The appearance of bottom surgery for MTF (male-to-female) transgender people can vary depending on the specific procedure performed and the individual’s anatomy. However, in general, the goal of MTF bottom surgery is to create a vulva and vagina that is as similar to a cisgender woman’s genitals as possible.

Some of the most common procedures performed for MTF bottom surgery include:

• Vaginoplasty: Vaginoplasty is the most common type of MTF bottom surgery. During vaginoplasty, a surgeon creates a new vagina using tissue from the penis, scrotum, or labia. The new vagina is typically lined with skin from the inner labia or the urethral lining.

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• Orchiectomy: Orchiectomy is the removal of the testicles. This procedure is often performed as part of MTF bottom surgery, but it can also be performed as a standalone procedure.

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Orchiectomy

• Labioplasty: Labioplasty is a procedure to reshape the labia. This procedure is often performed in conjunction with vaginoplasty, but it can also be performed as a standalone procedure.

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The recovery time for MTF bottom surgery varies depending on the specific procedure performed. However, most people need to stay in the hospital for a few days after surgery. The recovery process can be challenging, but most people are able to return to their normal activities within a few weeks.

It is important to note that the appearance of MTF bottom surgery can vary depending on the individual’s anatomy and the surgeon’s technique. If you are considering MTF bottom surgery, it is important to talk to a surgeon who is experienced in performing this type of surgery. The surgeon can help you to understand the different options available and to choose the procedure that is right for you.

Male-to-female (MTF) gender confirmation surgery, also known as genital reconstruction surgery or vaginoplasty, involves the creation of female genitalia. It is important to note that the specific techniques and results of bottom surgery can vary depending on the surgeon, the individual’s anatomy, and their desired outcomes. Here is a general overview of the procedure:

1. Preparatory Steps: Before undergoing MTF bottom surgery, individuals typically undergo hormone replacement therapy (HRT) for a certain period to induce feminizing changes in the body, including breast development and fat redistribution.
2. Surgical Techniques: There are various surgical techniques for MTF bottom surgery, including penile inversion, sigmoid colon, or peritoneal pull-through methods. The most common technique is penile inversion, where the penile skin and tissue are used to create the vaginal canal. The testes are typically removed through an orchidectomy.
3. Vaginal Canal Creation: During the surgery, the penile skin is inverted to form the lining of the vaginal canal. The erectile tissue of the penis, known as the corpora cavernosa, is reshaped and used to create the labia majora. The glans of the penis is often repurposed to form the clitoral hood.
4. Clitoroplasty: The surgeon may also create a clitoris by using the glans of the penis or other available tissue. The size and sensitivity of the clitoris can vary depending on the individual’s anatomy and surgical technique.
5. Labiaplasty: The labia minora, or inner labia, are formed using tissue from the penile skin or other sources. The surgeon sculpts and shapes the labia to resemble natural female genitalia.
6. Urethral Lengthening: The surgeon may also perform urethral lengthening, which involves extending the urethra to a position near the neovaginal opening, allowing for urination while seated.
7. Recovery and Postoperative Care: After the surgery, individuals typically require a recovery period during which they follow specific postoperative care instructions provided by their surgical team. This may include proper wound care, pain management, dilation (to prevent the neovagina from narrowing), and regular follow-up visits.

It is important to note that the outcomes of MTF bottom surgery can vary, and it is crucial to consult with qualified surgeons who specialize in gender-affirming surgeries. They can provide personalized information, discuss specific techniques, potential risks, and expected outcomes based on individual circumstances.

Vaginoplasty

Vaginoplasty in Male-to-Female (MTF) Bottom Surgery:

Vaginoplasty is a gender-affirming surgical procedure that involves the creation of a neovagina for individuals undergoing male-to-female (MTF) transition. Here are key aspects of what vaginoplasty in MTF bottom surgery typically involves:

1. Preoperative Assessment:
   • Before undergoing vaginoplasty, individuals undergo a thorough preoperative assessment, including discussions with healthcare providers, psychological evaluations, and medical examinations. This process helps ensure that individuals are well-informed and mentally prepared for the procedure.
2. Anesthesia:
   • Vaginoplasty is typically performed under general anesthesia. This ensures that the individual is unconscious and pain-free during the surgical procedure.
3. Penile Disassembly:
   • The surgical process involves disassembling the penile structures while preserving sensitive tissues that will be used in creating the neovagina. The penile skin is often inverted to form the vaginal lining.
4. Testicular Removal (Orchiectomy):
   • In many cases, individuals undergo orchiectomy (removal of the testicles) as part of the same surgical session. This reduces testosterone production and contributes to a more feminine hormonal balance.
5. Vaginal Canal Creation:
   • The penile skin, inverted during the procedure, is used to create the vaginal canal. This involves carefully shaping and suturing the tissues to form the neovagina. The depth of the neovagina can vary based on individual factors and surgical techniques.
6. Clitoroplasty:
   • Clitoroplasty involves creating a neoclitoris from sensitive tissues. The size and appearance of the neoclitoris are carefully crafted to provide sexual sensation and enhance the overall aesthetic outcome.
7. Labia Construction:
   • Labia minora and labia majora are constructed using available tissues, such as penile and scrotal skin. This contributes to the external appearance of the genitalia.
8. Urethral Lengthening (Optional):
   • Some individuals may choose to undergo urethral lengthening during vaginoplasty, allowing for a more anatomically typical location for the urethral opening.
9. Dilation:
   • Dilation is a crucial postoperative care component. It involves the use of dilators to maintain the depth and width of the neovagina. Regular dilation helps prevent the closure of the vaginal opening during the initial stages of recovery.

• Postoperative Care:
  • After surgery, individuals receive postoperative care instructions, which may include guidelines for wound care, dilation schedules, and restrictions on physical activities. Regular follow-up appointments with healthcare providers are scheduled to monitor the healing process.

It’s important to note that the specifics of vaginoplasty can vary based on the surgical techniques used by the healthcare provider, as well as individual factors such as anatomy and desired outcomes. The decision to undergo vaginoplasty is a highly personal one, and individuals typically engage in thorough discussions with experienced healthcare professionals to determine the most suitable options for their gender-affirming goals and overall well-being.

Orchiectomy

Orchiectomy, also known as testicle removal, is a surgical procedure commonly chosen by individuals undergoing male-to-female (MTF) transition. While orchiectomy can be performed as a standalone procedure, it is often part of the broader process of gender-affirming care. Here’s an overview of what orchiectomy in MTF bottom surgery typically involves:

1. Preoperative Assessment:

1. • Before undergoing orchiectomy, individuals undergo a comprehensive preoperative assessment, including discussions with healthcare providers, psychological evaluations, and medical examinations. This process ensures that individuals are well-informed and mentally prepared for the procedure.

1. Anesthesia:

1. • Orchiectomy is typically performed under general anesthesia. This ensures that the individual is unconscious and pain-free during the surgical procedure.

1. Surgical Incisions:

1. • During orchiectomy, small incisions are made in the scrotum to access and remove the testicles. The size and placement of the incisions may vary based on the surgeon’s technique and individual anatomy.

1. Testicle Removal:

1. • The surgeon removes the testicles from the scrotum. This step is a key aspect of orchiectomy and is irreversible.

1. Closure of Incisions:

1. • The incisions are carefully closed with sutures or other closure techniques to promote proper healing. Depending on the surgical approach, dissolvable stitches or sutures that need removal may be used.

1. Postoperative Care:

1. • After orchiectomy, individuals receive postoperative care instructions, including guidelines for wound care, pain management, and restrictions on physical activities. Regular follow-up appointments with healthcare providers are scheduled to monitor the healing process.

1. Hormone Therapy Adjustment:

1. • Orchiectomy leads to a reduction in testosterone production since the testicles are responsible for its secretion. If individuals were undergoing hormone therapy prior to orchiectomy, the hormone regimen may be adjusted following the procedure.

1. Psychosocial Support:

1. • Psychosocial support is an integral part of postoperative care. Individuals may receive counseling or support to address emotional aspects related to the surgery and its implications for their gender-affirming journey.

1. Impact on Gender Dysphoria:

1. • Orchiectomy can have a positive impact on gender dysphoria by reducing the presence of male secondary sex characteristics. Some individuals choose orchiectomy as a step towards further gender affirmation, such as vaginoplasty.

1. Continuation of Gender-Affirming Journey:

1. • Orchiectomy is often one part of a broader gender-affirming journey. Some individuals may choose to undergo additional procedures, such as vaginoplasty, to further align their physical characteristics with their gender identity.

It’s important to note that the decision to undergo orchiectomy is highly personal, and individuals often engage in thorough discussions with experienced healthcare professionals to determine the most suitable options for their gender-affirming goals and overall well-being.

Penile Inversion Vaginoplasty

Penile inversion vaginoplasty is a common surgical procedure for individuals undergoing male-to-female (MTF) gender-affirming surgery. It involves the creation of a neovagina using the penile skin and other tissues. Here is an overview of what penile inversion vaginoplasty typically involves:

1. Preoperative Assessment:
   • Before undergoing penile inversion vaginoplasty, individuals undergo a thorough preoperative assessment, including discussions with healthcare providers, psychological evaluations, and medical examinations. This process ensures that individuals are well-informed and mentally prepared for the procedure.
2. Anesthesia:
   • Penile inversion vaginoplasty is typically performed under general anesthesia. This ensures that the individual is unconscious and pain-free during the surgical procedure.
3. Penile Disassembly:
   • The surgical process begins with disassembling the penile structures while preserving sensitive tissues that will be used in creating the neovagina. The penile shaft is separated from the glans, and the erectile tissue is often removed.
4. Vaginal Canal Creation:
   • The penile skin is inverted to form the lining of the neovagina. The surgeon carefully shapes and sutures the penile skin to create the vaginal canal. The depth and width of the neovagina may vary based on individual factors and surgical techniques.
5. Clitoroplasty:
   • Clitoroplasty is often performed during penile inversion vaginoplasty. It involves creating a neoclitoris from sensitive tissues, typically the glans of the penis. The neoclitoris is designed to provide sexual sensation and enhance the overall aesthetic outcome.
6. Labia Construction:
   • Labia minora and labia majora are constructed using available tissues, such as penile and scrotal skin. This contributes to the external appearance of the genitalia.
7. Urethral Lengthening (Optional):
   • Some individuals may choose to undergo urethral lengthening during penile inversion vaginoplasty, allowing for a more anatomically typical location for the urethral opening.
8. Closure of Incisions:
   • The incisions made during the procedure are carefully closed with sutures or other closure techniques to promote proper healing. Dissolvable stitches or sutures that need removal may be used.
9. Postoperative Care:
   • After surgery, individuals receive postoperative care instructions, which may include guidelines for wound care, dilation schedules, and restrictions on physical activities. Regular follow-up appointments with healthcare providers are scheduled to monitor the healing process.

• Dilation:
  • Dilation is a crucial postoperative care component. It involves the use of dilators to maintain the depth and width of the neovagina. Regular dilation helps prevent the closure of the vaginal opening during the initial stages of recovery.

It’s important to note that the specifics of penile inversion vaginoplasty can vary based on the surgical techniques used by the healthcare provider, as well as individual factors such as anatomy and desired outcomes. The decision to undergo penile inversion vaginoplasty is highly personal, and individuals typically engage in thorough discussions with experienced healthcare professionals to determine the most suitable options for their gender-affirming goals and overall well-being.

Scrotal Graft

Scrotal graft is a surgical technique sometimes used in male-to-female (MTF) bottom surgery, particularly in vaginoplasty. This approach involves utilizing scrotal skin to enhance the depth and appearance of the neovagina. Here is an overview of what scrotal graft in MTF bottom surgery typically involves:

1. Preoperative Assessment:
   • Before undergoing scrotal graft surgery, individuals undergo a thorough preoperative assessment, including discussions with healthcare providers, psychological evaluations, and medical examinations. This ensures that individuals are well-informed and mentally prepared for the procedure.
2. Anesthesia:
   • Scrotal graft surgery is typically performed under general anesthesia. This ensures that the individual is unconscious and pain-free during the surgical procedure.
3. Penile Disassembly:
   • Similar to other MTF bottom surgery procedures, scrotal graft surgery often begins with disassembling the penile structures while preserving sensitive tissues that will be used in creating the neovagina. The penile shaft is separated from the glans, and the erectile tissue may be removed.
4. Vaginal Canal Creation with Penile Skin:
   • The penile skin is inverted and used to create the lining of the neovagina. The surgeon carefully shapes and sutures the penile skin to form the vaginal canal. This provides the base structure for the neovagina.
5. Scrotal Graft Utilization:
   • Scrotal skin is harvested and used as additional tissue to enhance the depth and appearance of the neovagina. The scrotal graft is typically incorporated into the construction of the labia minora and/or labia majora.
6. Clitoroplasty:
   • Clitoroplasty is often performed during scrotal graft surgery. It involves creating a neoclitoris from sensitive tissues, typically the glans of the penis. The neoclitoris is designed to provide sexual sensation and enhance the overall aesthetic outcome.
7. Labia Construction:
   • Labia minora and labia majora are constructed using available tissues, including the penile skin and scrotal graft. This contributes to the external appearance of the genitalia.
8. Urethral Lengthening (Optional):
   • Some individuals may choose to undergo urethral lengthening during scrotal graft surgery, allowing for a more anatomically typical location for the urethral opening.
9. Closure of Incisions:
   • The incisions made during the procedure, including those on the scrotum, are carefully closed with sutures or other closure techniques to promote proper healing. Dissolvable stitches or sutures that need removal may be used.

• Postoperative Care:
  • After surgery, individuals receive postoperative care instructions, which may include guidelines for wound care, dilation schedules, and restrictions on physical activities. Regular follow-up appointments with healthcare providers are scheduled to monitor the healing process.

It’s important to note that the decision to use a scrotal graft and the specifics of the surgical technique can vary based on the individual’s anatomy, surgeon expertise, and desired outcomes. The choice of surgical approach is often made through collaborative discussions between the individual and experienced healthcare professionals to align with the individual’s gender-affirming goals and overall well-being.

Labia Construction

Labia construction is an important component of male-to-female (MTF) bottom surgery, contributing to the external appearance of the genitalia. This procedure is often part of vaginoplasty and aims to create labia minora and labia majora using available tissues. Here is an overview of what labia construction in MTF bottom surgery typically involves:

1. Preoperative Assessment:
   • Before undergoing labia construction, individuals undergo a thorough preoperative assessment, including discussions with healthcare providers, psychological evaluations, and medical examinations. This ensures that individuals are well-informed and mentally prepared for the procedure.
2. Anesthesia:
   • Labia construction is typically performed under general anesthesia. This ensures that the individual is unconscious and pain-free during the surgical procedure.
3. Penile Disassembly:
   • The surgical process often begins with disassembling the penile structures while preserving sensitive tissues that will be used in creating the neovagina. The penile skin and potentially scrotal skin are used in labia construction.
4. Vaginal Canal Creation:
   • The penile skin, inverted to form the lining of the neovagina during vaginoplasty, is used as the primary tissue for labia construction. The surgeon carefully shapes and sutures the penile skin to create the labia minora.
5. Scrotal Graft Utilization (Optional):
   • In some cases, scrotal skin may be utilized as additional tissue to enhance the depth and appearance of the labia or contribute to the construction of the labia majora.
6. Clitoroplasty:
   • Clitoroplasty is often performed during labia construction. It involves creating a neoclitoris from sensitive tissues, typically the glans of the penis. The neoclitoris is designed to provide sexual sensation and enhance the overall aesthetic outcome.
7. Labia Majora Construction:
   • The labia majora are created using the available tissues, which may include penile skin and scrotal graft. The surgeon shapes and sutures the tissues to form the outer, larger folds of the labia.
8. Urethral Lengthening (Optional):
   • Some individuals may choose to undergo urethral lengthening during labia construction, allowing for a more anatomically typical location for the urethral opening.
9. Closure of Incisions:
   • The incisions made during the procedure, including those used for labia construction, are carefully closed with sutures or other closure techniques to promote proper healing. Dissolvable stitches or sutures that need removal may be used.

• Postoperative Care:
  • After surgery, individuals receive postoperative care instructions, including guidelines for wound care, dilation schedules, and restrictions on physical activities. Regular follow-up appointments with healthcare providers are scheduled to monitor the healing process.

The specifics of labia construction can vary based on the surgical techniques used by the healthcare provider, individual anatomy, and desired outcomes. The decision-making process involves collaborative discussions between the individual and experienced healthcare professionals to align with the individual’s gender-affirming goals and overall well-being.

Dilation

Dilation is a crucial aspect of postoperative care for individuals undergoing male-to-female (MTF) bottom surgery, particularly after procedures like vaginoplasty. The goal of dilation is to maintain the depth and width of the neovagina, preventing the closure of the vaginal opening during the initial stages of recovery. Here is an overview of what dilation in MTF bottom surgery typically involves:

1. Purpose of Dilation:
   • Dilation is essential for preventing the neovagina from contracting and closing. It helps maintain the depth and width achieved during surgery, allowing for functional and comfortable use of the neovagina.
2. Timeline for Dilation:
   • Dilation typically begins a few weeks after surgery, once the initial healing has occurred. The exact timeline may vary based on the surgeon’s recommendations and the individual’s recovery progress.
3. Frequency of Dilation:
   • Initially, individuals may be advised to dilate multiple times a day. Over time, the frequency may decrease, and a regular schedule is established. The exact schedule is often provided by the healthcare provider and tailored to the individual’s needs.
4. Types of Dilators:
   • Dilators come in various sizes, and individuals progress to larger sizes over time. The initial dilators used are often smaller in diameter, and as healing progresses, individuals transition to larger sizes. Some dilators may be curved to match the anatomical shape of the neovagina.
5. Lubrication:
   • Adequate lubrication is essential for a comfortable and effective dilation process. Water-based or recommended medical-grade lubricants are commonly used.
6. Insertion Technique:
   • Individuals are instructed on proper insertion techniques to avoid discomfort or injury. Relaxation and a gradual approach are emphasized to ensure a comfortable experience.
7. Duration of Dilation Sessions:
   • The duration of each dilation session may vary but typically ranges from 15 to 30 minutes. As individuals progress, the duration may be adjusted based on the healthcare provider’s guidance.
8. Monitoring Progress:
   • Healthcare providers monitor individuals’ progress during follow-up appointments. This may include assessing the neovaginal depth and addressing any concerns or challenges faced by the individual.
9. Gradual Reduction in Frequency:
   • As healing progresses and the neovagina stabilizes, the frequency of dilation sessions may be gradually reduced. However, regular maintenance dilation is often recommended to preserve the neovaginal depth.

• Intimacy and Sexual Activity:
  • Individuals are typically advised to avoid penetrative sexual activity during the initial stages of recovery. Once healing is complete, individuals can resume sexual activity, and dilation may be incorporated as part of a sexual routine.
• Psychosocial Support:
  • Dilation can be a physically and emotionally challenging aspect of postoperative care. Psychosocial support, including counseling and education, is often provided to help individuals navigate this aspect of their recovery.

It’s important for individuals undergoing MTF bottom surgery to follow the guidance of their healthcare providers regarding dilation protocols and postoperative care. Regular communication with healthcare professionals ensures a smoother recovery process and addresses any concerns that may arise.

Urethral Lengthening

Urethral lengthening is an optional surgical procedure that some individuals undergoing male-to-female (MTF) bottom surgery may choose. This procedure aims to reposition the urethral opening to a more anatomically typical location in alignment with the neovagina. Here is an overview of what urethral lengthening in MTF bottom surgery typically involves:

1. Preoperative Assessment:
   • Before undergoing urethral lengthening, individuals undergo a thorough preoperative assessment, including discussions with healthcare providers, psychological evaluations, and medical examinations. This ensures that individuals are well-informed and mentally prepared for the procedure.
2. Anesthesia:
   • Urethral lengthening is typically performed under general anesthesia. This ensures that the individual is unconscious and pain-free during the surgical procedure.
3. Incisions and Tissue Dissection:
   • The surgical process involves making incisions to access the urethra. Tissues are dissected to allow for the repositioning of the urethral opening.
4. Urethral Mobilization:
   • The urethra is mobilized and repositioned to achieve a more typical location in alignment with the neovagina. This involves careful surgical techniques to preserve urinary function.
5. Extension of Urethra (Optional):
   • In some cases, the surgeon may opt to extend the length of the urethra to ensure that the urethral opening is appropriately positioned. This extension may involve using additional tissues to lengthen the urethra.
6. Urethral Reconstruction:
   • The repositioned urethra is reconstructed to ensure proper alignment and functionality. Sutures are used to close incisions and secure the repositioned urethra.
7. Closure of Incisions:
   • The incisions made during the procedure are carefully closed with sutures or other closure techniques to promote proper healing. Dissolvable stitches or sutures that need removal may be used.
8. Postoperative Care:
   • After surgery, individuals receive postoperative care instructions, including guidelines for wound care, catheter management (if used), and restrictions on physical activities. Regular follow-up appointments with healthcare providers are scheduled to monitor the healing process.
9. Catheter Use (Temporary):
   • In some cases, a catheter may be temporarily placed to assist with urinary drainage during the initial stages of recovery. The catheter is typically removed once the surgeon determines it is no longer needed.

• Recovery and Monitoring:
  • Individuals are monitored during the recovery period to ensure proper healing and urinary function. Follow-up appointments with healthcare providers involve assessments of the surgical site and any adjustments needed.

It’s important to note that urethral lengthening is an elective procedure, and not all individuals undergoing MTF bottom surgery choose to have this done. The decision is based on individual preferences, anatomical considerations, and discussions between the individual and their healthcare providers. As with any surgical procedure, individuals should thoroughly discuss their goals and expectations with experienced healthcare professionals to make informed decisions about their gender-affirming journey.