For many of our patients, gender affirming bottom surgery is one of the most gratifying steps of their medical transition. This article gives an overview of the three procedures that often get lumped together when people talk about “gender reassignment surgery” (GRS) or “female to male (ftm) bottom surgery.” We describe the techniques, staging and surgical results a patient can have undergoing a vaginoplasty, vulvoplasty (aka. “zero-depth vaginoplasty”), labiaplasty and penile-preserving vaginoplasty. We invite you to consult our additional content on preparing for bottom surgery and the recovery process to answer additional questions you may have.
These bottom surgery procedures can help patients achieve one or more of the following results:
All of the Gender Confirmation Center (GCC)’s bottom surgery procedures are performed by Dr. Ellie Zara Ley (she/her). She is a board-certified plastic surgeon and the only transgender woman of color to offer a full-spectrum specialization in gender affirming top surgery, bottom surgery, facial surgery and body contouring. She is a leader in the field of sex reassignment or genital reconstruction surgeries, using the most tried-and-true methods backed by longitudinal research for her patients. You can request a free, virtual consultation with her to create your unique, surgical plan here.
The following chart explains what each bottom surgery procedure can accomplish. Below that we provide a description of each surgery and the results they provide.
|Vaginoplasty (stage 1 of a traditional vaginoplasty)
|Vulvoplasty (aka. “zero-depth vaginoplasty)
|Labiaplasty (stage 2 of a traditional vaginoplasty)
Although historically these procedures have been referred to as “feminizing” surgeries, we recognize that not everyone considers these bodily transformations or body parts to be feminine. We offer these procedures to patients regardless of their gender identity or expression.
Vaginoplasty is a surgery which creates a vaginal canal alongside a vulva or external genitals, such as the clitoris, and labia majora, and labia minora. This procedure is well-suited for individuals looking to have a vulva with a clitoris, erogenous sensation, and a vaginal canal that can be used for penetrative solo or partnered sex. At the GCC, we offer a two-stage approach to a traditional vaginoplasty. Patients can also opt for a penile-preserving vaginoplasty or a vulvoplasty (also known as a “zero-depth vaginoplasty”). These options are explained below.
In the first stage, the testicles and scrotal skin are removed, the urethra is shortened and the erectile tissue in the penis is removed. The removal of the testicles is called an orchiectomy. Since this is essentially a sterilization procedure, we encourage patients to learn about and discuss their fertility preservation options with their primary care provider.
A labiaplasty reconstructs the vulva to add more defined aesthetic details, such as clitoral hooding, full labia minora, and alterations the overall configuration of the labia majora. It allows the surgeon to correct any functional issues, asymmetry or aesthetic concerns a patient may have. The labia minora and clitoral hood are made primarily from skin grafts from the labia majora. This will allow your surgeon to tighten any loose skin that may have resulted from the first stage.
Penile preserving vaginoplasty is exactly what it sounds like: a vaginal canal is created without removing the penis. In this case, the vaginal canal is crafted not using penile tissue, but using scrotal tissue and sometimes grafts which come from internal parts of the body, such as the peritoneum (lining of the abdominal wall), the colon, or the hips. Vaginal canals created from the lining of the abdominal wall and the colon have the chance of being self-lubricating, although results are not consistent across patients.
A vulvoplasty is very similar to a vaginoplasty in all aspects, except a vaginal canal is not created. A vulvoplasty includes creation of a vulva, clitoris and labia majora using tissue from the penis, scrotum, and associated skin and tissues. This procedure is selected by patients who would like a vulva, are not interested in having penetrative sex through a vagina nor are they interested in having to dilate their vaginal canal to maintain it. Patients can still experience orgasm and full erotic sensation through their clitoris as early as 3 months post-op.
The majority of patients who undergo a vulvoplasty are happy with their choice and do not desire to have a vaginal canal. However, if someone does decide later on that they would like a vaginal canal after vulvoplasty, this is possible. Skin grafts can be taken from the hips to create the canal. The surgical considerations and complications for this procedure would be similar to a vaginoplasty, and the new vaginal canal must be dilated for the rest of one’s life to maintain the width and depth.
The virtual consultation will be billed to your insurance company. We will accept the insurance reimbursement as payment in full.