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Gender reassignment surgery: an overview

This article has been updated


Gender reassignment (which includes psychotherapy, hormonal therapy and surgery) has been demonstrated as the most effective treatment for patients affected by gender dysphoria (or gender identity disorder), in which patients do not recognize their gender (sexual identity) as matching their genetic and sexual characteristics. Gender reassignment surgery is a series of complex surgical procedures (genital and nongenital) performed for the treatment of gender dysphoria. Genital procedures performed for gender dysphoria, such as vaginoplasty, clitorolabioplasty, penectomy and orchidectomy in male-to-female transsexuals, and penile and scrotal reconstruction in female-to-male transsexuals, are the core procedures in gender reassignment surgery. Nongenital procedures, such as breast enlargement, mastectomy, facial feminization surgery, voice surgery, and other masculinization and feminization procedures complete the surgical treatment available. The World Professional Association for Transgender Health currently publishes and reviews guidelines and standards of care for patients affected by gender dysphoria, such as eligibility criteria for surgery. This article presents an overview of the genital and nongenital procedures available for both male-to-female and female-to-male gender reassignment.

Key Points

  • The management of gender dysphoria consists of a combination of psychotherapy, hormonal therapy, and surgery

  • Psychiatric evaluation is essential before gender reassignment surgical procedures are undertaken

  • Gender reassignment surgery refers to the whole genital, facial and body procedures required to create a feminine or a masculine appearance

  • Sex reassignment surgery refers to genital procedures, namely vaginoplasty, clitoroplasty, labioplasty, and penile–scrotal reconstruction

  • In male-to-female gender dysphoria, skin tubes formed from penile or scrotal skin are the standard technique for vaginal construction

  • In female-to-male gender dysphoria, no technique is recognized as the standard for penile reconstruction; different techniques fulfill patients' requests at different levels, with a variable number of surgical technique-related drawbacks

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Figure 1: Male-to-female genital surgery.
Figure 2: Phalloplasty techniques in female-to-male genital surgery.
Figure 3: The Norfolk technique for glans sculpturing.

Change history

  • 26 April 2011

    In the version of this article initially published online, the statement regarding the frequency of male-to-female transsexuals was incorrect. The error has been corrected for the print, HTML and PDF versions of the article.


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G. Selvaggi and J. Bellringer contributed equally to the research, discussions, writing, reviewing, and editing of this article.

Corresponding author

Correspondence to James Bellringer.

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The authors declare no competing financial interests.

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Selvaggi, G., Bellringer, J. Gender reassignment surgery: an overview. Nat Rev Urol 8, 274–282 (2011).

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