Male to female gender affirmation surgery, also known as, gender confirmation surgery, refers to the surgical process of creating female genitalia for an individual assigned male genitalia at birth.

Innovations in the field of medicine means there are now a range of effective procedures available to surgically create a penis or vagina. For a transman looking for surgery aimed at creating neophallus (meaning “new penis”), the following two techniques are the most common: Metoidioplasty and Phalloplasty. The choice of which method is utilized is dependent on the individual’s unique requirements and situation.

Metoidioplasty is a form of surgery that uses tissue from the clitoris that has been enlarged through hormone therapy to create a microphallus. Hence, for best results, those wishing to undergo this procedure must first have received continuous testosterone therapy for at least a year and be in possession of a clitoris measuring at least 3cm in length. The aim is to enable individuals to urinate while standing, but they will not be able to engage penetrating sexual activity due to size (5 – 7cm in length in most cases). Those looking to achieve the latter objective should instead consider phalloplasty.

Phalloplasty is a procedure aimed at creating a neophallus that is similar in size to that of a regular erect penis. The procedure involves transplanting tissue from the arm, leg, abdomen, or groin for use in creating the neophallus to enable both urination while standing and intercourse. The surgery may be the patient’s first procedure or take place following successful metoidioplasty.

An orchiectomy is a procedure used in a transwoman and involves removing the testicles, which are responsible for sperm and testosterone production. Scrotoplasty, on the other hand, is a procedure used in a transman by creating a scrotum-like organ that closely represents that found in male genitalia.

The aim of an orchiectomy procedure is to remove the testicles, so that sperm is no longer produced and to reduce testosterone production, which can remove the need for testosterone suppression therapy, and decreasing the amount of estrogen medication required thereafter. Some patients have this surgery to enable what is known as ‘genital tucking.’ This procedure could be performed at the same setting with vaginoplasty. Additionally, orchiectomy procedures have been found to help in preventing testicular cancer, prostate cancer, and male breast cancer.

Vaginoplasty is a form of surgery used to help transition of a transwomen, with the aim of providing them with a female-like sexual organ to enable sexual intercourse. There are numerous techniques used to achieve this. The doctor in charge of treatment is

responsible for discussing which procedures to use depending on the individual needs, the amount of existing genital tissue, and their history of genital surgeries.

The most popular forms of Vaginoplasty currently used are as follows:

· Penile skin inversion with scrotal skin graft extension is one such standard procedure.

· Colonic vaginoplasty involves using a small part of the colon. This procedure is suited to individuals whose existing tissue is not adequate, but a deeper vaginal cavity is desirable. Alternatively, this surgery can be used to correct an initial surgery that caused neovaginal stenosis.

· Peritoneal vaginoplasty is a procedure previously only used to treat women born without a vaginal cavity, although this technique is now used in sex reassignment surgery.

· Thigh or groin skin graft vaginoplasty is used in cases where only slight expansion of the vaginal cavity is necessary, where the existing genital tissue is insufficient, or in patients looking to avoid grafting from the abdomen.