What is 'Bottom' surgery? Bottom surgery or gender affirmation surgery (also known as gender affirming surgery or gender reassignment surgery) is an option for trans women. There are three surgeries that can help a patient surgically transition from being a man to a woman. They are: vaginoplasty, vulvoplasty, and orchiectomy. VAGINOPLASTY During a vaginoplasty surgery, a surgeon creates both an outer and inner vagina by using skin and tissue from a penis. Your surgeon will use skin from the penis and scrotum to build the inner and outer labia of the vagina Your surgeon will create a new opening for the urethra (so you can urinate) Your surgeon will use tissue from your foreskin to build the new opening of the vagina (also called the introitus). VULVOPLASTY The vulva is the outside part of the vagina. A vulvoplasty is a type of surgery that uses skin and tissue from a penis to create all of the outside parts of a vagina (except for the vaginal canal). The steps of a vulvoplasty are the same as a vaginoplasty. During a vulvoplasty, your surgeon will: create a clitoris out of the glans (or head) of the penis, create an inner and outer labia from skin on the penis and scrotum, create the opening of the urethra so you can urinate, and create the introitus (opening of the vagina). The only thing that’s different between a full vaginoplasty and a vulvoplasty is the internal part of the vaginal canal. Vaginoplasty creates a vaginal canal. Vulvoplasty creates all the parts of a vagina except for the vaginal canal. After vulvoplasty, this means you won’t be able to have intercourse or insert a penis into your vagina. ORCHIECTOMY Many transgender patients choose to start their surgical transition process with an orchiectomy. Orchiectomy is a procedure where a surgeon removes the testicles. For transfeminine patients, having an orchiectomy may also make your hormone regimen simpler later on. That’s because after the testicles are removed, the amount of testosterone (or male hormone) that your body makes drops to almost zero. By dropping the amount of testosterone that’s produced by your body, you may be able to take less estrogen. Taking less estrogen may also lower your chances of developing blood clots and other health problems that may be associated with high doses of estrogens. Hormones can be complex. It’s best to talk with your doctor who’s prescribing your hormones before you have an orchiectomy so that you understand exactly how your hormone therapy will change after surgery.