is obtaining sufficient depth for the neovagina. Sometimes, additional skin grafts (from the scrotum or other areas of the body) are needed to achieve the desired depth.
  3. Non-penile Inversion Techniques: For those who may not have sufficient penile and scrotal skin (due to prior surgeries, medical conditions, or hormone-induced changes), alternative techniques using grafts from other parts of the body, like the colon, can be considered. However, these methods are less common and may come with additional risks and considerations.
  4. Sensate Clitoroplasty: Maintaining clitoral sensation is a crucial aspect of the surgery. A segment of the penile glans, which is nerve-rich, is used to create the neoclitoris, allowing for the potential of erotic sensation.
  5. Labiaplasty: This usually follows vaginoplasty and focuses on refining the appearance of the external genitalia. It can be done as a separate procedure or as part of the primary surgery.
  6. Recovery: Recovery from MTF bottom surgery is intensive. Patients typically require a hospital stay, followed by several weeks of reduced activity. They will also need to follow a regimen of vaginal dilation to maintain depth and width of the new vaginal canal. This dilation process can be long-term.
  7. Risks and Complications: As with any surgical procedure, there are potential risks. These might include:
    • Loss of sensation
    • Scarring
    • Fistulas (an abnormal connection between the vagina and urethra or rectum)
    • Strictures or narrowing of the vaginal canal
    • Issues related to depth or width of the vagina
    • Complications from anesthesia
  8. Results and Satisfaction: Many transgender women report high levels of satisfaction after undergoing bottom surgery, both in terms of aesthetic appearance and function. However, individual experiences can vary, and it’s essential to have realistic expectations.

If someone is considering MTF bottom surgery, it’s crucial to consult with experienced surgeons and medical professionals. They can provide detailed information tailored to individual needs, discuss risks and benefits, and help set realistic expectations for both the procedure and recovery.