The Art and Science of Feminizing Bottom Surgery

Introduction

Starting the process of becoming the gender one identifies with often includes a series of big changes. For many transgender women, having male-to-female bottom surgery to make their bodies look more feminine is a very important step. Feminizing bottom surgery also has many other names, like vaginoplasty, gender confirmation surgery, male-to-female (MTF) genital reconstruction, transfeminine bottom surgery, MTF bottom surgery, genital reassignment surgery, etc.

What Is Feminizing Bottom Surgery?

Feminizing bottom surgery is a medical procedure designed to create female genitalia for individuals assigned male at birth but who identify as female. Feminizing bottom surgery includes various surgical techniques, each tailored to meet individual anatomical and personal preferences. The prevalent method involves utilizing the penile inversion technique, where the penile tissue is repurposed to create a neovagina. The glans are transformed into a clitoral hood, preserving sensitivity. Non-penile inversion techniques, such as using the rectosigmoid colon (a section of the large intestine located near the rectum) or peritoneal grafts (tissue extracted from the peritoneum, which lines the abdominal cavity), may be considered based on specific anatomical considerations.

Why Is Transfeminine Bottom Surgery Done, and for Whom Is It Performed?

Transfeminine bottom surgery is performed to match an individual's physical characteristics with their gender identity. It constitutes a major stage in the gender affirmation process, helping transgender women feel more comfortable and authentic in their bodies. Meeting criteria from the World Professional Association for Transgender Health (WPATH) is necessary. This includes a professionally diagnosed and documented history of gender dysphoria, informed decision-making ability, and, in some areas, being 18 or older.

Good candidates for feminizing bottom surgery generally meet certain criteria:

• Candidates often experience significant gender dysphoria related to their genitalia.

• Surgeons often prefer individuals at least 18 years old and demonstrate emotional and psychological maturity.

• Candidates should be physically healthy to tolerate MTF bottom surgery and recovery.

• A complete mental health check-up ensures individuals have realistic expectations, understand the risks involved, and are emotionally prepared for the procedure.

What Are the Components of the Feminizing Bottom Surgery?

The surgery involves the creation of key components:

• Vaginal Canal - The primary focus is on crafting a functional vaginal canal with depth and width based on individual preferences and anatomical considerations.

• Clitoroplasty - This includes forming a neo-clitoris, emphasizing improved sexual satisfaction and aesthetic outcomes while preserving nerve endings for sensory pleasure.

• Labiaplasty - Constructing the labia majora and minora to achieve a natural appearance, emphasizing symmetry and aesthetic harmony in line with individual preferences.

Various surgical techniques that are used in the MTF bottom surgery include -

• Orchiectomy: It is the surgical removal of the testicles, eliminating the need for testosterone blockers and reducing estrogen requirements for a feminine appearance. It can be done alone or combined with scrotal skin reduction.

• Vaginoplasty: It creates female genitals and a vagina by removing male genital organs, crafting the vulva, adjusting the urethra, and forming a vaginal canal using penile and scrotal skin. Post-surgery requires regular vaginal dilations for maintenance.

• Vulvoplasty: It is similar to vaginoplasty and involves removing male genitals, forming the external vulva, and adjusting the urethra for seated urination. Unlike vaginoplasty, it does not involve creating a vaginal canal, eliminating the need for hair removal and vaginal dilations.

What Is the Surgical Procedure of Feminizing Bottom Surgery?

Before the Surgery

Before undergoing male-to-female bottom surgery, individuals undergo a thorough consultation with a gender-affirming surgeon. This involves a comprehensive assessment of both physical and mental health. Many individuals choose to undergo hormone therapy before surgery to induce secondary feminine characteristics, aiding in the overall transformation process.

Doctors may request medical records, letters of recommendation, a BMI below 35, no smoking or a commitment to quit, a support person during and after surgery, and genital hair removal before the MTF bottom surgery.

During the Surgery

On the day of surgery, patients receive general anesthesia before incisions are made according to the chosen surgical technique. The steps include the removal of penile tissue (if using penile inversion), creation of the vaginal canal, and clitoroplasty and labiaplasty. Together, these steps contribute to the formation of a neovagina.

After the Surgery

After surgery, patients remain in the hospital for postoperative monitoring to ensure proper healing. This period involves managing pain and discomfort, along with the temporary use of a catheter for urine drainage. A conformer is placed in the vagina for shape maintenance, drainage tubes may be inserted, and incisions are covered with bandages.

The postoperative phase also involves a diligent routine of dilation exercises to maintain vaginal depth and prevent stenosis. As time progresses, the frequency of dilation gradually decreases. Emotional support is necessary during this period. This entails the availability of mental health services and participation in support groups.

What Are the Benefits of MTF Bottom Surgery?

• Improved gender affirmation and social affirmation.

• A positive impact on mental health with reduced gender dysphoria, and an enhanced sense of self.

• The procedure could enhance the quality of life by enabling individuals to live more authentically and comfortably.

• Increased comfort with body image.

• For those opting for vaginoplasty, the creation of a functional neovagina can offer a more fulfilling and authentic sense of femininity.

• Transfeminine bottom surgery facilitates a closer alignment between physical appearance and gender expression.

• For some, the surgery positively affects intimate relationships.

What Are the Risks Associated With MTF Bottom Surgery?

• Complications like post-surgery infections, excessive bleeding, scarring, and nerve damage may occur.

• Alterations to the urinary system during surgery may lead to temporary or, in rare cases, persistent urinary problems.

• The breakdown of recently formed vaginal tissue may lead to necrosis in some cases.

• Surgery may impact sexual function, including changes in arousal, orgasm, and erectile function.

• A vagina that is insufficiently deep or small for intercourse.

• Vaginal stenosis, which denotes the closure or narrowing of the vaginal opening, may occur.

• The development of a passage between the rectum and vagina, termed rectovaginal fistula, may occur.

• Some individuals may experience psychological challenges, like post-surgery adjustment and potential regrets.

Conclusion

Getting feminizing bottom surgery is a big change that affects the body and feelings. People can make better choices about changing their bodies to match their gender by learning about the process, the risks, and how they might feel. This can help them feel more in control of their decisions. It is important to be patient and resilient and have people supporting this journey. Everyone's experience is different. In the big picture, surgery to make a person's bottom look more like a woman's is an important part of helping transgender women feel good about themselves and their bodies.