Bottom surgeries help bring an individual’s physical features in line with their gender identity. For transfeminine people, options include vaginoplasty, labiaplasty, and orchidectomy. If you want to pursue surgery, please see our article on Surgery Referral Sessions.
Vaginoplasty
Vaginoplasty is the creation of a vaginal canal and external genitalia that align with your gender identity. This involves penile inversion, where the penile skin is used to line the vaginal canal, and scrotal skin is used to create the labia majora, and the glans is commonly used to create a clitoris.
Vaginoplasty can offer sexual function, including the ability to experience penetrative intercourse and achieve orgasm.
Labiaplasty
Labiaplasty involves altering the size, shape, or appearance of the labia minora (inner vaginal lips) or labia majora (outer vaginal lips). This is commonly done during vaginoplasty, but can be done as a separate procedure.
Penectomy
This is the removal of the penis. This is usually done at the same time as a vaginoplasty, or can be followed up with a vaginoplasty at a later date. It can also be done at the same time as an orchidectomy (removing the testes and scrotum), which is called a nullification.
Orchidectomy
Orchidectomy (sometimes orchiectomy) is the removal of the testes, which reduces testosterone production.
Orchidectomy is a relatively straightforward and minimally invasive procedure, typically performed as an outpatient surgery. It does not result in the creation of female-typical genitalia, but can be performed in conjunction with other bottom surgeries or as a standalone procedure.
Can I get an orchidectomy before SRS (sex reassignment surgery)?
Positive Impacts:
- Reduced Dysphoria: Removing the source of testosterone production can alleviate gender dysphoria and improve overall wellbeing.
- Hormone Management: Without testicles, there is no need for medication to suppress testosterone production, which simplifies hormone therapy.
- Surgical Preparation: Orchidectomy can make the SRS procedure easier and faster by eliminating the need to remove the testicles during that surgery.
Negative Impacts:
- Skin Availability: Scrotal skin can sometimes be used as a source of additional tissue for creating vaginal depth during SRS. Removing the testicles does not necessarily eliminate this option, but can reduce the amount of skin available.
- Surgical techniques have advanced to the point where a lack of scrotal skin may not impact the results of vaginoplasty.
- Surgical Complications: Any surgery carries risks, including infection, bleeding, and adverse reactions to anaesthesia. Undergoing multiple surgeries increases the overall risk of complications.
- Cost: Orchidectomy is an additional surgical procedure with associated costs, which may not be covered by insurance and could add financial burden.
Considerations:
- Gender Dysphoria: If having testicles causes distress, removing them may provide relief even before undergoing SRS.
- Hormone Therapy: Orchidectomy simplifies hormone therapy for MTF individuals because testosterone blockers aren't needed any more.
- Surgical Preferences: Some people prefer to undergo orchidectomy as a separate procedure for personal or medical reasons, while others prefer to combine both surgeries into one.
Is the prostate removed in feminising surgery?
Contrary to misconception, feminizing surgery typically does not involve the removal of the prostate. The focus of these procedures is primarily on altering external genitalia and secondary sexual characteristics.