Male-To-Female Bottom Surgery: A Guide To The Different Procedures

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Gender reassignment surgery for male-to-female involves procedures that eliminate male features and replacing them with feminine attributes which function and looks natural. The methods are categorized into hormone therapy, top surgery, and bottom surgery. While hormone therapy may be necessary for most of the operations, it will depend on your choice to undergo top surgery or bottom surgery or both.

Bottom surgery for male-to-female sex reassignment entails removing the penis, scrotum (testicles), urethra, and replacing them with female genitals and urethra. Before you undergo this surgery, it will be helpful to have undergone one year of hormone therapy.

Preparing For Bottom Surgery

  • Prepare yourself mentally to accept the changes in your body and the society towards your gender affirmation
  • Do not smoke for at least three months before the operation
  • Maintain a healthy meal but avoid getting overweight
  • Pay attention to the instructions given by your surgeon
  • Hormone therapy since at least one year is required before the surgery

Types Of Bottom Surgery


Penectomy involves removing the penis surgically. Besides transgender women, patients with or running the risk of penile cancer undergo this surgery. Removing your penis may have both physical and psychological consequences, so this operation should not be taken lightly.

Surgery for trans-women will not involve obliterating the penis. Part of the glans will be kept to create the clitoris. Your penile shaft skin will be inverted to form the vagina.


Orchiectomy involves removing the testicles and most trans-women choose this procedure to start the transition surgery process. Removal of the testicles eliminates the testosterone almost entirely which is why this surgery may make your hormone regimen simpler, and your intake of estrogen can be decreased.

This procedure is considered simple and is done under local or general anesthesia. An incision about one inch long is made in the center of your scrotum after which your surgeon will remove your testicles after cutting the spermatic cord. The surgery takes around 20 minutes.


This is surgery is also known as cosmetic vulvoplasty; it constructs or reconstructs the external skin folds surrounding the vulva – labia minora and labia majora. It can be performed either alone or can be combined with Vaginoplasty.

Labiaplasty involves removing tissue from your penis or scrotum to create the labia. This process eliminates the penis and the scrotum during the process.


Urethroplasty is a surgery to reconstruct urethral strictures. In a trans-woman, this technique is done to shorten the urethral length. Men are born with urethra measuring up to eight inches long while female urethra is only two inches.

For gender affirmation surgery, this procedure is done to shorten the male urethra and relocate the external opening. In cases that involve sexual complications, excess erectile tissue that surrounds the urethral meatus is trimmed.


Vaginoplasty is the construction of the vagina through penile inversion. The purpose of this surgery is both for aesthetic and functional reasons. In this procedure, the erectile tissue is removed from the penis to make the vaginal opening, and the glans penis is used to create the clitoris.

Recovery And Postoperative Care

After the surgery, the recovery will depend on the type of operation you have undergone. Particular attention should be given to your surgeon’s instructions. Besides that, there are a few measures you can take in the first few weeks after the surgery.

  • Swelling of the neovagina will prevent you from sitting, use a donut ring to sit
  • Avoid strenuous work and heavy exercise. Also, avoid bike riding and swimming
  • Do not smoke or take tobacco for the first two months
  • Antibiotics and medications should be considered for the pain and possible infections as prescribed by your surgeon
  • After three to four month you can have sexual intercourse
  • Hospitalization will be at least for a week
  • Bottom surgeries will require a catheter for about a week


What can I expect in my sexual activity after a bottom surgery?

A: Wait for three to four months before you start having sex. You will be able to have orgasms with your new clitoris.

Will my scars disappear?

A: Scars will never entirely disappear. You can hope for your scars to conceal under your pubic hair.

Is there a specific weight to maintain after the surgery?

A: There is no specific weight, but it is advised to keep your body mass index (BMI) below 27.




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