Choosing to affirm your gender identity though surgery could be the most important and exciting decision you make.

Gender affirming MTF “bottom surgery”

Orchiectomy

Removal of both testes to reduce testosterone levels

Scrotectomy

Sometimes combined with bilateral orchiectomy in non-binary patients who do not want to have vaginoplasty

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Zero-depth vaginoplasty

Removal of external male genitals with creation of clitoris and vulva without cavity for receptive penetration

Vaginoplasty

Removal of male genitals and creation of clitoris, labia and vaginal cavity for penetrative intercourse

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Orchiectomy +/- scrotal skin reduction

Orchiectomies are typically performed under a short general anaesthetic. The surgery is done through a small midline incision in the scrotum. It will not affect future bottom surgery choices. Recovery is swift and you will be able to resume work and regular daily activities within a couple of days.

In most patients the scrotum will later be used for vulvo- or vaginoplasty. However, some non-binary patients wish to combine the orchiectomy with a scrotectomy (removal of all parts of the scrotum).

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Surgeon performing laparoscopic surgery with instruments and cables in the foreground

The surgery removes the largest source of testosterone with very short recovery time. It eliminates the need for anti androgen medication with all its side effects.

You will need a supporting letter from a gender specialist and you should have been on hormone treatment for a minimum of 6 months.

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To preserve your ability to become a biological parent, you may want to discuss sperm preservation before having your testes removed.

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Vulvoplasty or Shallow-depth vaginoplasty

What does it involve?

Removal of penis, scrotum and testicles with creation of labia and clitoris with repositioning of urethral opening - but no creation of vaginal canal

Who benefits?

It is a good procedure for those who are not interested in receiving penetrative vaginal sex, have concerns about age or are not able to commit to regular postoperative dilatation

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Requirements

You will need letters from gender identity specialist and you would need to have been on hormone treatment for at least 12 months as outlined in WPATH guidelines.

The treatment

You spend about two nights in hospital. Swift recovery without need for postoperative vaginal dilatation.

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Vaginoplasty

What does it involve?

Vaginoplasty creates an aesthetically pleasing and fully functioning vagina. It involves formation of vagina, vulva, labia as well as clitoris with clitoral hood from part of the penile tip, scrotal and urethral flaps as well as the inverted penile tissue. Blood vessels and nerves will be preserved to guarantee sensation. Both testes and the erectile bodies of the penis will be removed.

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Requirements

To qualify for the surgery you will need to present supporting letters from gender specialist, you will need to have been on hormone therapy for a minimum of 12 months with real life experience in your chosen gender. You will need to be healthy in body and mind and have healthy weight for your frame.

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Who benefits?

Mainly younger patients who are keen to engage in receptive penetrative intercourse.

The creation of a vaginal canal between rectum and bladder makes the surgery more challenging and will require regular postoperative dilatation to ensure that depth and girth of the vaginal cavity will be preserved following successful surgery.

The treatment and recovery

You will spend about 5 days in hospital. Recovery will include a regular vaginal dilatation regime. It may take up to six weeks until you will be able to resume your regular activities.

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Medical illustration showing a finger palpating the pelvic floor and vaginal canal anatomy.

Contact Mr Seipp or the SPIRE Yale hospital

Arrange your private consultation to discuss your goals and expectations