Transfeminine Bottom Surgery

• Peritoneal Flap Vaginoplasty: This technique uses tissue from the abdominal lining to enhance vaginal depth and moisture—particularly helpful in primary or revision cases with limited existing tissue. When performed robotically with the Da Vinci system, the procedure offers greater safety and precision, allowing surgeons to securely suture the neovagina in place with enhanced accuracy and reduced complication risk.
• Penile Inversion Vaginoplasty: Uses existing genital tissue to create the vaginal canal and vulva.
• Vulvoplasty (otherwise known as zero depth vaginoplasty): Creates a feminized appearance of the external genitalia without forming a vaginal canal—offering a dimple but no depth. This approach avoids the need for lifelong dilation and carries a lower risk of complications, making it a great option for those not seeking receptive vaginal intercourse.
• Orchiectomy (Testicle Removal): Sometimes performed as a standalone or first-stage procedure, especially for those not pursuing full vaginoplasty right away.
• Hair Removal: We offer laser hair removal to eliminate genital hair prior to vaginoplasty or vulvoplasty, ensuring a smoother surgical field. Many patients also enjoy the aesthetic appearance that hair removal offers when paired with bottom surgery. 
• Revision Vaginoplasty: For patients who have undergone prior vaginoplasty and are experiencing complications such as scarring, sensation changes, or concerns with depth or aesthetics, our surgeons offer personalized revision plans. 
  
  Bottom surgery is often one part of a larger transition journey. Whether this is your first step or one you've envisioned for years, know you're not alone. Our team at The Center for Gender Affirmation supports all patients with compassion and clarity while providing world-class care. Our team of nurses, APPs, and patient navigators will be by your side the entire journey, ensuring close follow-up and availability to answer any questions day or night. 

Before
Before bottom surgery, you’ll meet with your surgeon to review your medical history, transition goals, and determine the most affirming procedure for you, whether that’s vaginoplasty or vulvoplasty. You’ll also complete labs, imaging, pre-surgical clearances, and mental health documentation. Our team will guide you through hair removal (if needed), insurance steps, and pre-op preparation, like bowel protocols or stopping certain medications. Most importantly, we’ll ensure you feel informed, supported, and emotionally and physically ready for this next step in your journey.

During the Procedure
Vaginoplasty creates a vagina using the tissue you already have. Your surgeon will recommend the best procedure for you based on your body, overall health, and desired outcome. During the procedure, a new clitoris is created using sensitive tissue so that sexual sensation can be preserved. The surgery is done under general anesthesia and usually takes several hours to complete.

Risks and Recovery
Most patients stay in the hospital for about 5 days and can resume basic activities like bathing and eating right after discharge, ideally with help at home for the first two weeks. Plan to take approximately 8 weeks off work, with energy and comfort levels around 75% by month two, 80% by month three, and full recovery typically reached by six months.

As with any surgery, there are risks—including bleeding, infection, scarring, or complications such as fistulas or strictures. Our microsurgeons use advanced, nerve-sparing techniques to reduce these risks and support long-term healing and function.

Travel and Accommodations 
Patients travel from across the country to receive care at our New Jersey locations. To simplify the journey, we offer virtual consultations and travel concierge support.

Insurance and Financial Planning
Bottom surgery is covered by many insurance plans, and our patient navigators will help secure pre-authorizations and explain financial options. No one should have to choose between safety and affordability.

Additional Resources
Looking for more information? Explore our Patient Resource Center for aftercare checklists, dilation guides, and downloadable prep tips.