Everyone deserves to see their true identity reflected in the mirror. To attain this, many transgender women choose to undergo bottom surgery, a procedure that matches a person’s genitals with their gender identity. Bottom surgeries account for over 35% of gender-affirming procedures in the US. What's more, around 50% of trans women dream of having the surgery in the future. So what’s stopping them from making this pivotal step towards a more fulfilling life right now? Many have natural concerns about the surgery, possible complications, results, and the recovery process. Now is the time to put these fears to rest.
This article will answer your questions and ease your concerns regarding male-to-female (MTF) bottom surgery. We'll break down the different types of surgeries available, give tips on choosing a surgeon, explore costs, discuss how to prepare, and walk you through the recovery process.
Table of Contents
- What is MTF Bottom Surgery?
- MTF Bottom Surgery Types
- MTF Bottom Surgery Process
- Best MTF Bottom Surgeons
- Male-to-Female Bottom Surgery Cost
- How to Prepare for MTF Bottom Surgery
- MTF Bottom Surgery Requirements
- MTF Bottom Surgery Recovery
- Male-to-Female Surgery Results
- Takeaways
What is MTF Bottom Surgery?
Male-to-female (or transfeminine) bottom surgery is a type of sex reassignment surgery that reshapes the male reproductive organs to look like female genitalia, aligning a patient's physical form with their gender identity. This procedure encompasses various surgical techniques tailored to each individual's needs and goals.
Bottom surgery can significantly improve self-esteem and overall mental health. By matching physical appearance with gender identity, bottom surgery helps people navigate social environments and personal relationships with greater confidence. Additionally, it can improve intimacy and personal comfort.
💡Expert Insight
"Since gender reassignment surgery is such a serious and irreversible procedure, it's easy to assume that people may often regret it. However, the reality is that regret rates are incredibly low, less than 1%. For male-to-female surgeries, patients report 90% satisfaction with aesthetic outcomes and 93% satisfaction with overall results. To put this in perspective, the median satisfaction for other, more common surgical procedures is 69.5%. This high satisfaction rate can be explained by the rigorous patient approval and the overwhelmingly positive impact on patients’ mental health and well-being." — Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, MTF Bottom Surgeon.
24.05.2024
Bottom surgery leads to reductions in:
- gender dysphoria;
- psychological distress;
- harmful habits like smoking;
- suicidal tendencies.
In essence, bottom surgery is not just about changing physical attributes; it enables a life where people can truly feel like themselves.
To learn more about other types of gender-affirming surgery, check out our Sex Reassignment Surgery Guide.
Who is the perfect candidate?
According to the American Society of Plastic Surgeons, male-to-female (MTF) bottom surgery can be beneficial to people who:
- experience persistent gender dysphoria;
- are recommended for surgery by two mental health professionals;
- have experience living in alignment with their gender identity;
- can legally consent to the procedure;
- maintain a positive outlook and realistic expectations;
- have their medical or mental health concerns well-managed.
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What does MTF bottom surgery look like?
Male-to-female bottom surgery usually involves creating a vagina, labia, clitoral hood, and clitoris from the existing genital tissue. The goal is to not only achieve an appearance that reflects the individual's gender identity but also to enable sexual function and sensation. Each surgical approach takes into account the patient's unique anatomy and objectives.
MTF Bottom Surgery Types
Orchiectomy
This procedure involves the removal of the testicles and may serve as an initial step toward further genital reconstruction. It is one of the more straightforward and cost-effective gender-affirming surgeries, typically completed in under 30 minutes under general anesthesia. Since the testicles produce the majority of testosterone, undergoing an orchiectomy means most patients can cease taking anti-androgen medications or testosterone blockers.
Transgender women can choose orchiectomy to:
- alleviate gender dysphoria;
- simplify hormone therapy;
- ease the discomfort of tucking;
- have more clothing options that reflect their identity.
How it’s done: An orchiectomy is performed through a small incision in the scrotum, where both testicles are removed. This procedure is typically done under general anesthesia and takes less than an hour.
A scrotectomy, which can accompany an orchiectomy, removes the scrotal sack, smoothing the area. However, patients planning further genital reconstruction should avoid doing a scrotectomy since they will need scrotal tissue for future use.
Full-depth vaginoplasty
One of the most common MTF surgeries, this technique not only forms the outer vulva but also constructs a complete vaginal canal. It allows for sexual intercourse and urination in a manner consistent with the individual's gender identity. This procedure is a go-to for those who want a natural-looking vagina with sensory functionality.
Full-depth MTF vaginoplasty is a go-to for trans women who want:
- a complete anatomical transition;
- a natural-looking vagina with sensory functionality;
- an ability to have penetrative sex and experience orgasm.
There are 2 main approaches to transgender vaginoplasty:
- Penile inversion vaginoplasty utilizes penile and scrotal skin to craft the vaginal canal. Surgeons carefully invert the penile skin to form the interior of the canal while using scrotal skin to build the exterior vulvar structures. Clitoris is formed from the tip of the penis.
- Robotic peritoneal vaginoplasty employs a robotic surgical system to create a canal. Through a small incision near the belly button, the robotic system allows surgeons to craft the vaginal canal using the peritoneum, a thin layer of tissue lining the abdomen. Although this technique is less common, it offers a shorter recovery time and reduced risk of complications.
Vulvoplasty (Zero-depth vaginoplasty)
Unlike transgender vaginoplasty, vulvoplasty does not create a vaginal canal, hence the term "zero-depth." It focuses on forming the external genitalia, such as the labia and clitoris, without the additional maintenance required for a neovagina.
This option is suitable for transgender women who:
- do not desire to have penetrative sex;
- prefer a less complicated procedure with shorter recovery times;
- wish to minimize the risk of surgical complications;
- want to avoid ongoing maintenance (e.g., dilation post-surgery).
The procedure involves the following steps:
- Tissue reconfiguration. Surgeons reconfigure and sculpt the existing genital tissue to form the labia and clitoral hood.
- Clitoral creation. A part of the glans penis is preserved and reshaped to create a clitoris, positioned to enable sensation and, potentially, orgasmic function.
- Introitus formation. Although no vaginal canal is created, an opening is made at the site of the vaginal entrance to mimic the appearance of a vulva.
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MTF Bottom Surgery Process
Your surgeon will detail the surgery plan, which might include one or multiple procedures. For example, you might have an orchiectomy and a vaginoplasty in one go.
Surgical steps generally include:
- removing or altering existing organs and tissues;
- constructing new anatomical structures to achieve a feminine appearance.
Surgeons might place drains to manage fluids or insert a catheter for urination.
How long does gender reassignment surgery take?
- Orchiectomy typically takes about 30-60 minutes, making it one of the shortest and easiest gender-affirming surgeries.
- Vaginoplasty is a more complex procedure lasting between 2 and 6 hours.
- Vulvoplasty takes less time than vaginoplasty (2-3 hours) since no vaginal canal is created.
Is bottom surgery painful?
Any gender-affirming procedure is performed under anesthesia, preventing pain during surgery. However, you will experience some post-operative discomfort. Pain management, including prescribed medications, is an essential part of the recovery process. Substantial pain should subside in the first few days after the surgery and clear up completely within 2 months.
Best MTF Bottom Surgeons
The path to gender congruence involves making many choices. Arguably, the most crucial one is choosing a skilled and experienced surgeon. Bookimed partners with over 20 gender-affirming clinics and doctors worldwide. This network can simplify the process of finding the right surgeon for you.
Dr. Pichet Rodchareon
📍 Bangkok, Thailand
Dr. Pichet Rodchareon is one of Thailand's leading gender surgeons. He has over 30 years of expertise in both bottom and top surgeries and facial feminization procedures. He earned his degree from Chulalongkorn University, Thailand's first institution to perform and teach gender reassignment surgery. Throughout his illustrious career, Dr. Pichet has performed more than 3,000 surgeries. He actively participates in several prestigious organizations, including:
- The International Society of Aesthetic Plastic Surgery (ISAPS);
- The World Professional Association for Transgender Health (WPATH);
- The Society of Plastic and Reconstructive Surgeons of Thailand;
- The Society of Aesthetic Plastic Surgeons of Thailand.
Bangkok Plastic Surgery is the clinic under the direction of board-certified surgeon Dr. Pichet Rodchareon. As one of Thailand’s top experts in aesthetic surgical operations and sex reassignment surgery, he and the highly skilled team provide optimal care for all patient´s needs. He has performed over 3,000 procedures with beautiful and functional results and remarkable patient satisfaction. He has dedicated his practice to the unique enhancement and preservation of each patient’s unique identity and approaches every patient differently. As an active member of the World Professional Association for Transgender Health (WPATH), Dr. Pichet is committed to providing high-quality care for patients seeking gender-affirming surgeries.
Hospital certificates and accreditation of quality
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| Sex reassignment surgery | $10000 - $13000 |
Dr. Ali Nurhan Özbaba⚕️Plastic surgeon
With a rich background spanning 35 years and over 30,000 treatments, Dr. Özbaba excels in plastic, reconstructive, and gender-affirming surgery. He is a member of the Turkish Society of Aesthetic Plastic Surgery (TSAPS).
Kucukcekmece Hospital is a multidisciplinary clinic located in Istanbul, Türkiye. Its strongest specialties are plastic surgery, gender reassignment surgery, bariatric surgery, neurosurgery, orthopedics, and cardiology. Kucukcekmece Hospital excels in male-to-female (MTF) surgeries, including top surgery (breast augmentation), bottom surgery (vaginoplasty), facial feminization surgery (FFS), and voice feminization surgery. Kucukcekmece Hospital serves both adults and children. Every year, 45,000 patients choose the clinic for medical care.
Major international patient flow comes from the USA, Asia, Europe, Africa, and Arab League states.
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Dr. Hakan Teymur⚕️Plastic surgeon
Dr. Teymur has over 20 years of experience in plastic, reconstructive, and aesthetic surgery. He has performed more than 1,000 operations and holds memberships in such esteemed organizations as:
- European Board of Plastic, Reconstructive and Aesthetic Surgery;
- European Society of Aesthetic Plastic Surgery.
Dr. MED Clinic is a private multi-specialty medical center in Istanbul, Turkey. The team is dedicated to plastic surgery, sex reassignment surgery, aesthetic medicine, cosmetology, and weight loss surgery. The clinic's success rate for plastic surgery, including sex change operations, is 98%. Dr. MED specialists apply the latest technologies in plastic and reconstructive surgery, offering such gender-affirming options as top surgery, bottom surgery, and facial reconstructive surgery. Dr. MED Clinic serves only adults. Every year, more than 4,500 patients choose Dr. MED Clinic for medical care. Patients from Europe, the Commonwealth, the USA, Canada, Australia, and CIS visit the clinic most often.
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Dr. Barış Nuhoğlu⚕️Plastic surgeon, urologist
Boasting 27 years of experience, Dr. Nuhoğlu is a distinguished member of several medical associations, including:
- European Association of Urology;
- Turkish Urology Association;
- Endourological Society.
He has contributed significantly to the medical field with over 100 publications, presentations, and book chapters, both national and international.
AquaHealth Clinic is a private multi-specialty medical center located in Istanbul, Turkey. The clinic's team is dedicated to urology, sexology, and gender affirmation surgery. The clinic has over 30 years of experience and specializes in transgender surgeries such as penile inversion vaginoplasty. AquaHealth Clinic serves only adults. Every year, 50 patients choose AquaHealth for medical care. Patients from Europe and the Commonwealth visit the clinic most often.
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Male-to-Female Bottom Surgery Cost
On average, the total cost for male-to-female bottom surgery is around $25,000. However, this figure can vary significantly based on the specific procedure, the surgeon's expertise, the facility's location, and additional medical expenses.
Surgery Type | Cost Range |
|---|---|
Orchiectomy | $2,000-$8,000 |
Vaginoplasty/vulvoplasty | $10,000-$30,000 |
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How to Prepare for MTF Bottom Surgery
Preparing for male-to-female bottom surgery involves several steps to ensure your health and readiness for the transformation ahead. Here’s a concise guide to get you started:
Medical and health preparation
- Surgical planning. Communicate your priorities and medical history to your surgeon, including conditions like high blood pressure or diabetes.
- Lab tests and evaluations. You will be asked to undergo necessary medical checks to assess your fitness for surgery.
- HRT. It is recommended to be on estrogen hormone replacement therapy (HRT) for at least 1 year before surgery. You will be required to stop HRT 2 weeks before surgery and will be able to resume it 1-2 weeks after.
- Quit smoking. Cease smoking 3-6 weeks before surgery to enhance healing and reduce surgical risks.
- Medications adjustments. Doctors will ask you to stop taking anti-inflammatory drugs, aspirin, blood thinners, and certain herbal supplements to lower bleeding risks.
- Allergy disclosure. Inform your surgeon about any allergies to medications, skin cleaners, latex, or foods.
- Hair removal. Permanent hair removal, like laser hair removal or electrolysis, should be started 9-12 months before vaginoplasty to clear the area that will become the neovagina. If hair remains on the skin used to create the vaginal canal, this can lead to discomfort, infections, and hygiene issues.
- 24 hours before surgery. Eat only light meals and stop all food and liquid intake by midnight. You may take medications with a sip of water in the morning.
Lifestyle and support
- Organize a support system. Arrange for help from friends, family, or a mental health professional for at least 1-2 weeks post-surgery.
- Time off work. Request 6-8 weeks off from work to recover.
Special considerations
- Weight. Maintain a healthy lifestyle, as a high body mass index (BMI) can increase risks and complicate healing.
- Fertility preservation. Consider options for sperm preservation before surgery to maintain the possibility of having biological children in the future.
MTF Bottom Surgery Requirements
Informed consent vs. WPATH standards of care
When judging patients’ eligibility for surgery, sex reassignment clinics and doctors usually follow one of the 2 approaches:
- informed consent model;
- World Professional Association for Transgender Health (WPATH) guidelines.
➤ The informed consent model empowers you to make decisions about your surgery after being fully informed of the risks by your physician without needing additional approval from other healthcare professionals.
➤ WPATH guidelines require letters of readiness from a mental health professional verifying your readiness and eligibility for surgery. Genital surgeries require two such letters from different experts. While WPATH standards aim to ensure patient safety and preparedness, they've faced criticism for limiting personal autonomy.
At what age can you get bottom surgery?
Most regions require you to be at least 18 years old to consent to surgery.
➤ In Europe, you generally need to be 18 for surgery without parental approval. However, some countries have lower age limits (e.g., 15 in Slovenia, 16 in Scotland, and 17 in England).
➤ In the US, the situation varies, with 22 states prohibiting gender-affirming surgeries for minors. Among these, 21 states also limit access to hormone therapy for those under 18.
MTF Bottom Surgery Recovery
Recovery from male-to-female bottom surgery varies depending on the type of procedure you've undergone. It is crucial to avoid applying excessive force or movement to surgical incisions during the healing process.
Below are approximate recovery timelines for different procedure types:
Procedure | Hospital Stay | Recovery time |
|---|---|---|
Orchiectomy | Same-day discharge | 2-3 weeks |
Vaginoplasty | 1-5 days | ● short-term: 6 weeks ● long-term: up to 1 year |
Vulvoplasty | 2-3 days | ● short-term: 4 weeks ● long-term: up to 1 year |
Dilating after bottom surgery
🤔What is dilation?
Dilation is a crucial post-operative practice for transgender patients who have undergone vaginoplasty. It ensures the newly formed vaginal canal remains open, flexible, and maintains its depth and width.
🤔Is dilation painful?
Dilating after bottom surgery should not be extremely painful, although it will initially cause some discomfort as you find the most comfortable angles and techniques for your body. Using lubricant and adjusting the dilator's position can help alleviate discomfort. If you experience severe pain, it's essential to stop and seek advice from your care team.
🤔How to dilate after bottom surgery?
Dilation involves the regular insertion of medical dilators into the vaginal canal. These specially designed devices help keep the canal from narrowing or closing, which is vital for the neovagina's functionality and health.
🤔How long do you have to dilate after gender reassignment surgery?
Following SRS, dilation is a life-long commitment, though the frequency will decrease over time. During the first weeks post-surgery, you'll need to dilate 3 times a day for 20 minutes. After the first year, many can reduce dilation to once daily or weekly, depending on their surgeon's advice.
Sex after bottom surgery
💡Expert Insight
"Many transfeminine people wonder if they'll still be able to have sex and experience sensations after surgery. Fortunately, the likelihood is that you'll continue to enjoy a fulfilling sex life after the procedure. Your surgeon will use skin from the penis to create a clitoris, which retains sensation. Nerve regeneration can start around 3 weeks post-surgery. Patients usually feel a return of erotic sensation in 3-9 months. Most transgender women can have orgasms through clitoral stimulation, and some studies even suggest that they may be more intense after surgery." — Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, MTF Bottom Surgeon.
24.05.2024
You can have sex after bottom surgery, with the type of sex depending on the specific procedure you've undergone:
- Vaginoplasty. You can engage in penetrative vaginal sex at least 12 weeks after surgery. Research shows that over 80% of people have no problem experiencing orgasm after the procedure.
- Vulvoplasty. While this procedure does not create a vaginal canal needed for penetrative sex, it does involve the construction of a sensitive clitoris. Therefore, patients who have undergone vulvoplasty can experience orgasm through clitoral stimulation.
In all cases, including orchiectomy, your body will need several weeks to heal adequately. It's essential to wait until your surgeon gives the green light to resume sexual activities.
Showering and bathroom use
Maintaining cleanliness in the genital area after bottom surgery is crucial to prevent infections.
- Keep the area dry. Initially, you will have to keep the external part of your vagina dry. Using an absorbent pad between the labia can help absorb any extra moisture.
- Gentle washing. Once you're cleared to wet the area, gently wash with soap and water without scrubbing or directing shower spray directly onto the surgical site.
- Wiping. Always wipe from front to back when using toilet paper or cleaning the genital area. This practice prevents bacteria from the anal region causing infections.
Male-to-Female Surgery Results
MTF bottom surgery marks a pivotal point in many transgender women's lives, offering profound relief from gender dysphoria. Here are some of the impressive male-to-female surgery results you can expect:
- High satisfaction rates. According to the Journal of the American Society of Plastic Surgeons, 99.7% of patients report satisfaction with their surgical outcomes.
- Improved sexual function. For many, sexual function post-surgery is a concern, but the data is encouraging. Another study highlights that 91.4% of respondents were pleased with their sexual function following penile inversion vaginoplasty.
- Healing process. The body undergoes a natural healing process after surgery. While scars may never vanish entirely, they significantly fade over time, becoming a small trade-off for the vast improvements in quality of life.
- Prostate health. The surgery does not remove the prostate gland. While estrogen therapy may slightly affect prostate size, the risk of prostate cancer remains. Regular medical exams are crucial to monitor prostate health and ensure long-term well-being.
- Revision surgery. Sometimes, achieving a desired outcome requires more than one surgical procedure. Medicine and surgery are complex, and adjustments might be necessary to fully realize one's vision.
💡Expert Insight
"Revision surgeries after the surgical MTF transition are not as common as you might think — only about 7.9% of patients end up needing them. If you do need a revision, there's no need to worry. Surgeons specializing in gender confirmation are highly experienced in fixing complications or improving results. Revisions can widen or deepen the vaginal canal, enhance appearance, make scars less visible, and fix urethral problems if you're having trouble urinating." — Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, MTF Bottom Surgeon.
24.05.2024
Bottom Surgery Risks and Complications
Like any serious surgical intervention, feminizing bottom surgery comes with certain risks. Although serious complications are rare, sometimes patients may experience:
- changes in sensation;
- difficulty in emptying the bladder;
- difficulty during intercourse due to a shallow vagina;
- narrowing of the vaginal opening;
- tissue necrosis (breakdown);
- rectovaginal fistula (a hole between the rectum and vagina);
- narrowing of the urethra.
Like with any surgery, there is a small risk of general surgical complications like anesthesia side effects, bleeding, blood clots, and infection.
💡Expert Insight
"Surgical risks are a valid concern, but most complications from male-to-female surgery can be managed without revision surgeries. Complications occur in 1-14% of cases. Most serious complications, like tissue necrosis, are especially rare (1%). Vaginal stenosis is more common (14%) but can be resolved with regular dilation or minor surgery. Choosing an experienced, board-certified surgeon, avoiding smoking and alcohol before surgery, and following recovery instructions can significantly lower the risk of complications." — Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, MTF Bottom Surgeon.
24.05.2024
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Takeaways
- Over 35% of gender-affirming procedures in the U.S. are bottom surgeries, with 54% of transgender women considering it for the future.
- Male-to-female (MTF) bottom surgery is a good option for healthy individuals with consistent gender dysphoria, support from mental health professionals, and legal consent ability.
- Surgical options include orchiectomy (testicle removal), full-depth vaginoplasty, and zero-depth vaginoplasty.
- MTF bottom surgery costs range significantly, with general estimates around $25,000.
- The informed consent model and WPATH guidelines represent two approaches to surgery eligibility. While WPATH requires comprehensive mental health evaluations and letters of readiness, the informed consent model allows patients to proceed based on understanding the risks.
- Essential preparation steps for surgery include undergoing medical evaluations, adjusting hormone therapy, quitting smoking, and performing hair removal for vaginoplasty.
- Short-term recovery times vary between 2 and 6 weeks, with complete recovery sometimes taking up to a year.
- Although rare, possible complications include changes in sensation, urinary retention, vaginal stenosis, and tissue necrosis.
- Male-to-female surgery results in impressive satisfaction rates, with 99.7% of patients reporting positive outcomes.
- Bottom surgery significantly reduces psychological distress, decreases harmful habits, lowers suicidal tendencies, and enhances the quality of life and self-esteem.
Related Articles
- Cleveland Clinic. (2023). Feminizing Bottom Surgery. https://my.clevelandclinic.org/health/procedures/feminizing-bottom-surgery
- Johns Hopkins Medicine. Vaginoplasty for Gender Affirmation. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/vaginoplasty-for-gender-affirmation
- Gender Confirmation Center. (2024). Everything you Need to Get Bottom Surgery. https://www.genderconfirmation.com/how-to-get-bottom-surgery/
- Medical News Today. (2021). Sex and sexual health tips for transgender women after gender-affirming surgery. https://www.medicalnewstoday.com/articles/transgender-women-after-surgery
- Plastic and Reconstructive Surgery. (2023). Regret after Gender-Affirming Surgery: A Multidisciplinary Approach to a Multifaceted Patient Experience. https://pubmed.ncbi.nlm.nih.gov/36727823/
- Annals of Plastic Surgery. (2018). Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty-Where We Are Today: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/29489533/
- Urology. (2019). Male-to-Female Gender Reassignment Surgery: An Institutional Analysis of Outcomes, Short-term Complications, and Risk Factors for 240 Patients Undergoing Penile-Inversion Vaginoplasty. https://pubmed.ncbi.nlm.nih.gov/31207304/
- The Journal of Sexual Medicine. (2022). Coming Soon: Ability to Orgasm After Gender Affirming Vaginoplasty. https://academic.oup.com/jsm/article-abstract/19/5/781/6961290
- BioMed Research International. (2018). Sexuality after Male-to-Female Gender Affirmation Surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994261/