How do gender-affirming surgeries work?

Dear Reader,  

Understanding health care can be complicated, especially if you’re not familiar with medical terminology. The very short answer to your question this yes, these types of surgeries do exist. The surgeries you reference are part of gender-affirming care (GAC). In addition to being available to support people navigate an often confusing and exclusionary health care system, GAC can support a diagnosis of gender dysphoria. This is a term used to describe the experience of great distress a person may feel due to their gender identity not matching their sex assigned at birth. GAC treatments can help a transgender or non-binary person “transition,” or live authentically in their gender identity.  

The gender-affirming surgeries you refer to are only one part of GAC. Services can range from social services, mental health care, hormonal treatments, and gender-affirming surgery. GAC is like a toolbox of resources: the tools someone chooses to use depend on their individual circumstances. 

What is gender-affirming surgery? 

Everyone approaches the idea of transition differently, based on their own circumstances. Some choose to have gender-affirming surgery, while others don’t. For example, some people experience severe gender dysphoria from having body parts typically associated with a certain sex (penis, vulva, breasts). These folks might consider pursuing gender-affirming surgery to help them feel more aligned with their gender identity.   

It’s important to note that although some people may decide to begin actively transitioning to align their body with their gender identity, no one chooses to be transgender. It’s not that they want to be another sex—they already are that sex and, they just weren’t assigned it when they were born because of the body parts they had. 

Can a surgeon construct a penis or vagina through gender affirming surgery? 

More commonly referred to as “bottom surgeries”, these are procedures that reconstruct the genitals and may help people feel more aligned with their gender identity. These include procedures that remove the reproductive organs and those that reconstruct an individual’s current anatomy to create a penis, vagina, or vulva.  

Can you experience sexual pleasure and masturbate after gender-affirming bottom surgery?  

The short answer is yes: most people can experience sexual stimulation and masturbate after having bottom surgery.  

Research shows that many people orgasm more and feel more aroused after having surgery than they did before. However, sexual pleasure isn’t only influenced by the body's physical capacity to be aroused—it's also shaped by mental health and personal history. Gender dysphoria is associated with low sexual desire in many transgender and non-binary people. The decrease in dysphoria after gender-affirming surgery can increase someone’s desire, arousal, and enjoyment of sex. Feeling more comfortable in your own skin can make a big difference when it comes to sexual pleasure and satisfaction, emotionally and physically. 

Although there are lots of non-penetrative ways to have sex (including oral sex, fingering, and mutual masturbation), many of the surgeries available allow people to have penetrative sex while preserving nerve tissue that contributes to pleasure.  

• During a vaginoplasty, a surgeon will use the nerve endings from the penis to construct the clitoris, so most people will still experience arousal from clitoral stimulation. However, the new vaginal canal isn’t self-lubricating, so lube will likely be your best friend when it comes to penetrative sex. Due to their anatomy, people who have had vaginoplasty can masturbate through clitoral stimulation or stimulate their prostate through vaginal or anal penetration.
• Since the results of a metoidioplasty are often too small for penetration, some people choose to have a phalloplasty if they want to have penetrative sex. However, people can’t always get erect on their own with the new penis. Therefore, using erectile sleeves three months after surgery or opting for a penile implant a year after surgery may be helpful. Even with the construction of testicles, scrotum, and a penis, it’s important to note that ejaculation won’t be possible given that the body can’t produce or store sperm.  

How can you address concerns about sexual experience after surgery?  

Depending on the surgery, there will likely be a recovery time of several weeks or months before you’re fully healed and cleared to have sex. Additionally, regaining sexual sensation in the genital area may take some time, so patience really is a virtue here! That said, although most people are happy with their sexual experience after undergoing bottom surgery, as with any procedure, there are still some risks. It’s possible to experience a loss of erotic sensation or have some pain during sex after these surgeries.  

If you’re interested in gender-affirming surgery but concerned about how it could impact your desire and pleasure, consider bringing this up with a surgeon or another health care provider. They can develop a surgical plan that’s focused on maintaining sexual sensation and help you work toward penetrative sex, if that’s the goal.  

Hope this helps!