Feminizing bottom surgery is a procedure that allows your physical body to match your gender identity. It reconstructs organs in the male reproductive system into parts of a vulva and possibly a vagina. Recovery can take up to several months.
Feminizing bottom surgery is a surgical procedure that transforms and reconstructs some of the organs in the male reproductive system into parts of the external (outside) female reproductive system (vulva). The vulva includes:
Feminizing bottom surgery may or may not include creating a vaginal canal (vagina).
Feminizing bottom surgery has many other names. Other names for the procedure include:
Getting feminizing bottom surgery is a personal decision. You may feel a disconnect or emotional distress between your assigned gender and gender identity (gender dysphoria). Getting feminizing bottom surgery can help affirm your gender identity and ease gender dysphoria.
Experts estimate that 5% to 13% of transgender women get feminizing bottom surgery.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
First and foremost, it’s essential to find trusted, experienced healthcare providers and hospital systems. But how do you find providers and hospital systems you can trust? The following can help:
Providers that can help you understand the risks, benefits and steps you must take before feminizing bottom surgery include:
You must also meet the criteria from the World Professional Association for Transgender Health (WPATH). This includes:
Your providers may also require the following:
Tell your provider about any ongoing medical concerns so they can help you plan for feminizing bottom surgery. Detail any prescription or over-the-counter (OTC) medications you’re taking, including herbal supplements. Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol®), blood thinners (anticoagulants) and certain herbal supplements can increase your risk of bleeding.
You should also tell your provider about any allergies you have. These include allergic reactions to:
The healthcare providers on your feminizing bottom surgery team generally include:
Shortly before feminizing bottom surgery, your anesthesiologist will give you anesthesia, so you aren’t awake and won’t feel any pain.
Once you’re asleep, your surgical team will:
It depends. Feminizing bottom surgery is a delicate procedure that takes a lot of time. Your body is unique, and the different techniques that make up the surgery can be complex. On average, it takes about five hours. But it’s a good idea to ask a healthcare provider. They can give you a better estimate according to your situation.
After feminizing bottom surgery, if you want a vagina, your surgeon will place a conformer into your vagina. A conformer is a medical object that helps your vagina keep its shape as you heal. They may also place drainage tubes to help drain any blood or fluid. A healthcare provider will then cover your incisions with bandages.
Your anesthesiologist will stop putting anesthesia into your body to keep you asleep, and you’ll move into a recovery room. In the recovery room, providers will wait for you to wake up and monitor your overall health.
Once your healthcare providers believe it’s safe, they’ll discharge you (let you go home). Most people must stay in the hospital for at least a few days after feminizing bottom surgery as they heal.
One of the main benefits of feminizing bottom surgery is it helps you achieve your desired physical gender identity. Studies show that other benefits may include reductions in:
Feminizing bottom surgery risks include:
The odds of these complications are rarer if you’re under the care of experienced healthcare providers in a hospital that regularly performs feminizing bottom surgery.
Other general surgery risks include:
You’ll have some pain and discomfort after feminizing bottom surgery. But the pain is rarely unbearable. Many people manage their pain with prescription and over-the-counter pain medications. The first several days after surgery are often the most painful.
Most people spend at least a few days at the hospital. But your stay can last up to a week. After about a week, your pain and discomfort should decrease.
You won’t be able to sit down or lie on your stomach for at least two weeks. So, you’ll need to stand rather than sit and sleep or lay on your sides or back. Your providers will tell you how much walking to do to help with your recovery. Typically, you should have a limit of 3,000 steps per day the first several weeks after the procedure to promote healing and reduce complications.
It’s important to remember that your body is unique, so your recovery time might be different from others. Follow your healthcare provider’s instructions on managing pain or discomfort as you recover.
Studies show that most people who get feminizing bottom surgery are happy with their appearance and functionality after the procedure.
Under the care of an experienced surgeon, your outlook for having feelings in your vagina and vulva — including sexual pleasure in your clitoris — is good.
Schedule regular follow-up appointments with your healthcare provider. They’ll check your incisions and remove your bandages, drainage tubes and any stitches. They’ll also check to see how well the area is healing.
During your recovery, it’s important to use vaginal dilators. Vaginal dilators are tube-shaped devices that you insert into your vagina to help stretch the tissue gradually. Healthcare providers will teach you how to use them. They’ll also give you instructions on how often to use them.
Your providers won’t remove your prostate during feminizing bottom surgery. So, you should schedule regular prostate exams starting at age 50. If you’re at a higher risk of getting prostate cancer, you should schedule regular exams beginning at age 45.
It’s also important to continue working with a therapist or counselor after feminizing bottom surgery. For many people, surgery is only one step in the process. A therapist or counselor can help discuss potential causes of stress to your mental health. This may include adjusting to new genitals and any recovery setbacks.
Depending on your job, you should be able to return to work a few weeks after feminizing bottom surgery. It’s a good idea to take even more time off work if you have a more physically demanding job.
Contact your healthcare provider immediately if you experience any of the following:
Talk to your healthcare provider. The cost may depend on:
A patient financial coordinator may be able to help estimate the cost of the procedure and discuss whether you’re eligible for government or other financial assistance programs.
Yes, you can typically have vaginal intercourse three months after recovering from feminizing bottom surgery. During the vaginoplasty, your healthcare team will make sure your vagina has a good enough size and depth to allow for intercourse.
A note from Cleveland Clinic
Feminizing bottom surgery helps affirm your gender identity. Not every person who has gender dysphoria wants feminizing bottom surgery. But for some, it can ease emotional and psychological distress, boost your self-confidence and have other positive effects on your life. It’s important to find providers with a lot of experience with this type of surgery and work with a mental health provider before and after the procedure. Working with trusted providers makes you more likely to be happy with your results.
Last reviewed by a Cleveland Clinic medical professional on 11/14/2023.
Learn more about our editorial process.