When a trans woman begins researching genital feminization surgeries, she often comes across complex terminology, contradictory opinions, and content that doesn’t always answer what she truly needs to know. At IM GENDER, we believe that a correct decision must be based on clear information and proper guidance.
This article was created with that purpose: to offer you a simple yet rigorous overview of the main genital affirmation techniques for trans women. There are different techniques, each with its own possibilities and limitations, and the goal is to find the one that best matches your anatomy, as well as your way of experiencing femininity and sexuality.
Definition of Genital Feminization Surgery
Genital feminization surgery is a series of surgical procedures aimed at modifying male genitalia to create female genitalia, both in appearance and function. Through this, many trans women feel aligned with their gender identity.
At IM GENDER, we approach genital affirmation surgery with a personalized focus. We seek the most appropriate technique for each woman, depending on her anatomy, hormonal history, expectations, and her personal experience of femininity. This requires time, attentive listening, and a shared decision-making process.
Which Vaginoplasty Technique Is Best?
Vaginoplasty is the most common genital affirmation surgery among trans women who want genitalia similar to that of a cis woman. This surgery aims to create an aesthetically feminine vulva with erogenous function, as well as a vaginal canal that allows for penetrative sexual intercourse with sensitivity and long-term stability.
There are several vaginoplasty techniques. To choose the right one, it’s essential to consider different variables—because the real question isn’t “Which is the best technique?” but rather “Which technique is best for me?”
At IM GENDER, we use a clinical algorithm developed from thousands of cases. This algorithm considers factors such as:
● The amount and quality of penile skin
● Previous testicular volume
● The impact of years of hormone therapy
● The natural elasticity of the tissue
● The presence or absence of prior surgeries
This initial assessment allows us to choose the most suitable technique, based not only on technical considerations but also on each patient’s wishes and expectations. However, it is essential that the woman participate in the decision, and to do so she must be offered clear information and proper guidance from the medical team.
So, which vaginoplasty technique is best?
According to Dr. Trinidad Labanca, specialist at IM GENDER, “There is no single best technique -rather, certain cases are more appropriate for one technique than for others. The goal is to choose the right technique for each woman, based on her needs.”
Penile Inversion: The Most Common Option
Penile inversion vaginoplasty primarily uses the skin of the penis to construct the vulva and vaginal canal. It is usually recommended when the penis measures around 12 centimeters or more when flaccid, circumcision has not been performed, and the skin is sufficiently elastic. For many years, this was the most widely used technique, as it achieved very good results: a stable vaginal canal, a vulva aesthetically similar to that of a cis woman, good erogenous sensitivity, and solid aesthetic and functional outcomes.
However, in recent years, with early detection of trans individuals and the frequent use of early hormonal blockers—which support adolescents and young people in their transition, especially emotionally and socially—penile inversion vaginoplasty is not always sufficient to achieve good vaginal depth, making it necessary to consider other techniques.
Colovaginoplasty: Greater Depth
Colovaginoplasty uses a small segment of the sigmoid colon, in addition to penile skin, to create the vaginal canal. Its main advantage is that it allows for stable vaginal depth even when genital skin is insufficient or very limited, whether due to early hormone treatment or natural anatomical variations.
Colon tissue has its own soft and resilient mucosa that adapts well to the internal pelvic environment. Although it is not “lubrication” per se, it does provide constant moisture.
Colovaginoplasty is not a first-choice technique. It requires major abdominal surgery and must be carefully evaluated. It is reserved for specific situations in which penile inversion or peritoneal techniques cannot provide a good result. As with all techniques, its indication forms part of the personalized process we follow at IM GENDER.
Peritoneal Vaginoplasty
Peritoneal vaginoplasty uses a thin internal abdominal membrane—the peritoneum—along with penile skin to create the deeper part of the vaginal canal. This tissue has a smooth texture, natural elasticity, and a slight humidity similar to the natural lubrication of cis women.
It is less invasive at the abdominal level than colovaginoplasty and is particularly useful for women with very little genital tissue or insufficient penile skin to achieve adequate depth.
In this technique, the outer part of the canal is built similarly to penile inversion, but the deeper section is lined with peritoneum. This combination allows for a longer canal with a smoother and more stable internal sensation, without the need for colon tissue.
Vulvoplasty: When Depth Doesn’t Matter
What is vulvoplasty? Vulvoplasty is the technique that creates an aesthetic, proportionate, erogenous, fully feminine vulva—but without a vaginal canal. It is not a “reduced” surgery nor an intermediate option. It is a complete and valid choice for women who do not desire penetration, those who prioritize a quicker recovery, or those who simply do not feel the need for a vaginal canal.
Many trans lesbian women feel entirely fulfilled with a vulvoplasty because their sexual life doesn’t revolve around penetration. In other cases, the decision is motivated by health considerations or personal preference. It can also serve as the first stage of a future full-depth vaginoplasty. Whatever the reason, vulvoplasty is a genital affirmation surgery that provides natural results, a smoother postoperative period, and no need for postoperative dilation.
Vaginal Aesthetics in Trans Women
Vaginal aesthetics are generally addressed during vaginoplasty, but many trans women come to IM GENDER feeling that the results do not reflect their identity and wishing to modify the external appearance of their genitalia.
It’s important to note that neither trans nor cis women share a single standard for vaginal aesthetics. Even so, there are certain aesthetic concepts commonly sought when designing vaginal appearance.
In our country, and generally in the Western world, trans women—and cis women as well—tend to prefer a youthful-looking vulva, with subtle outer labia that gently envelop fine, delicate inner labia, and a small “button-like” hanging clitoris that is sensitive and well integrated.
In other cultural contexts, such as Thailand, preferences lean toward more voluminous outer labia, more visible inner labia, and even a more prominent clitoris—in other words, a more mature-looking vulva.
When a woman is not satisfied with the appearance resulting from previous surgery, adjustments can be made to refine proportions, improve scars, or reshape volumes without affecting sensitivity.
Correcting Consequences of Tucking: Hernias and Varicocele
Prolonged or very tight tucking can lead to issues such as inguinal hernias or varicoceles. Sometimes these problems go unnoticed until they’re evaluated in the context of genital surgery.
If present, they can be treated during the same vaginoplasty or, if the patient does not wish to undergo full genital feminization, as an independent surgery. In both cases, these are common and safe procedures that prevent discomfort, pain, or more serious complications.
Now that you know what genital feminization surgery is and the different techniques available, we can help you understand which one best suits your body and support you throughout the entire process.
