I have a full depth penile inversion vaginoplasty on the books for early 2026. A whole lot of my personal energy and attention in 2025 has been devoted to research and logistics around this surgery. It’s been a very long time coming, and will be my last step of transition, beyond just continuing to fuck with my voice and being on HRT for life, and the remaining facial electrolysis I have to do. In the past year, I’ve been asked about logistics around this, and for research shares, and the like, and this article is my attempt to capture any insight I have about the research process at this snapshot of my life. This is an overwhelming choice, and there is a lot of complexity to this, associated with a lot of trans women with angry yelling opinions.
My attempt with this article is to communicate my process with this, and hopefully to give some organization to the absolutely overwhelming and fragmented information out there. This article is not me giving medical advice, it is not me endorsing an outcome. It is me trying to explain what is out there, and hopefully give you, the reader, a chance to know what is out there so that you can do your own research for yourself. Invariably, this is going to be colored by my own experience, but I’m going to try and make this more informational than preachy. If I’m full of shit, leave a comment. I’m sure I’ll make mistakes, and I’m even more sure that this article will be out of date pretty soon. And I can’t imagine that my feelings will be changed with post-op eyes.
And after starting to write this, I’m realizing that it’s going to be long and big, so I’m going to split this into three parts: a glossary of terms, an outline of my personal process for approaching all of this and coming to a choice, and then a list of various resources and surgeon’s sites. I strongly encourage anyone thinking about this to do a lot of reading and soul-searching and research. It’s a big, life-changing thing, and so much of it is out of your control.
Also, sorry not sorry about the tulip header photo, sometimes, you can’t resist.
Glossary
Before we go, and probably most helpfully, given the stares I get when I dive into talking with this with people who are just starting, I’m going to define a bunch of terms so that we all know what we are talking about. All of these are somewhat commonly discussed in trans surgery communities, and my definitions are as aligned as I can make them with common usage, but different communities might have different understandings, and as always, I recommend communicating a lot and being clear, but I believe that this glossary should make most transfeminine bottom surgery forua legible to a reader. I plan on amending this if I find stuff I forgot about, and/or if/when mistakes come to light.
- Bottom surgery — the general process of reconfiguring one’s genitals, usually in the context of transition care. There are many trans bottom surgeries, so this is a bit of a blanket term. It’s also somewhat the polite term one uses in public when one wants to disclose that *something* is done, but not necessarily wanting to get into medical detail
- Vaginoplasty — the process of creating or refining a vulva and vagina, urethra, and clitoris using surgery. Contrary to popular belief, most vaginoplasties are performed on cis women, for a variety of cosmetic and functional reasons, as will be extremely obvious when one uses internet search to look for information on “vaginoplasty”. Nearly every technique discussed in this article was initially developed for the treatment of cis women’s health. That said, the needs of trans women here obviously differ in important ways, which we will get into below
- Full depth/minimal depth/zero depth — different canal depths can be assigned from a vaginoplasty depending on the desires of the patient, from a full canal that can be used for intercourse to a little “divot” that can accept, say, a finger, to an aesthetic “dimple”. The choice here has important preparation and recovery consequences, discussed below.
- Nullification — colloquially, this is called the “barbie surgery”. A zero depth vaginoplasty with no vulva created, so you’re left with just a smooth lower half and a urethra, which can be a choice for non-binary or asexual patients
- Vulvaplasty — another name for zero depth or minimal depth, where the main goal is to create an aesthetic vulva and a functional clitoris without a vaginal canal. This is typically the terminology for zero depth or minimal depth that will be used on the actual surgeon’s website
- Orchiectomy — Often just called “orchi” this is removal of the testicles. This is generally a much simpler surgery than the other ones on this list, an outpatient surgery with roughly two weeks of couch rest as the recovery window. It is often excluded from the notion of “transfeminine bottom surgery” but often comes up, in particular around issues of whether the scrotum or tunica vaginalis is removed along with the testicles, which affects decisions about vaginoplasty.
- materials — a LOT of the ink spilled on transfeminine bottom surgery is about the exact material used to make the vaginal canal. The ones that I commonly know of at this time of writing are:
- penile inversion (PIV) — the material from the penis and scrotum is used to make the inside of the vagina. This is the oldest technique for trans women, and is generally considered to be the lowest risk type of vaginoplasty. Donwsides is that it requires that every piece of skin that is going to be, in the future, interior to the body needs to be hairless, which usually means 30-60 hours of electrolysis (I anecdotally know women who have gone as high as 100 hours)
- peritoneal pull-through (PPT) — this is the traditional way of doing canal reconstruction in cis women. It uses a piece of the abdominal tract and robotic laproscopic surgery techniques to create the vaginal canal. Advantages cited are that it will create a vagina better able to self-lubricate and perhaps more robust against being lost, disadvantages are that the additional abdominal surgery component makes recovery worse. Also, this is a newer technique, and has less research
- tunica vaginalis — this is a tissue that coats the testicles in amab people, and can be used to give additional depth, though i do not know of anyone who solely uses the tunica. it is sometimes, but not always, removed during an orchiectomy, so if you’re considering vaginoplasty after an orchi, please do talk about this with your orchi surgeon. The tunica is said to provide a stronger tissue than the penis, and some lubrication benefits
- colovagina — parts of the large intestine are used to construct the vaginal canal. There are some lubrication benefits here, but most of my research indicates that the colon is considered to be one of the physically least robust materials to use, and that this is generally considered to be a revision technique to reconstruct lost PPT or PIV canals
- jejunal graft — this is a much, much newer technique that only has limited availability. If you go for this technique, you mostly likely will have to travel and recover in another city. This uses the jejunum, a part of the small intestine, to create the vaginal canal. proponents of this technique cite dramatically reduced dilation times and much better lubrication and naturalness to the other techniques, but this is also a much rarer technique that I see a fraction of actual discussion and results cited than the other ones
- Other skin grafts/hybrid — sometimes, a surgeon might not find enough matter to make a vagina after harvesting from the above places, and so may offer either something like a hybrid piv/ppt, or supplement the penile matter with a skin graft from the hip, or even exotic choices like tilapia skin.
- Phallus-preserving vaginoplasty (Salmacian bottom surgery) — this is basically the use of PPT and the creation of a vulva using scrotal tissue where the patient can be left with a functional phallus/penis, and also a functional vaginal canal. This used to be quite rare, but is being offered by more and more bottom surgeons
- Dilation — post-operatively, the process by which the vaginal shape is established and held. Typically, this means inserting a steel core covered with silicone into the vagina and holding it at depth for a specified time. The exact dilation schedule is surgeon-dependent, but all dilation schedules definitely get to be less frequent over time and taper down to something like “once a week” in the maintenance phase.
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