bx-help-circle

Where can you find reliable information on social and mental support? Read about it here.

Social and mental support

bxs-calendar-x

Are you unsure about whether to have genital surgery, or are you on the waiting list for your first appointment? You can still take steps towards your transition.

No operation (yet)

fertilization

Are you considering genital surgery? It’s important to think in advance about whether you might want to have children and about retaining your fertility.

Fertility

hair-removal

To be eligible for genital surgery, you must be well-informed and meet the requirements.

Preparing for the genital operation

uterus

A hysterectomy is a gynaecological operation in which the womb is removed. You can read all about the operation and the recovery process here.

Hysterectomy (removal of the womb)

vulva

A colpectomy is a gynaecological operation in which the vagina is removed. You can read all about the operation and the recovery process here.

Colpectomy (removal of the vagina)

penis

 Metoidioplasty A metoidioplasty is an operation in which a penis of below-average size (a metoidio) is created using your existing genital tissue.

Metoidioplasty

proteses

On this page, you can read more about the various prosthesis options available following genital surgery and the different functions of these prostheses.

Prostheses after genital surgery

phallo

Phalloplasty is a surgical procedure in which a penis is created using tissue from elsewhere in your body. The technique used depends on your body and your preferences.

Phalloplasty

nazorg

What is the recovery period like after you’ve been discharged from hospital? Here you can read about the best ways to look after yourself (or have someone look after you) and what you can do to speed up the process

Aftercare

On this page, you will find more information about possible changes to your sex life following genital surgery.

Sexual Activity

bxs-briefcase-alt

On this page, you can read more about the healthcare facilities where you can have your operation, and how to arrange it.

Where will you have the operation? 

We recommend that you go through all the information chapters step by step to get a complete picture of the various treatment options and the process involved!<br></br>We strive to keep this information up to date. Do you have any additions or comments regarding the information above? Please email us at <email>info@genderaid.org</email>

Next Step

In the Decision Guide, you can indicate how important you consider certain characteristics.

Decision Guide

It looks like something went wrong while loading this page.

Whoops!

Broken Page

Making a decision for genital gender surgery can be complicated. The Decision Guide consists of 14 questions in which you can indicate which characteristics are important to you. The Decision Guide then indicates how these characteristics fit in with the different treatment options.* We recommend you to fill out the Decision Guide several times to get an objective result. The Decision Guide has to be filled out completely to see a result.

In Part 2 of the Decision Guide you will compare characteristics with each other. In order to get a complete picture of your needs, it is necessary to compare all characteristics with each other (even if they are not initially opposites of each other).

In Part 1 of the Decision Guide, you indicate how important you think a particular characteristic is on a scale of 0 to 100 (0 = not important, 100= extremely important).

a shorter recovery period and less risk of complications

not having to dilate for the rest of your life

a feminine appearance/demasculinization of the genitals

being able to stop taking testosterone blockers

How important to you is having a deep vaginal cavity?

How important to you is not having to dilate for the rest of your life? *

How important to you is being able to stop taking testosterone blockers? *

How important to you is a feminine appearance/demasculinization* of the genitals?

less or no risk of complications, such as losing part or all of the penis

How important to you is having a larger than average penis? *

How important to you is your genitals being sensitive to touch? *

How important to you is being able to urinate standing upright?

How important to you is being able to penetrate with the penis?

Something went wrong while processing the Decision Guide. Please try again!

What is GenderAid and how can I use it? The video below explains how it works.

GenderAid

The compare tool lists pros and cons for each option.

Compare Tool

Content

Feminization

Masculinization

The comparator provides arguments for and against each treatment option in the words of peers

Step 2: Compare

Here, you can indicate which characteristics are important to you and see which treatment option best matches your preferences

Step 3: Decision Guide

On this page, you will find an overview of the information about feminizing and demasculinizing genital surgery

Step 1: Information

On this page, you will find an overview of the information on masculinizing and defeminizing genital surgery

It looks like this page does not exist (anymore)

Page Not Found

On this page, you will find the results of the Decision Guide you completed. You can download or print the results and show them to your healthcare provider.

Questions

Download

You can complete the Decision Guide as many times as you'd like. Click here to start over

Start over

On this page you will find information about initiatives and organizations that can support you

Mental Support

Thank you!

Every genital operation carries risks; there is always a chance of complications. Experiencing a complication can be (very) distressing. With some operations, the risk of complications is considerably higher than with others. Recovering from complications can take days, weeks or months. You may never (fully) recover from some complications.*The figure shows how important you consider this value to be in comparison to other values.

Short recovery time and low risk of complications

Some people feel like having a vaginal cavity is important to feel like a woman. A vaginal cavity can also be important for sexual preferences. After a vaginoplasty, you will have a vaginal cavity with depth. Once the cavity has healed sufficiently, you can be penetrated vaginally.*The figure shows how important you consider it to be to have a vaginal cavity with depth.

A vaginal cavity with depth

Following a vaginoplasty, dilation is necessary. In principle, this is a lifelong commitment. How often you need to dilate and for how long varies from person to person and depending on the surgical technique used. Dilation takes a lot of time; you should not underestimate this. Some people consider it a burden.*The figure shows how important it is to you not to have to dilate for the rest of your life.

Not having to dilate for the rest of your life

The appearance of your genitals can impact how you view yourself or how others view you. The appearance depends on which treatment option you choose and on your available tissue. Following vulvoplasty and vaginoplasty, the appearance of your genitals will be similar to that of a cis woman. If you undergo an orchidectomy or do not have surgery (yet), there will be little or no change to the appearance of your current genitals.*The figure shows how important you consider this value to be in comparison to other values.

A feminine appearance / demasculinisation of the genitals

You can choose not to have surgery (yet)! If you don’t have surgery, your genitals will remain unchanged, which is a downside for many people.*A major advantage of not having surgery (yet) is that you avoid the risk of complications. You’ll retain sensation in your genitals and won’t have any surgical scars. You won’t have a long recovery period and won’t need to take time off school or work. You will keep your testicles, which means you will remain fertile.

No surgery (yet)

Of all the genital operations, this one has the fewest complications and the shortest recovery time. You will be infertile following this operation and will no longer need to take testosterone blockers.*There will be little change to the appearance of your genitals. However, tucking is easier after an orchidectomy.

Orchidectomy

If your testicles are removed, your body will stop producing testosterone. You will then no longer need to take testosterone blockers. The figure shows how important you consider it to be able to stop taking testosterone blockers, compared to other values.

Stopping testosterone blockers

Of all the operations, vaginoplasty carries the highest risk of complications. After vaginoplasty, your genitals will resemble a vulva, and you will have a vaginal cavity. You will be infertile following this operation and will no longer need to take testosterone blockers.*Once you have recovered sufficiently, you will be able to receive penetrative sex in the vagina. You will need to dilate and rinse your vagina for the rest of your life.

Vaginoplasty

Vulvoplasty carries a higher risk of complications than orchidectomy, but a lower risk than vaginoplasty. Following vulvoplasty, your genitals will resemble a vulva. This appearance is the same as after vaginoplasty, but you will not have a vaginal cavity. You will be infertile following this operation and will no longer need to take testosterone blockers.*As you do not have a vaginal cavity, you cannot be penetrated vaginally. You do not need to dilate.

Vulvoplasty

Your answers do not point to a clear result. We recommend reviewing all sections of the website carefully and then completing the Decision Guide again.

Experiencing a complication can be (very) distressing. Every genital operation carries risks; there is always a chance of complications. With some operations, the risk of complications is considerably higher than with others. Recovering from complications can take days, weeks or months. You may never (fully) recover from some complications.*The figure shows how important you consider this value to be in comparison to other values.

Low risk of complications

For many people, the (erotic) sensation in their genitals is important to feel like their genitals are ‘their own’ and to be able to enjoy sexual activity. Surgery will affect the sensation in your genitals. After a metoidioplasty, there is a good chance that you will retain (erotic) sensation in your genitals. After a phalloplasty, it is uncertain to what extent sensitivity to touch will return. After a phalloplasty, the clitoris is buried beneath the skin, which may result in reduced erotic sensation.*The figure shows how important you consider the value “sensitivity to touch” to be in comparison to other values.

Sensitivity to touch

Of all external genital surgeries, this procedure has the fewest complications and the shortest recovery time. You have the best chance of retaining sensation in your genitals, and the appearance of the genitals is masculinised. Your penis is below average in size. You will need aids to be able to penetrate. You urinate whilst sitting, from behind your scrotum.*If you wish, you can keep your vagina, womb and/or ovaries. For example, to preserve your fertility, to continue producing your own hormones, or because of your sexual preferences.

Metoidioplasty without urethral lengthening

Your penis is smaller than average. The majority is able to urinate through their fly, whilst standing, following a urethral lengthening operation – though this often requires several operations. You will need aids if you wish to penetrate.*Following this operation, there is a high chance that you will retain (erotic) sensation in your genitals, and the appearance of the genitals will be masculinised. The risk of complications is higher than with a metoidioplasty without urethral lengthening. Your vagina and womb must have been removed previously, but you can retain your ovaries.

Metoidioplasty with urethral lengthening

You can choose not to have surgery (yet)! If you don’t have surgery, your genitals will remain unchanged, which is a downside for many people.*A major advantage of not having surgery (yet) is that you avoid the risk of complications. You’ll retain sensation in your genitals and won’t have any surgical scars. You won’t have a long recovery period and won’t need to take time off school or work.

Some people find it important to be able to urinate whilst standing, directly from the fly. This requires a penis of sufficient length and an extension of the urethra. Extending the urethra involves many additional complications. Multiple operations are usually required. Ultimately, following a metoidioplasty or phalloplasty with urethral lengthening, some people can urinate through the fly whilst standing.*The figure shows how important you consider this value to be in comparison with other values.

Urinating whilst standing

For some people, being able to penetrate during sexual activity is important. You cannot penetrate using your own genitals unless you undergo surgery. In most cases, penetration is not possible even after a metoidioplasty. You will need an external prosthesis.*After a phalloplasty, you may sometimes be able to penetrate using your own penis. However, you will need a tool to make the penis stiffer. This can be achieved with an external device. Sometimes, an internal erectile prosthesis can be implanted. An internal prosthesis is always temporary and can only be replaced a few times.*The figure shows how important you consider the value ‘penetration’ to be in comparison to other values.

Penetration

After the operation, you will have a penis of (above) average size. Compared to metoidioplasty, the risk of complications is higher, there is less sensation when the penis is touched, and the likelihood of experiencing erotic sensations is lower.*If you wish, you can keep your vagina, womb and/or ovaries. For example, to preserve your fertility, to continue producing your own hormones, or because of your sexual preferences. You will urinate whilst sitting, with the stream coming from behind the scrotum.*In some cases, an internal penile prosthesis may be implanted after a recovery period of at least one year. This prosthesis usually allows for penetration. Internal penile prostheses are associated with many complications and are always temporary. They can only be replaced a few times.

Phalloplasty without urethral lengthening

After the operation, you will have a penis of (above) average size. Compared with metoidioplasty, the risk of complications is higher, sensation when the penis is touched is reduced, and the likelihood of experiencing sexual sensation is lower. Of all the treatment options, this operation carries the highest risk of complications. The risk of complications is higher and the likelihood of you experiencing (sexual) sensation in the penis is considerably lower than with metoidioplasty.*Your vagina and womb must have been removed previously, but you can keep your ovaries. Around 70 per cent (7 out of 10 people) are able to urinate standing up from the crotch after a urethral lengthening, often after several operations.*Once the penis has healed sufficiently, an internal penile prosthesis can be implanted. In most cases, this prosthesis will allow you to have penetrative sex. Internal penile prostheses need to be replaced regularly and can only be replaced a limited number of times.

Phalloplasty with urethral lengthening

For some people, the size of the penis influences their self-image, how they feel others perceive them, or how they can use their penis. Following a metoidioplasty, you will have a penis that is below average in size. Following a phalloplasty, you will have a penis that is (above) average in size. Penis size depends, amongst other things, on your own available tissue.*The figure shows how important you consider penis size to be in comparison to other values.

Penis size

Values

In this report, you will find your results of the GenderAid decision-making guide. The results are not intended as advice; they are simply meant to help you with your decision. They provide an overview of what is important to you, which treatment options are suitable and offer suggestions on how to proceed.

You can take this report to your healthcare provider and/or share it with your loved ones to discuss the results.

Decision-Aid Results

Treatments

The figure below shows an overview of the values you consider important regarding genital surgery.*These results relate solely to the medical and physical characteristics that differ between the treatment options. It is a good idea to discuss these characteristics with your healthcare professionals during your consultations regarding genital surgery.*These results are based on your personal preferences, because you weighed up the values of the treatment options against one another in the Decision Guide. It may be the case that you consider certain values to be equally important; in that case, these values will have the same score in the figure.

These questions are about your personal preferences. Based on what you know and feel right now, which of the statements below best reflect your choice at this moment? There are no right or wrong answers.

Final Questions

Post-operative burden

Appearance

Burden

(Un)certainty

Decision

General

Function

If any new questions come up, or if you want to take notes, there is space for that below.

New questions or notes

Decision Guide Results

The figure below provides an overview of which treatment options best suit your value preferences. This is not advice but is intended to help you gain an understanding of your preferences and the treatment options that match them. The result does not determine your final treatment.*These results are based on your personal preferences, because you weighed up the values of the treatment options against one another in the Decision Guide. It is possible that several treatment options may score equally highly in the figure. Only a limited number of medical and physical characteristics have been taken into account. You may therefore disagree with your results.

Treatment options

Share this page

bxs-calendar

I can have children through natural means

I don’t need to make a decision about whether I want children at the moment

I don’t need to prepare for an operation

I don't need to have [permanent hair removal](/masculinization/info/preparing-for-the-genital-operation#additional-preconditions-phalloplasty) 

I don’t need to change my lifestyle to meet the require-ments for an operation (smoking and BMI)

My genitals do not have a masculine appearance

I cannot urinate whilst standing, from the fly

I’ll retain the current function of my genitals

I experience dysphoria/aversion towards my genitals

I will not be absent for a period of time due to recovery

I can have sex in the way I’m used to with my current body

I will still be able to be penetrated vaginally and anally

If I want to pen-etrate, I can do so using aids (such as a penile prosthesis or a dildo)

I can still decide to have an operation at a later stage

I am not affected by any health risks that an operation might cause

I won’t have to take time off work to recover

Metoidioplasty without urethral extension

I can no longer conceive children through natural means

Before the operation, I need to make a decision about whether I want to have [children and about retaining my fertility](/masculinization/info/fertility) and whether I would like to have children some day 

I can only have the operation if [my BMI is between 18 and 30](/masculinization/info/preparing-for-the-genital-operation#general-terms-and-conditions-of-genital-surgery)

I must [stop smoking](/masculinization/info/preparing-for-the-genital-operation#general-terms-and-conditions-of-genital-surgery)

I can keep my vagina; a colpectomy is only necessary before urethral lengthening.

I don’t need to have [permanent hair removal](/masculinization/info/preparing-for-the-genital-operation#additional-preconditions-phalloplasty) 

My penis is smaller than it would be after a phalloplasty

The length of my penis depends on the size of the clitoris

I cannot urinate standing up through my fly

I will have small scars in my genital area

I will have a smaller than average penis (1-4 cm)

I have more ‘bulge’ than before the operation (but less than with a phalloplasty)

My penis may still grow after the operation

I am recovering from my operation, and this has consequences (questions from people, absence from work, more frequent visits to hospital)

I have more ‘bulge’ than I did before the operation, but less than with a phalloplasty

I don’t have any noticeable scars on my body

The operation may alter the sensation in my genitals

Penetration is usually not possible with my penis

There’s a good chance I’ll be able to have an orgasm

My penis is made from my own genital tissue, which means I’ll retain my sexual sensation

If I want to penetrate, I can do so using aids (such as a penile prosthesis or a dildo)

The operation is a major procedure on my body

My body is subject to less strain than after a [phalloplasty](/masculinization/info/phalloplasty)

My body is less likely to experience [complications](/masculinization/info/metoidioplasty#complications) without urethral lengthening 

My recovery time is shorter than after a phalloplasty

Metoidioplasty with urethral extension

My uterus and vagina must be removed - I can no longer conceive children through natural means

Before the operation, I need to make a decision about whether I want to have [children and about retaining my fertility](/masculinization/info/fertility) 

I must first undergo a [colpectomy](/masculinization/info/colpectomy-removal-of-the-vagina) before I can have a urethral lengthening

The donor skin for the urethra will need to be [permanently depilated](/masculinization/info/preparing-for-the-genital-operation#additional-preconditions-phalloplasty)

The length of my penis depends on the size of the clit-oris

There is about a 70% chance that I will be able to urinate through the fly whilst standing (sometimes only after several operations)

I am recovering from my operation, and this has consequences (questions from people, ab-sence from work, more frequent visits to hospital)

I have noticeable scars on my body (e.g. on my arm) which may prompt people to ask questions

I am undergoing a long surgery process, which means I will be dependent on care from those around me for an extended period

I have more ‘bulge’ than before the operation, but less than with a phalloplasty

The operation is a major procedure affecting my body

My body is at greater risk of [complications](/masculinization/info/metoidioplasty#complications) than it would be with an operation without urethral lengthening

Other parts of my body that were used as donor skin (for the urethra) also need to recover from the operation

Phalloplasty without urethral extension

Before the operation, I need to make a decision about whether I want to [have children and about retaining my fertility](/masculinization/info/fertility) 

The donor skin for the shaft of the pe-nis may need to be [permanently depilated ](/masculinization/info/preparing-for-the-genital-operation#additional-preconditions-phalloplasty)

Compare Masculinizing Treatment Options

Next Step