‘Sex’ means different things to different people. Many people think about sex as only revolving around the penetration of the vagina with a penis. But there are many other forms of sex that can be enjoyable. If you choose to have genital surgery, this will change your genitals and, consequently, the way you experience sex.

If you are experiencing significant gender dysphoria, this may affect your sex drive. You may have little or no desire for sex. It is difficult to say whether your sex drive will change as a result of surgery. We do know, however, that reduced genital gender dysphoria can lead to an improvement in your sex life. It is important to take this into account when making a decision. Are you unsure how genital surgery might change your sexual activity? Or do you have specific questions about sex before or after genital surgery? If so, we recommend that you book a consultation with a sexologist from your gender team.

If possible, it’s a good idea to explore what feels good for you sexually. Take plenty of time to explore this and discuss it with any partner(s) you may have. If you can explore this before genital surgery, it will help you after genital surgery.

For example, ask yourself the following questions:

After genital surgery, you are likely to experience your sex life differently than you did before the operation. After surgery, you will have new genitals. Not everything works in the same way as cisgender genitals do. For example, nerves need to heal after the operation, which means you will gradually regain sensation. Every change requires you to rediscover your experience of your genitals and your sensuality. Making your genitals feel ‘your own’ and learning to use them pleasurably is important following genital surgery. It is often easier to reach orgasm when you masturbate than when you have sex with someone else. After genital surgery, it is important that you continue to explore what feels enjoyable for you sexually, both on your own and together with your any partner(s) you may have.

Don’t underestimate how long it takes to rediscover your sexuality after genital surgery. Over the years, you’ll develop more confidence around your genitals, so take plenty of time for this. The more comfortable you feel in your own body, the greater the sexual pleasure you’re likely to experience.

Regardless of gender, a person’s sex drive is influenced by the hormone testosterone. As your body produces almost no testosterone after the removal of the testicles, this may affect your sex drive. This is the case even if you have been suppressing testosterone with medication for at least a year. Another effect of lower testosterone levels is a change in erections and ejaculation. This effect varies from person to person but is probably similar to your experience with testosterone suppressants.

On the other hand, after an orchidectomy, you may experience less gender dysphoria. As a result, you may be more likely to feel pleasure and sexual excitement (and therefore also to have erections).

After vulvoplasty, the appearance of your genitals will have changed significantly. It is therefore important to discover for yourself what feels good and to make your new genitals feel ‘your own’ sexually. The main difference between vulvoplasty and vaginoplasty, in terms of sexual function, is that after vulvoplasty you do not have a vaginal cavity. This means you cannot be penetrated vaginally. For all women, both cis and trans, the (reconstructed) clitoris is generally the most sensitive part of their vulva and is therefore often the most important area to stimulate for sexual pleasure. For some people, penis-in-vagina sex is not important. In that case, vulvoplasty may fit your sexual preferences.

Around 65% (still) experience an orgasm following vulvoplasty. More than 95% retain sensation in the clitoris after two years. After vulvoplasty, an orgasm feels very different from what you may be used to. For example, after the operation, you might experience less of a ‘peak’ during your orgasm and instead a longer build-up. No semen is released during an orgasm. It is worth considering how important your current orgasm experience – in other words, how climaxing feels to you now – is to you.

It is not uncommon for trans women and gender-diverse people to experience difficulties reaching orgasm following vulvoplasty (around 30%). Sometimes this is due to physical reasons related to: complications, lower testosterone levels or altered sensation in the nerve endings of the vulva. Psychological factors are also often a cause, for example because you are not yet used to your new genitals. Or because you are putting too much pressure on yourself to have an orgasm. Some people find that their orgasms are less intense or find it very difficult to build up to an orgasm. Many of these ‘orgasm problems’ can be reduced or resolved over time. So, take your time getting to know your new genitals and don’t put pressure on yourself. It helps to focus on exploring, playing and communicating with any partner(s) you may have as well as on your own.

After a vaginoplasty, your genitals will feel very different from what you are used to. You should therefore take plenty of time to discover what feels good and to get to know your new genitals sexually.

Once all the wounds have healed, the odour of your genital area will be different following vaginoplasty. Every vagina has its own unique odour. This is perfectly normal and is part of having a new vagina. There’s no need to see a doctor straight away if your genital area smells different to what you’re used to. If you’re concerned, you can discuss the odour during your follow-up appointments at your healthcare centre.

Once you have fully recovered, penetration into the vaginal cavity is usually possible. If vaginal penetration is important to you, then vaginoplasty may be a good option. It may take a while before penetration into the vagina feels comfortable. First, explore on your own what feels good around and inside the vagina. You can use your fingers or sex toys for this; that’s something you’ll have to discover for yourself. Try to relax as much as possible whilst doing this, and don’t forget to use lubricant.

Your new vagina won’t get wet on its own. Some trans women and gender-diverse people feel that their vagina does get moist on its own after vaginoplasty. However, there is never enough moisture to allow penetration of the vagina without lubricant. You should therefore always use an unscented, water-based lubricant whenever your vagina is penetrated – whether during sex with partner(s), or during solo sex. If you do not use lubricant, this can lead to skin irritation, minor cuts and pain.