Male and female bodies

Male to female gender reassignment surgery is an umbrella term referring to a variety of medical procedures that treat gender dysphoria. For transgender women, gender reassignment surgery can have a monumentally positive impact on mental health.

While feminizing hormone therapy helps create female characteristics, many transgender patients opt for surgical procedures as well. There is no right or wrong way to transition. Undergoing any form of male to female gender reassignment surgery is a highly personal decision.

If you’re considering gender reassignment surgery, below you’ll find a guide outlining the most common procedures.

Bottom Surgery

Bottom surgery refers to surgeries that reshape and reconstruct male genitalia into female genitalia. There are three main types of bottom surgery: vaginoplasty, vulvoplasty, and orchiectomy.


During a vaginoplasty, your surgeon builds the inner and outer labia of the vagina by using skin from the penis and scrotum. They also use tissue from your foreskin to build a vaginal opening, create a clitoris with skin from your penis, and create a new urethra so you can urinate.

After a vaginoplasty, you stay in the hospital for about five days. For six months, you will have to dilate your vagina two to three times a day. This means inserting a lubricated dilator into the vaginal canal and holding it there for a set number of minutes. 


During a vulvoplasty, your surgeon uses tissue from the penis to create the external parts of the vagina (the clitoris, inner and outer labia, the vaginal opening). The main difference between a vulvoplasty and a vaginoplasty is the lack of vaginal canal. A vulvoplasty does not create a vaginal canal, so you cannot have vaginal intercourse after a vulvoplasty.

After a vulvoplasty, patients usually remain in the hospital for three days.


An orchiectomy is a procedure in which the testicles are removed. It is a much simpler procedure than a vaginoplasty or vulvoplasty and can even be done under local anesthesia. It only takes about 20 minutes. One benefit of orchiectomy is that your body will naturally produce less testosterone, so it may make your hormone regiment simpler.

Recovery is usually mild, although you may experience bruising or bleeding for a few days after surgery.

Other Procedures

Many people use the term gender reassignment surgery to talk exclusively about bottom surgery. However, there are many other procedures people undergo during a gender transition.

Facial Feminization Surgery

Facial feminization surgery includes a wide range of procedures that aim to create a more traditionally feminine face. While surgery is highly subjective to individual goals, it often includes reshaping the forehead, lips, cheekbones, jaw, and chin.

Breast Augmentation

While hormonal therapy can stimulate breast development, some transgender women may want to enhance their natural breasts more. Breast augmentation involves increasing breast volume using either fat transplants or implants.

Voice Feminization Surgery

Voice feminization surgery refers to two types of surgeries that raise vocal pitch. Anterior glottic web formation shortens the vocal cords, while cricothyroid approximation fixes cricoid cartilage to thyroid cartilage to lengthen the vocal cords. Both have the potential to create a higher pitch overall.

Tracheal Shave

A tracheal shave reduces the size of the Adam’s apple, often done as part of facial feminization surgery. The surgeon makes a small incision under the chin, folds back the muscles covering the thyroid cartilage, and then stitches up the incision.

Buttock Enhancement

Buttock enhancement refines the shape of the buttocks either through fat grafting or implants. For transgender women, this can help create an hourglass figure.

Frequently Asked Questions

This is a lot of information to parse through, and it’s understandableto have some questions. Below, we’ll cover some of the most common questions people have about female to male gender reassignment surgery.

How do I prepare for surgery?

That depends on the operation. With more intense surgery, like a vaginoplasty, you may need to refrain from eating or drinking before the operation. You may also be asked to make certain lifestyle changes, like quitting smoking or losing weight, prior to undergoing surgery.

However, for surgeries that require local anathesia, preparation will usually be milder. Talk to your surgeon about how to best prepare. Make sure to follow instructions carefully to avoid complications.

How long is the recovery?

Again, this depends on your choice of gender reassignment surgery. For a vaginoplasty or vulvoplasty, you will be in the hospital for a few days. You will also have to see a physical therapist for a number of weeks to ensure you’re healing properly.

However, less invasive procedures usually have shorter recovery times. With a tracheal shave, for example, you’ll just have to eat softer foods for a few days.

How do I find the right surgeon?

In genral, you want to work wtih a board-certified plastic surgeon with experience in the type of surgery you want. You can ask for referals from people in the trans community. You can also find informaton online from the World Professional Association for Transgender Health.

How do you choose between a vaginoplasty and a vulvoplasty?

There are benefits and drawbacks to both procedures, and it comes down to personal choice.

The main difference is that a vaginoplasty creates a vaginal canal, allowing for vaginal sex, while a vulvoplasty does not. Some transgender women may have no interest in vaginal sex, meaning a vulvoplasty makes more sense.

A vulvoplasty also carries a slightly lower risk for medical complications. Plus, the recovery is easier as you will not have to dilate your vagina after surgery.

However, if having vaginal intercourse is important to you, a vaginoplasty may be the better option.

How much does female to male gender reassignment surgery cost?

That depends on the type of operation you get. Costs are high, however, and can range anywhere from $35,000 to $40,000.  The good news is that more and more insurance companies are open to covering gender reassignment surgeries and procedures. Depending on your coverage, you may be able to get some or most of the costs covered.

Can I orgasm afterwards?

Yes! After both a vaginoplasty and a vulvoplasty, you will be able to acheive orgasm via clitoral stimulation.


Undergoing gender reassignment surgery can have myriad benefits for your mental health and overall well-being. However, it’s a major decision that requires careful thought and consideration. Everyone’s needs are different, and there is no right way to transition. It’s about deciding what is right for you and your body.

Ready to get started? Leif Rogers is an Ivy League-educated, board-certified plastic surgeon and a standing member of the American Society of Plastic Surgeons. If you’re interested in gender reassignment surgery, get in touch with his team to schedule a consultation.

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