Gender-affirming genital surgery

    Gender-affirming genital surgery includes procedures that alter genital anatomy according to a person’s goals. Options differ in appearance, sensation, urinary function, sexual function and aftercare. Surgery is optional, and no technique can guarantee every desired outcome.

    Last reviewed: November 20265 sources

    What you may notice

    • Goals involving genital appearance
    • Interest in standing urination or penetration
    • Questions about sensation or sexual function
    • Concerns about fertility or donor-site scars
    • Questions about long-term care

    Why it can happen

    Goals and experiences of gender incongruence vary. Surgical suitability depends on existing anatomy, health, previous treatment and the desired functions. Some options involve several operations, and choices can affect fertility, hormone needs and future procedures.

    What may help

    Options include vaginoplasty, vulvoplasty, metoidioplasty and phalloplasty, with selected additional procedures. Vaginoplasty creates a canal and generally requires ongoing dilation; vulvoplasty does not create a canal. Urethral lengthening and implants add specific risks. Preparation should address fertility, any required hair removal and practical aftercare. Removal of both testes or ovaries requires a long-term hormone and bone-health plan.

    When to consult

    Consult an experienced gender-affirming surgical team for technique-specific outcomes, complications and follow-up. After surgery, inability to pass urine, heavy bleeding, fever, rapidly worsening pain or concerning tissue colour changes requires urgent assessment. Persistent urinary or dilation problems also need review.

    Related options

    2 options

    Surgical procedures

    Evidence and sources

    1. Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022;23(Suppl 1):S1-S259. doi: 10.1080/26895269.2022.2100644.
    2. American Society of Plastic Surgeons. Gender surgeries [Internet]. Arlington Heights (IL): American Society of Plastic Surgeons; [cited 2026 Nov 7]. Available from: https://www.plasticsurgery.org/reconstructive-procedures/gender-surgeries
    3. UCSF Gender Affirming Health Program. Genital surgical procedures [Internet]. San Francisco (CA): University of California, San Francisco; [cited 2026 Nov 7]. Available from: https://transcare.ucsf.edu/genital-surgical-procedures-vaginoplasty-orchietcomy-and-phalloplasty
    4. UCSF Gender Affirming Health Program. Vaginoplasty procedures, complications and aftercare [Internet]. San Francisco (CA): University of California, San Francisco; [cited 2026 Nov 7]. Available from: https://transcare.ucsf.edu/guidelines/vaginoplasty
    5. UCSF Gender Affirming Health Program. Phalloplasty and metoidioplasty: overview and postoperative considerations [Internet]. San Francisco (CA): University of California, San Francisco; [cited 2026 Nov 7]. Available from: https://transcare.ucsf.edu/guidelines/phalloplasty