Opting for genital surgery is an important decision, and one that has many consequences of mental, physical, social and sexual significance. Genital surgery also carries the risk of medical complications. If you are considering genital surgery, it may help your decision to think about the impact of your genitals on your gender identity. What do you think or hope that genital surgery will do for you? Is it a choice that will suit your life as it is at the moment? Will you be able to count on support from friends and family? Genital surgery can have a major impact on your life. It is therefore important to discuss such a choice with those around you.

Since 2014, Dutch law allows the gender to be changed on a person’s birth certificate without them having undergone genital surgery.

To feminise your pubic region, you can pull the penis backwards, towards the anus, and push the testicles upwards. This is what is known as 'tucking'. Use surgical tape when you apply ‘tucking, and if you shave beforehand, the tape will stick better. There are also special undergarments (gaffs/dance belts) to keep genitals in place; you can find them in theatre shops or on the internet (e.g. Transmissie).

You can find all kinds of videos on YouTube explaining different ways for 'tucking'.

'Tucking' may affect sperm quality. More information on fertility preservation and fulfilling a desire to have children can be found here. In addition, 'tucking' may cause skin problems later in life. Discuss this with your treating physician.

Facial and body hair can be removed in various ways (temporarily or permanently). Examples include shaving, electrolysis (electric hair removal) and laser treatments. Incidentally, hair removal creams and the like are not effective.

Before a vaginoplasty or vulvoplasty, part of the genital area must be permanently depilated. This process can take up to a year.

Hormone treatment brings your hormone levels up to the level of a cisgender woman. This will result in several changes taking place in your body. Some of these will be permanent; for example, you may become infertile. The extent and duration of changes vary from person to person and are related to genetic predisposition and duration of therapy: the longer hormones are taken, the more permanent the effects.

In addition to reduced fertility, hormone treatment can cause certain physical changes: • Body fat and muscles: More fat will accumulate around your hips and thighs and your muscle mass will decrease. • Breast development: Within 2 to 3 months, breasts will start to grow. Touching them can be painful. Current research shows that one year of hormone treatment results in an average AAA cup size. Breast enlargement operations, if so desired, are not possible until 12 to 24 months after hormone treatment. • Face: Subcutaneous fat will increase and contribute to a more feminine shape of your face. This process may take up to three years, which is why it is recommended to wait with any facial surgery. • Body hair: your body hair will become thinner and softer and will grow less quickly.

Sexuality is important to many people. You learn more about your genitals by discovering what is sexually important and pleasurable to you. Your sexual life depends not only on genital surgery, but also on many psychological and biological factors. The things to consider include whether you would like to have or already have a partner, and whether you would want to talk to your partner about your sexual desires .

Sex drive (libido) depends on the hormone testosterone — regardless of gender. Hormone treatment can therefore cause changes in how you experience sexuality, as your testosterone levels decrease. For example, it often leads to a decrease in erections, both in intensity and duration, which means that penetration is no longer always successful.

However, despite the hormone treatment, you may still experience erotic sensations and orgasms, although perhaps in a different way than you did before. For example, some people experience orgasms that last longer and are felt throughout the body, but with a less intense peak. The ejaculate may consist of a small amount of clear or white fluid, or there may be no fluid at all.