Surgery to create male genital organs

Masculinizing "bottom" surgery refers to reconstructive surgery to create male genital organs (penis and/or scrotum) in people who were assigned female at birth. Some or all female reproductive organs may be removed, depending on a person's goals for gender affirmation.

The decision to pursue masculinizing genital surgery is highly personal; the procedure may not be for all people who experience gender dysphoria.

If you are a transgender or gender-expansive person who desires masculinizing genital surgery, there are many options to consider based on your goals. It is important to discuss your specific goals with a surgeon trained in masculinizing bottom surgery techniques. Depending on your goals, different surgical techniques may be offered.

Metoidioplasty

Metoidioplasty is the surgical construction of a small penis from a hormonally enlarged clitoris. The penis is usually about one to three inches in length; this usually does not allow for penetrative intercourse. However, sensation and orgasmic function usually are retained.

During surgery, the clitoris is released from its suspensory attachments, allowing it to lengthen and lower to the position of a penis. If desired, the urethra can be extended through the released clitoris using a graft (usually taken from the lining of the mouth). This allows a person to stand to urinate.

Phalloplasty

Phalloplasty is the surgical creation of a penis. This can be a multistage surgery involving different surgeons, such as urologists and plastic surgeons.

To create a penis, a large area of donor skin, or flap, is taken from another area of the body, such as the arm or thigh. This leaves a large scar where the skin was removed.

The flap is rolled into the shape of a penis and secured into position above the clitoris. Blood vessels in the flap are connected to blood vessels in the groin, to provide the penis with a blood supply. Nerves also are reconnected to try to provide the penis with sensation. The urethra also can be lengthened and connected to the flap so that during urination, urine comes out of the tip of the penis. This allows a person to stand to urinate.

After surgery, a catheter is inserted to carry urine from the bladder out of the body and away from the newly constructed penis while it heals. Recovery after phalloplasty is longer than with other gender-affirming surgeries due to the increased complexity of the procedure. Surgical complications can be high.

Additional masculinizing procedures performed with phalloplasty

Other masculinizing surgical procedures that can be performed with phalloplasty include:

  • Creation of a glans (glansplasty) for a more circumcised look
  • Placement of a penile prosthetic implant to allow for penetrative intercourse
  • Creation of a scrotum (scrotoplasty) from the labia majora; after healing, testicular implants can be placed in the scrotum for a more natural look

Surgery to remove female sexual organs

Other masculinizing bottom surgeries include removal of internal female sexual organs. Some of these procedures may be required before phalloplasty and include:

  • Hysterectomy—surgical removal of the uterus and cervix
  • Oophorectomy—surgical removal of one or both ovaries, often with removal of the fallopian tubes
  • Vaginectomy—surgical removal of the vaginal lining and closure of the vaginal canal

Gender-affirming surgery at Main Line Health

Masculinizing bottom surgery is available at Main Line Health through the Comprehensive Gender Care Program. If you are interested in bottom surgery, a consultation will be scheduled with our plastic and reconstructive surgeon. During this consultation, your goals will be discussed and a surgical technique will be recommended. 

Before requesting a consultation, we recommend that you review the eligibility criteria for masculinizing bottom surgery.

To learn about gender-affirming surgical options offered at Main Line Health or to schedule an appointment with a gender care surgeon, please call 484.337.5329 for a consultation.