Bottom surgery is one of the most personal decisions in a gender-affirming journey. It can take years of reflection, conversation, and self-discovery to arrive at the moment of choosing surgical care — and when that moment comes, you deserve a team that listens carefully and points you toward the path that genuinely fits your goals. While Dr. Mark Youssef and the Transgender Surgery Institute of Southern California focus primarily on top surgery and chest procedures, we understand that bottom surgery is often part of a broader, lifelong story of alignment. This page offers clear information and helps you find your next step.
What Is Bottom Surgery?
“Bottom surgery” is an umbrella term for a range of gender-affirming genital procedures. These surgeries are highly individualized — what’s right for one person may not be right for another, and the available techniques continue to evolve. Outcomes depend on anatomy, personal goals, surgical approach, recovery time, and the long-term function and sensation each person hopes to experience.
Because of this complexity, bottom surgery is best entrusted to surgeons who specialize specifically in these procedures and perform them at high volume. Our role at the Institute is to make sure you feel informed, supported, and connected with the right specialists — not to perform these procedures ourselves.
Transmasculine (FTM) Bottom Surgery
Transmasculine bottom surgery typically includes options such as:
- Metoidioplasty — a procedure that releases and reshapes existing tissue, often pursued by individuals who want a more compact result, preserved erogenous sensation, and a generally shorter recovery.
- Phalloplasty — a multi-stage procedure that constructs a phallus using tissue grafts, with options that may include urethral lengthening, scrotoplasty, and the placement of erectile or testicular implants.
- Hysterectomy and vaginectomy — frequently performed as companion procedures, depending on the surgical plan.
Each path involves different recovery timelines, staged surgeries, and considerations around urinary function, sensation, and aesthetics. A thorough consultation with a specialized surgeon is the best way to understand which approach aligns with your goals.
Transfeminine (MTF) Bottom Surgery
Transfeminine bottom surgery generally centers on vaginoplasty, with several established techniques:
- Penile inversion vaginoplasty — the most widely performed technique, which uses existing genital tissue to construct the vaginal canal, labia, and clitoris.
- Peritoneal or intestinal vaginoplasty — alternative approaches that may be recommended based on anatomy or prior surgical history.
- Vulvoplasty — a procedure that creates external genital structures without a vaginal canal, sometimes chosen for medical or personal reasons.
These procedures involve careful planning around hair removal, dilation protocols, recovery, and long-term care. The right surgeon will walk you through every consideration with patience and clarity.
Our Referral Relationship with Align Surgical
For patients interested in bottom surgery, we maintain a referral relationship with the team at Align Surgical Associates (opens in new tab). Align is a nationally recognized practice dedicated to gender-affirming genital and facial surgery, with surgeons who focus exclusively on this work. We trust their expertise, their patient-centered approach, and the depth of care they provide throughout every stage of treatment.
If bottom surgery is part of your journey, we encourage you to explore Align Surgical’s resources directly. They can answer detailed clinical questions, discuss candidacy, and guide you through the consultation process with the specialization these procedures require.
How We Can Still Support You
Even when a procedure falls outside our direct scope of practice, we remain a steady resource. If you’re navigating decisions across multiple stages of care — including top surgery before, alongside, or after bottom surgery — we’re happy to talk with you about how the pieces fit together. Our goal is simple: to help you feel informed, respected, and confident in whatever direction your path takes.