DIRECTO EN INSTAGRAM: 26 de junio, a las 19 h, "Hablemos de cirugía de afirmación de género" con el Dr Ivan Mañero. / 3 de julio, a las 13h, "Sexualidad después de la vaginoplastia" con la Dra. Labanca.

DIRECTO EN INSTAGRAM: 26 de junio, a las 19 h, "Hablemos de cirugía de afirmación de género" con el Dr Ivan Mañero. / 3 de julio, a las 13h, "Sexualidad después de la vaginoplastia" con la Dra. Labanca.

MTF bottom surgery

Transgender genital surgery, also known as sex reassignment surgery, can be done employing multiple approaches which facilitate the modification of the genitals to align with the gender identity of the transgender individual.

At IM GENDER, we are specialists in the three different MTF bottom surgery procedures, such as penile inversion vaginoplasty, penile inversion vaginoplasty with graft and colovaginoplasty. We will explain to you all the details about these surgical operations.


At our sex reassignment clinic, we have the latest tools and technologies to carry out transgender vaginoplasty to the most exacting standards of excellence and safety. Our team has a wealth of skill and an extensive background in performing this surgery.

Moreover, we acknowledge the diverse sexual inclinations that transgender individuals might have, which is why we also provide vulvoplasty, an alternative that delivers the same aesthetic and sensitivity as vaginoplasty but without forming a canal. In addition, we are perpetually integrating new concepts and technologies. As such, we are knowledgeable about the recent developments in MTF bottom surgery.

Request an appointment

    Types of feminizing bottom surgery

    When considering genital affirmation surgery or vaginoplasty, our medical team carries out a thorough evaluation. We classify cases into three main techniques:

    • Penile inversion vaginoplasty 

    This technique is suitable for individuals with an adequately sized, thick and high quality penile skin. By inverting the penile skin, we create a functional vaginal canal of appropriate width, allowing for regular sexual intercourse.

    • Colovaginoplasty 

    In cases where the penis is small, previous circumcision has occurred, or penile development has been impeded by hormonal inhibitors during prepuberty, we recommend colovaginoplasty. This technique provides a deeper neovagina and is perfect for those seeking a fulfilling sexual experience.

    • Penile inversion vaginoplasty with graft 

    When the penile dimensions are not suitable for successful penile inversion, but colovaginoplasty is not required, vaginoplasty with a skin graft is an alternative. This technique ensures the creation of a neovagina with appropriate depth and dimensions, without employing the rectosigmoid flap technique.


    After MTF bottom surgery, you will stay at the clinic for at least a week to ensure proper recovery and receive necessary care under the supervision of our experienced surgeons.

    During the recovery process, proper wound care and dilation are crucial. Starting from the third to seventh day after the procedure, a member of our medical team will guide you on the dilation and washing technique. You will be provided with dilators of different sizes and a vaginal washing kit, which should be used as instructed by the doctor, typically on the day of discharge.


    Although complications are rare, it is essential to be aware of potential issues and take necessary precautions. Our medical team will provide instructions on preventing complications, and in case any abnormalities or concerns arise, you should consult your doctor for proper diagnosis and resolution. Common complications include:

    • Wound dehiscence.
    • Urinary tract infection (while the catheter is in place) and local infections.
    • Changes to sexual sensation.

    If you have any doubts or discomfort, do not hesitate to reach out to your referring surgeon or our patient care team, available through a 24 hour phone line.


    It is normal to want to know what the result will be like after the surgical procedure. MTF bottom surgery offers the possibility of achieving a natural looking vagina with the ability to urinate. Depending on the chosen technique and the individual’s specific case, sexual penetration may also be possible.

    However, it is important to note that not all cases allow for penetration, and a personalised approach is necessary to determine the most suitable surgical technique for each patient.

    MTF bottom surgery results

    At IM GENDER, we get that it is important to see real life examples of MTF vaginoplasty results before making any choices. In these photos, you can check out actual cases of people who have been treated at our clinic. This way, you can get a feel for what is possible and it will help you make a fully informed decision.

    How to prepare for bottom surgery

    For some transgender women, having a vaginoplasty can be a really important and big step in their transition, but for others, it might not be something they need to do.
    Before going ahead with vaginoplasty surgery, our plastic surgeons will work out if the surgery is a good fit for each person. We will take a look at things like how healthy you are, your medical history and talk through all the options.

    You will need to get a blood test done at least 3 months before the vaginoplasty surgery. Watching what you eat and giving your insides a good clean out is also a must. Plus, it is important to give alcohol, smoking, and drugs a miss for a month before the procedure. If you do not, it could be bad news for your health and make any problems after the surgery worse.

    Also, you should know that you do not usually have to stop taking oestrogen before the bottom surgery. When it comes to other medications like cyproterone, spironolactone, and triptorelin, experience has shown you do not need to stop taking them. You can keep taking them right up until the operation. You will be advised to stop taking them completely one or two weeks after the vaginoplasty. Lastly, while you are at the clinic, just keep in mind you will have a urinary catheter in place.
    When you see your surgeon, he will explain everything and clear up any questions that might arise.


    What is MTF bottom surgery?

    Male to female bottom surgery is a transgender genital surgical operation performed on trans women to align their physical appearance with their gender identity. The surgery aims to create a neovagina, resembling the appearance and functionality of a cisgender woman’s vagina. It involves the construction of essential structures such as labia majora, labia minora, clitoris and vaginal canal. The procedure may make use of penile and scrotal skin, preserving the sensitive nerves, and creating a clitoris and labia minora. The ultimate goal is to enhance aesthetics, sensitivity, and functionality, allowing for sexual pleasure and urination.

    Does this kind of surgery require hospital admission?

    Yes, for trans vaginoplasty, you will be admitted to IM CLINIC one day before the gender affirming surgery. During this time, relevant tests will be done, and bowel cleansing will be performed using laxatives and antibiotics. Bowel cleansing is essential due to the proximity between the intestine and the newly created vagina.

    Can I have children after male to female bottom surgery?

    If you wish to have children after undergoing transgender vaginoplasty, you may consider sperm cryopreservation before the plastic surgery. This allows for future options and family planning.

    Is sensitivity retained after trans vaginoplasty?

    Yes, sensitivity is preserved and enhanced after transgender vaginoplasty. Surgeons take great care to retain and recreate sensation in the neovagina and surrounding areas. The clitoris, constructed using the sensitive glans tissue of the penis, often retains its sensory function. Sensitivity varies from person to person, and it takes time for nerves to heal and sensation to fully develop after surgery.



    After surgery, you should maintain your usual diet, placing importance on high fibre consumption to alleviate the common occurrence of initial constipation.

    Urinary catheter

    Expect to have a urinary catheter for approximately 4 to 6 weeks. Alternate the leg on which the catheter is attached each day to prevent complications.


    Engage in relative rest, avoiding excessive physical exertion and overloading your legs. Short walks are recommended, but avoid strenuous activities.


    Dilations play a crucial role in your recovery. During the first month, perform vaginal douching before each dilation session as instructed by your doctor.


    Consult your surgeon regarding the appropriate time to resume physical activities. The medical team will provide guidance on the best activities.


    Attend all postoperative visits as scheduled. The treatment plan will be personalised based on your specific case and the surgical technique used.

    IM GENDER Team

    At IM GENDER we have been specialising in the care of transgender people for more than 20 years. Two decades of experience, professionalism, research and training endorse our medical team and staff.

    How much does MTF bottom surgery cost?

    The price of the feminizing genital surgery depends on the kind of surgery and the different treatments are combined. Don’t hesitate to contact us or ask for an appointment for further information and advice.