Understanding Vulvoplasty

Vulvoplasty is a type of gender-affirming surgery. This procedure creates the outer female genitals, called the vulva. The vulva includes the clitoris and the inner and outer labia. This procedure is like a vaginoplasty, except that no vagina is made.

During this surgery, the male genitals (penis, testes, and scrotum) are removed. Tissue from these is then used to create the vulva. This surgery is also called a female bottom surgery.

Why vulvoplasty is done

A vulvoplasty creates the outer female genitals. This surgery can be helpful for transgender women and gender nonbinary people who want their genitals to match their gender identity.

This surgery does not create a vagina or vaginal canal. Because of that, it may be an option for people who:

• Want to have the look of female genitals, but don't want a vagina

• Don't want to have vaginal sex

• Want to have a clitoris that provides sexual sensation

• Can’t have a vaginoplasty due to their health history (such as past radiation treatment in the pelvic area or severe urinary problems)

• Don't want to have the lifelong care needed after a vaginoplasty, such as vaginal dilation and douching

• Want to be able to pee while sitting down

Fertility issues: Freezing your sperm

It’s important to know that after a vulvoplasty, you will not be able to have a child. This is because the testes are removed during the procedure. The testes are where sperm is made.

If you think you may want to have children, you may be able to freeze your sperm in a sperm bank. This must be done before the surgery. Talk with your healthcare provider to see if this is an option for you.

Before you have gender-affirming surgery

Before having any type of gender-affirming surgery, you may be advised that it is helpful to see a mental health provider.

You may need to:

• Be age 18 or older

• Have hormone therapy for at least 6 months before surgery

These guidelines are from the World Professional Association for Transgender Health (WPATH) Standards of Care. Most insurance companies require people to meet these standards before starting any treatment.

Talk with your healthcare provider, plastic surgeon, and insurance company to find out what’s required in your case.

A personal choice

Choosing how and when to transition is a very personal decision. There are many ways to transition. Surgery is just one option. Not all trans people want or are able to have surgery.

Cost can be a major issue. This surgery may not be fully covered by your health insurance. Talk with your healthcare provider about your own personal situation and needs.