Myths and Misconceptions About Gender Affirmation Surgery

Gender affirmation surgery, also known as bottom surgery or sex reassignment surgery (SRS), involves reconstructing the genitals of transgender individuals to match their gender identity. For transgender women, this means surgically constructing female genital structures like the vagina, labia, and clitoris.

Bottom surgery is a complex process that many people do not fully understand. Several persistent myths and misconceptions continue to surround this life-changing procedure.

Here, we will explore and debunk some of the most common myths and misconceptions about gender affirmation surgery for transgender women.


“It's Just a Hole”

One of the biggest myths is that after surgery, transgender women simply have a non-functional, cosmetic "hole" rather than a real, working vagina. This notion is completely inaccurate.

Using advanced surgical techniques, skilled surgeons are able to construct female genitalia that closely match the full aesthetics, dimensions, and functions of a natal vagina. The external structures of the vulva, including the labia and clitoris, are meticulously formed from existing male genital tissues.

The vaginal canal is expertly created using skin grafts and lined to emulate natural lubrication and sensation. While the aesthetics may vary slightly from person to person, the surgical results appear natural and integrate fully into the body.

The constructed vagina is not just a static hole, but a dynamic organ capable of accommodating penetrative sex, childbirth in some cases, menstruation, and the complex microbiological environment of a natal vagina. With proper aftercare, transgender women are able to enjoy full sexual and reproductive vaginal function.


Inability to Achieve Orgasm

Another myth speculates that transgender women are unable to experience orgasms after vaginoplasty. For most patients, this is simply not true.

When performed by a skilled, experienced surgeon, modern gender affirmation procedures preserve neurovascular bundles in the genital tissues. This allows for erotic sensation in the neoclitoris, vulva, and vaginal canal.

Many transgender women report experiencing clitoral orgasms, and even vaginal orgasms in some cases, for the first time after surgery.

Of course, loss of genital sensation is a risk with any surgery. Poor surgical technique can sometimes damage nerves and impair orgasmic capability.

However, when done properly, most gender affirmation procedures today allow patients to retain full erotic sensation and the ability to climax. Open communication with the surgical team helps ensure optimal functional results are achieved.


Penetration is Impossible

Some assume that transgender women are unable to have penetrative vaginal sex after bottom surgery. This depends greatly on the specific surgical technique utilized.

For most transgender women, surgeons perform a full-depth vaginoplasty. This meticulously constructs a vaginal canal similar in depth and width to that of most natal vaginas.

The full-depth technique employs skin grafts to create a capacious, durable vaginal lining able to comfortably accommodate an average penis, sex toys, or medical exams.

However, some patients may opt for a shallower, non-canal procedure. These zero-depth or minimal-depth techniques do not facilitate penetrative sex. But they are rare exceptions, not the norm. When performed by a highly qualified vaginoplasty specialist, full-depth surgery allows for penetrative vaginal intercourse in the vast majority of cases.


High Rates of Regret

Opponents of gender affirmation surgery often falsely claim that transgender patients come to regret having these procedures at high rates. In truth, studies consistently demonstrate that regret rates after vaginoplasty fall at around 1-2%. This makes regret an exceptionally uncommon outcome.

For most transgender women, bottom surgery dramatically reduces gender dysphoria and improves body image, sexual function, and overall well-being.

Extensive medical and mental health screening minimizes the small risk of adverse surgical outcomes. Post-operative regret is rare because candidates carefully consider and become certain of the permanence of surgical transition prior to undergoing irreversible procedures.

While a small minority may experience partial regret, the vast majority of transgender women report being highly satisfied with their surgical results and would make the same decision again. For these patients, gender affirmation surgery allows them to fully actualize their gender identities and finally feel at home in their bodies.


Unpleasant Vaginal Odor

Some wrongly assume that transgender women's neovaginas give off a strong, unpleasant odor. With proper aftercare and hygiene practices, this is not the case.

As with natal vaginas, following recommended vaginal health and hygiene guidelines helps maintain a normal, healthy vaginal pH and microbiome.

When transgender women care for their vaginas properly by gently washing the external vulva only and avoiding douching internally, there should be minimal odor. Any noticeable or unpleasant smell could indicate a hormonal imbalance or infection needing medical attention.


Hormones Are No Longer Needed

A common misconception proposes that transgender women no longer require hormone therapy after undergoing gender affirmation surgery. In reality, estrogen therapy should be continued even after bottom surgery is completed.

Testosterone blockers are usually discontinued after surgery removes the testes, which eliminates most endogenous testosterone production.

However, exogenous estrogen is still essential for transgender women's long-term health. Estrogen maintains female secondary sex characteristics, supports cardiovascular and bone health, and keeps the vaginal tissues healthy.

Abruptly ceasing estrogen post-operatively could lead to adverse effects like hot flashes, low energy, bone loss, vaginal atrophy, tissue breakdown, and emotional instability. Unless contraindicated for a specific medical reason, transgender women should remain on feminizing hormone therapy for life.


Permanent Loss of Libido

Some believe that bottom surgery will permanently eliminate transgender women's sex drive and libido. In truth, this outcome is rare when proper surgical techniques are used.

For some transgender patients, severe genital dysphoria may repress libido prior to transitioning. After this distress is resolved through surgery, sex drive often rebounds or even increases thanks to patients' new comfort with their genitalia. While pain and recovery time can temporarily suppress libido after any surgery, few transgender women experience a permanent loss once fully healed.

With the genital dysphoria resolved, many patients actually report improvements in libido, sexual satisfaction, intimacy, and overall quality of life after surgery. Their reconstructed anatomy finally aligns with their gender identity, allowing true sexual comfort and desire to emerge.



In conclusion, modern gender affirmation surgeries allow transgender individuals to fully realize their identities, free of debilitating dysphoria about the appearance and function of their genitals.

When performed by a qualified, experienced surgeon, procedures like vaginoplasty offer transgender women the chance to lead happy, authentic lives in bodies that match who they are inside. While surgical transition is not for everyone, it can profoundly benefit those for whom it is medically necessary.