GRS, or Genital Reconfiguration Surgery, is the name given to several different surgeries that change the shape and function of existing genitals. GRS may occur concurrently to, or after a hysterectomy, orchidectomy, or oophorectomy. Genital surgeries are not available to people under 18 years old.

Genital surgeries have picked up a few different names over the years, with Genital Reconfiguration Surgery simply being the most recent. You may have heard patients refer to it as bottom surgery, lower surgery, Sexual Reassignment Surgery, Gender Reassignment Surgery, a sex change surgery, inning-an-outie, vice versa, or others.

TransHub uses the term Genital Reconfiguration Surgery to be specific that the only thing changing during surgery is physiological, rather than gender. It’s always good to remember that genitals don’t have genders, people do, and you are already the woman, man or non-binary person you’ve always been.

While genital surgery is often seen as the ‘last part’ of gender affirmation, it is just another step along the way of some people’s journeys. There’s no right or wrong way to be or embody your gender, regardless of your surgical status. Not all trans people want, seek or can have surgery, and being trans doesn’t necessitate surgery either. Find out more about that here.

Information and resources to assist clinicians learn more about genital surgeries can be found here.

Risks

All surgeries carry some risk, including complications, infection, blood clots, and rarely death. It’s important to ask your surgeon about possible risks and how to avoid them.

The Standards of Care - 7th Ed (SoC7) is published by the World Professional Association for Transgender Health (WPATH) and offers guidance to clinicians working with trans patients all over the world, including criteria and recommended referral pathways for those seeking particular medical and surgical interventions.

The SoC7 does not specify an order by which surgeries should occur, if sought at all, and are guidelines, not legislated requirements.

Vaginoplasty is a procedure to surgically create a vagina and vulva from existing tissue. Depending on the procedure and technique used, the tissue used to create the different parts of the vagina and vulva may be taken from different donor sites. This surgery is generally sought by trans people who were presumed male at birth (PMAB), including women and non-binary people.

A vaginal cavity is created, and tissue from the penis, testes, and in some cases lower intestine or other donor sites on the body are shaped to line the vaginal canal. The tissues are also used to create the external vulva including inner and outer labia. Often, what was the head (or glans) of the penis will be used to create the clitoris and surrounding tissue, in order to preserve sensation. The urethra is shortened and repositioned to the required place in the vulva.

The main form of vaginoplasty available today is the ‘penile inversion’ method, in which the skin on the outside of the penis is used to create the lining of the vagina. Previously, Sigmoid vaginoplasty was more common, but is used far less today. Surgeons around the world are experimenting with other donor tissue sites such as inner skin layers around the abdomen, and the body of knowledge is constantly growing. Peritoneal Pull-down Vaginoplasty (PPV) is now offered by several Australian surgeons and is gaining in popularity.

Some surgeons require patients to decrease hormones, particularly estrogen, for a period of time in the lead up to, and immediately following, vaginoplasty surgery. For those using estradiol implants, it’s worthwhile trying to time surgery so that blood levels are low when surgery takes place, with the next implant due for insertion after surgery.

Recovery

Healing from any genital surgery can take quite a while, and it’s important to plan time to rest and recover.

In general, 4 to 8 days in hospital are required after surgery, followed by another 7-10 days of close outpatient supervision. During this time, you will likely have a catheter in place. Rest is then advised for the next 5-6 weeks, and it is recommended that any strenuous activity is avoided up to 8-12 weeks after the procedure. The amount of rest required will vary from patient to patient. No sex, arousal, or sexual contact is advised for at least 3 months after the procedure.

Recovery from a vaginoplasty will also include learning to use a vaginal dilator to help keep the vaginal canal open, as it can take some time for the body to get used to having a new cavity there. Regular dilation is often required for the first year after surgery, and irregular dilation for a period after that.

The specific instructions for your recovery will vary from surgeon to surgeon, and also depend on where and what specific surgical techniques are used.

Costs

Vaginoplasty can cost between $8,000 - $30,000 out of pocket in Australia, and sometimes more, depending on the procedures, techniques and surgeon. Some people also choose to travel overseas for vaginoplasty which can increase costs due to travel, accommodation, and other fees. Some private health insurers may cover some of the costs incurred, and further discussion with your prospective insurer may be needed.

For more information about accessing compassionate release of superannuation, go to our Superannuation page.

Location

Vaginoplasty is performed in Australia. The Australian Professional Association for Trans Health hosts a provider list of their members. It includes surgeons in Australia and is available here.

Vaginoplasty is also performed in other countries including Thailand and America, both of which have a number of world-leading surgeons.

Vulvoplasty, or shallow depth vaginoplasty/zero depth vaginoplasty is an alternative form of GRS to surgically create a vulva from existing tissue, with a shallow or no vagina. Depending on the procedure and technique used, the tissue used to create the different parts of the vagina and vulva may be taken from different donor sites. This surgery is generally sought by trans people who were presumed male at birth (PMAB), including women and non-binary people.

The results are similar in outwards appearance to vaginoplasty, but without a vagina present. It is also a less complex form of surgery, and may come with a reduced change of complications for people who are at higher surgical risk.

Tissue from the penis and testes are used to create the external vulva including inner and outer labia. Often, what was the head (or glans) of the penis will be used to create the clitoris and surrounding tissue, in order to preserve sensation. The urethra is shortened and repositioned to the required place in the vulva.

Recovery

Healing from any genital surgery can take quite a while, and it’s important to plan time to rest and recover.

In general, 4 to 8 days in hospital are required after surgery, followed by another 7-10 days of close outpatient supervision. During this time, you will likely have a catheter in place. Rest is then advised for the next 5-6 weeks, and it is recommended that any strenuous activity is avoided up to 8-12 weeks after the procedure. The amount of rest required will vary from patient to patient. No sex, arousal, or sexual contact is advised for at least 3 months after the procedure.

The specific instructions for your recovery will vary from surgeon to surgeon, and also depend on where and what specific surgical techniques are used.

Costs

Vulvoplasty costs can vary, depending on the procedures, techniques and surgeon. Some people also choose to travel overseas for vulvoplasty which can increase costs due to travel, accommodation, and other fees. Some private health insurers may cover some of the costs incurred, and further discussion with your prospective insurer may be needed.

For more information about accessing compassionate release of superannuation, go to our Superannuation page.

Location

Vulvoplasty is performed in Australia. The Australian Professional Association for Trans Health hosts a provider list of their members. It includes surgeons in Australia and is available here. Vulvoplasty is also performed in other countries including Thailand and America, both of which have a number of world-leading surgeons.

A phalloplasty is a procedure that surgically creates a penis, or phallus, from existing tissue, often including reconstruction of the urethra so as to allow for standing urination. A phalloplasty procedure may also include a simultaneous hysterectomy, oophorectomy, vaginectomy (to remove or partially remove the vagina) and other surgeries. This surgery is generally sought by trans people who were presumed female at birth (PFAB), including men and non-binary people.

The two main forms of phalloplasty are: the arm radial forearm free-flap (RFF) or anterior lateral thigh phalloplasty (ALT). These surgeries may be broken down into as many as three stages, with a period of several months to a year between each stage.

RFF phalloplasty is the most recent development in phalloplasty surgeries. In a free-flap procedure, the blood vessels and nerves in the donor tissue remain intact, and then able to be reattached to allow natural blood flow and sensation. At present, more than one admission is required, as RFF includes 4 operations, over a minimum of 18 months.

ALT phalloplasty is an older phalloplasty surgery that has been around for a while longer, and can result in reduced sensation. In this procedure, the blood vessels and nerves in the donor tissue are separated.

Surgeons will work out an individualised phalloplasty plan with you.

Recovery

Healing from any genital surgery can take quite a while, and it’s important to plan time to rest and recover.

In general, up to two weeks in hospital are required after each surgery, followed by a period of close outpatient supervision. During this time, you will likely have a catheter in place. Rest is then advised for the next 5-6 weeks, and it is recommended that any strenuous activity is avoided up to 8 weeks after the procedure.

Minor complications are quite common, which require consideration for travel and accommodation, as you may need to spend longer than the advised minimum time in the same city as your surgeon.

Full healing, including rediscovery of sexual sensation, can take up to 1-2 years.

The specific instructions for your recovery will vary from surgeon to surgeon, and depending on where and what specific surgical techniques are used.

Costs

Phalloplasty can cost between $50,000 - and $80,000 in Australia, depending on the technique and surgeon, and additional costs can be included ie. for anaesthetics. There are also many hidden costs that may come up as part of recovery.

For more information about accessing compassionate release of superannuation, go to our Superannuation page. Private health insurance can also cover costs like hospital admissions and help with rebates.

Location

Phalloplasties are performed in Australia by very few surgeons. In Australia, hysterectomy is always done separate to phalloplasty. The Australian Professional Association for Trans Health hosts a provider list of their members. It includes surgeons in Australia and is available here.

Phalloplasties are also performed in Thailand, the US, UK, and in some European countries.

A metoidioplasty is a procedure that creates a penis, or phallus, from a hormonally-enlarged clitoral shaft. This surgery is generally sought by trans people who were presumed female at birth (PFAB), including men and non-binary people.

When a person starts taking testosterone, the clitoral shaft will naturally enlarge. During a metoidioplasty, the existing clitoral shaft will be raised higher up on the body, and have the urethra inserted. The clitorial ligaments will also be detached, which allows the shaft to lengthen and drop into a position similar to a natal penis. A small graft is taken from the inside of the cheek and used as tissue for the urethra. A vaginectomy (removal of vagina) may also be completed at the same time.

While metoidioplasty is often considered to be a single-stage surgery, you may request additional surgeries in order to achieve the desired affirming results.

Recovery

Healing from any genital surgery can take quite a while, and it’s important to plan time to rest and recover. It is likely that you will be required to rest and take time off of work for at least the first two weeks after the procedure.

The specific instructions for your recovery will vary from surgeon to surgeon, and depending on where and what specific surgical techniques are used.

Costs

Costs for metoidioplasty can vary, depending on the technique and surgeon.

For more information about accessing compassionate release of superannuation, go to our Superannuation page.

Location

Metoidioplasty is performed in Australia by very few surgeons. The Australian Professional Association for Trans Health hosts a provider list of their members. It includes surgeons in Australia and is available here.

Metoidioplasty is also performed in Thailand, the US, UK, and in some European countries.