Gender Affirmation Surgery

Genital surgical procedures for male to female patients include:

  • Orquidectomy: resection of testicles
  • Penectomy: resection of the penis
  • Vaginoplasty: construction of the neo vagina
  • Clitoroplasty: construction of the clitoris
  • Labioplasty: construction of the lips


Techniques include inversion of the skin of the penis, colon vaginoplasty and skin grafts to cover the neovagina. Sexual sensation is an important goal in vaginoplasty, along with the creation of a functional and aesthetically acceptable vagina.


Surgical complications of MtF genital surgery may include total or partial necrosis of the vagina and lips, fistulas from the bladder or bowel to the vagina, stenosis of the urethra, and vaginas that are too short or too small for intercourse. While surgical techniques for creating a new vagina are functional and aesthetically excellent, anorgasmia has been reported in some cases worldwide following the procedure, and a second stage of vaginal lip reduction may be aesthetically necessary.

Average time: 4 hours

Type of anesthesia: Epidural + sedation




  • Adult age
  • A true transsexual with gender dysphoria
  • Surgery recommended by 2 mental health specialists trained in gender identity issues.
  • Emotionally stable
  • Medically healthy with any medical conditions being treated and under control.
  • Living as a female 24 hours a day at least for one year in a row.



  • Support of spouse, family, significant other, friends
  • Economically stable

Frequently asked questions:

¿How long will it take me to recover from vaginoplasty?

After spending a week in the hospital, you will need to stay in Cali for at least 2 weeks.


¿When can I go back to work after a vaginoplasty?

Most people return to work after vaginoplasty in about 4-6 weeks.  You can resume strenous work and exercise in 6-8 weeks.


¿How often should I dilate?

Our recommended dilation schedule is as follows:

Week 1 – Week 6: 3 times a day

Week 7 – Week 9: 2 times a day

Week 10 – Week 12: 1 times a day

Week 13 forward: dilation or intercourse a minimum of once or twice a week for the rest of your life.


¿What about orgasms?

Most if not all our patients are able to have orgasm following a vaginoplasty. Some people experience orgasm within several months to a year and a half.


¿What do dilators look like?

The dilators have a shape like a candle but they come in different sizes from small to large.  When dilating, you should use the largest dilator which fits comfortably in the vagina.  You can use any other type of dilator, dildo, or vibrator as long as it fits comfortably into the vagina and does not cause pain or injury to the tissues.


¿Do I need to douche?

Following removal of vaginal packing, 1 week after surgery, we recommend douching every other day for the first three weeks, and then once or twice weekly to keep the vagina fresh and free of abnormal bacteria.  Remember that the lining of the vagina is normal skin and this has a different PH and different natural bacterial flora than natal vaginal mucosa.


¿ How long will it take for my scars to go away?

Scars never disappear.  All scars are permanent.  It takes about one year for scars to heal completely and during the first few months they are usually pink or reddish and sometimes tender and raised, but between six months and a year they usually become flat, white and soft and are barely visible by 8-12 months after surgery.


¿What weight do I have to be to have surgery?

We don’t require any specific weight but strongly recommend that you be as close to your ideal weight as is reasonably possible.  It is recommended that your body mass index (BMI) is below 27.

Being near your ideal weight will reduce the chances of complications and will help in the aesthetic result.


¿What’s required if I smoke

It’s important that you stop smoking for several weeks before and after surgery (at least two weeks) or you risk complications associated with non-healing.  Smoking causes long-term constriction of blood vessels which will decrease the amount of blood required to heal your incisions.  There is a significant increase in complications such as wound break down, infection, bad scarring, etc. in people who smoke.


¿ What hair removal is required or necessary?

Hair removal from the scrotum prior to MTF is preferable.   The scrotal skin is used to add to the length of penile skin to increase depth of the vagina.  If hair is left on the scrotal skin, it can continue growing inside the vagina and it will be more difficult to keep the vagina clean.  Normal skin shedding can accumulate on the hairs and bacteria can also accumulate eventually causing possible inflammation and infection.  Also, with dilations and intercourse, some of the hairs can break off and wind up high up into the apex of the vagina, occasionally causing formation of a “hair ball” which can result in chronic irritation and infection.

For this reason, it is always good to have at least one or two speculum vaginal examinations by your doctor, gynecologist, or surgeon each year to make sure the vagina is healthy and free of hair balls.  We recommend starting hair removal several months prior to surgery.  Laser hair removal works well on hair that is dark with skin that is light.   However, if the hair is light or the skin is dark, then electrolysis is recommended.  Treatments should occur every 4-6 weeks for about 4-6 months prior to surgery.


¿ Do I have to be on hormones for FFS or Breast augmentation?

Patients who desire either FFS (facial feminization surgery) or chest reconstruction (breast augmentation), do not have to be on hormones or have letters from mental health specialists.  However, in the case of breast augmentation, we feel it is beneficial for a patient to be on hormones for about 6 months to see what amount of breast development results from hormone therapy before having breast augmentation.