Transgender women, individuals assigned male at birth who transition to female, may undergo a procedure known as vaginoplasty as part of their transition. Vaginoplasty, often called “bottom surgery” or “gender confirmation surgery,” is a procedure that constructs a vagina and vulva.

During vaginoplasty:

  1. The testes are removed in a procedure called orchiectomy.
  2. The penis is inverted, or other grafts are used to create a vaginal canal and a vulva.
  3. The glans penis (head of the penis) is often reshaped and used to create a clitoris, which typically retains sensation due to the preservation of the nerve supply.
  4. The urethra is shortened and repositioned.
  5. Labia (vaginal lips) are created using scrotal and other penile skin.

The result is a neovagina and a vulva that can appear very similar to a cisgender woman’s genitals. The neovagina is often capable of sexual penetration and orgasm, though it does not have the ability to menstruate or bear children. It’s important to note that transgender women may also opt for a less intensive procedure called an orchiectomy (removal of the testes) without vaginoplasty.

The specifics of these procedures and their results can vary widely, depending on the techniques used, the individual’s anatomy, and the surgeon’s expertise. As with any surgery, there are risks involved, and a period of recovery is required.

Not all transgender women opt for or can access bottom surgery, and some may choose different procedures based on their personal needs and goals. Some transgender women may choose not to pursue any surgical interventions at all. All of these paths are valid, and the most important thing is for each person to choose the path that feels right for them. It’s crucial to have detailed discussions with healthcare providers who are knowledgeable and experienced in transgender healthcare to fully understand all the options.