Genital reassignment surgery, also known as gender affirmation surgery, gender surgery, or even sex change surgery, although the latter is not the most accurate term, is part of the medical process that some transgender people choose as part of their transition towards a bodily experience more aligned with their gender identity. Regardless of its name, it is a highly specialised procedure that involves profound physical, emotional, and social dimensions.
In this article, we explain what this type of surgery involves, the techniques currently available, and the most respectful and accurate terminology to use, in accordance with international guidelines such as those from WPATH (the World Professional Association for Transgender Health).
What Is Genital Reassignment Surgery?
Genital reassignment surgery refers to a set of surgical procedures designed to modify a person’s genitals to better align with their gender identity.
While the term “reassignment” has been used historically, today many professional organizations and trans individuals prefer terms like gender-affirming surgery or gender confirmation surgery. These reflect the aim of the intervention: to affirm an existing identity, rather than to assign a new one, as the word “reassignment” might suggest.
It’s important to understand that genital surgery is often just one part of a broader gender affirmation process, which may also include hormone therapy, additional surgeries, such as facial or body feminization or masculinization, psychological support, and social and legal changes. Each person’s journey is unique, individual, and non-transferable.
Types of Gender-Affirming Surgery
There are various gender-affirming surgical procedures depending on the sex assigned at birth and the individual’s goals.
Surgeries for Trans Women
Some of the most frequent feminizing surgeries for trans women include:
- Vaginoplasty: Reconstruction of a neovagina with erotic sensitivity and sexual function. Various vaginoplasty techniques exist depending on the physical characteristics of the genitalia, the woman’s goals, and her personal circumstances.
- Orchiectomy: Removal of the testicles, which may be performed as a standalone procedure or as part of vaginoplasty.
- Vulvoplasty: Construction of external female genitalia without a vaginal canal. This is often chosen by trans women who do not desire penetrative sexual intercourse.
Surgeries for Trans Men
Common masculinizing procedures include:
- Metoidioplasty: Elongation of the hormonally enlarged clitoris to create a functional neophallus that allows urination while standing.
- Phalloplasty: Construction of a penis using skin grafts from other parts of the body.
- Testicular implants
- Hysterectomy and vaginectomy: Removal of the uterus, ovaries, and/or vagina.
- Mastectomy: Removal of breast tissue to achieve a flatter chest. While not a genital procedure, it is often included under gender-affirming surgery due to its significant physical and emotional impact for many trans men.
Surgeries for Non-Binary Individuals
Non-binary individuals may seek gender-affirming surgeries typically associated with either trans men or trans women. The most common include bilateral subcutaneous mastectomy (also known as trans mastectomy) and vulvoplasty.
Why Use the Term Gender-Affirming Surgery?
Language plays a crucial role in shaping how we understand trans identities and gender journeys. The term “sex reassignment surgery” is based on a normative view in which the sex assigned at birth is given precedence, implying the surgery “reassigns” someone.
In contrast, terms like gender-affirming surgery, gender confirmation surgery, or trans genital surgery are more accurate and respectful. They recognize that gender identity is not created or imposed externally – it already exists. Surgery, when chosen, serves to affirm that identity physically.
WPATH, in its Standards of Care (SOC8) and IM GENDER, recommends using terminology that reflects this affirming, person-centered approach focused on self-determination and well-being.
Gender-Affirming Surgery Isn’t Always Necessary
Not all trans people want or can access genital surgery. This decision is deeply personal, and there is no single way to experience a gender journey.
Affirming one’s gender doesn’t always mean changing the body. It’s essential to avoid implying that such surgeries are “necessary to truly be a man or woman,” as this invalidates other equally valid and authentic trans experiences.
Replacing “Genital Reassignment Surgery” with “Gender-Affirming Surgery”
Understanding, respecting, and updating the language we use is a meaningful way to support trans people and promote a more inclusive, conscious, and just society. Avoid expressions like “sex change” or “they had surgery to become a man/woman,” “used to be a man/woman,” or “when they were a woman,” as these reinforce stereotypes and oversimplify complex realities.
Using current terms like gender-affirming surgery, trans surgery, or genital gender confirmation surgery is a way of showing respect to all individuals. It’s also important not to discuss these intimate procedures in a casual or invasive manner. Talking about someone’s surgeries without their consent can be disrespectful and intrusive.
Want to Learn More About Gender-Affirming Surgery and Available Procedures?
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