5. How is gender affirming bottom surgery performed?
Penile Inversion: This method uses penile skin to create the neovagina, with the labia crafted from scrotal tissue. It offers sensation but lacks natural lubrication. Some variations provide added depth and partial self-lubrication.
Rectosigmoid Vaginoplasty: Intestinal tissue is used to form the vaginal lining, often combined with penile inversion when tissue is limited. Ideal for transgender women who started hormones early, it offers self-lubrication and is also used for cisgender women with short vaginal canals.
Non-penile Inversion (Suporn Technique/Chonburi Flap): This technique uses perforated scrotal grafts for the vaginal lining and penile tissue for the inner labia. It promises greater depth, enhanced sensation, and improved aesthetics.
Phalloplasty: This surgery uses a skin graft, typically from the forearm, thigh, abdomen, or back, to extend the neopenis to 5-8 inches. Forearm and thigh grafts offer better sensation, while back grafts leave subtler scars. Urethral extension uses graft tissue. A later surgery can add a penile implant for full erections.
Metoidioplasty: A simpler alternative to phalloplasty, this procedure repositions the HRT-elongated clitoris to resemble a penis. Optional enhancements include urethral extension using cheek or vaginal tissue and the Centurion procedure for added girth. Vaginal removal is optional. The resulting neopenis may have limited erectile and penetrative abilities.