SRS, or sex reassignment surgery, is a set of surgical procedures that modify a person’s body to align with their gender identity. You may also see it called gender confirmation surgery (GCS) or gender-affirming surgery (GAS), which are newer terms for the same category of procedures. The surgery most people mean when they say “SRS” is bottom surgery, the reconstruction of genitalia, though the broader category can include chest surgery, facial feminization, and other procedures. In the U.S., roughly 13,000 gender-affirming surgical procedures were performed annually as of 2019-2020.
Why the Name Keeps Changing
If you’ve seen multiple terms and wondered whether they mean the same thing, they mostly do. “Sex reassignment surgery” was the standard term for decades. Over time, medical organizations shifted toward “gender confirmation surgery” and then “gender-affirming surgery” to reflect the idea that the procedure confirms a person’s existing identity rather than reassigning them a new one. In practice, all three terms refer to the same procedures, and you’ll still encounter “SRS” widely in online discussions and older medical literature.
Transfeminine Bottom Surgery
For transgender women and transfeminine individuals, the two primary options are vaginoplasty and vulvoplasty. The choice between them depends on personal goals, lifestyle, and what feels right for the individual.
Vaginoplasty
Vaginoplasty creates both a vulva (the external genitalia) and a vaginal canal with depth. The most common technique, penile inversion vaginoplasty, uses existing genital tissue, repositioned and reshaped. A newer approach uses peritoneal tissue, the lining of the abdominal cavity, which has some advantages: it shares a developmental origin with vaginal tissue and can transform over time into tissue that closely resembles a natural vagina. Peritoneal techniques may also offer better natural lubrication and reduced risk of the canal narrowing.
The clitoris is constructed from the head of the penis, which preserves nerve endings and allows sexual sensation. Research on transgender women who underwent vaginoplasty or vulvoplasty found that 90% reported the ability to orgasm within six months of surgery.
Vaginoplasty requires a significant aftercare commitment, primarily dilation. This means inserting a medical device into the vaginal canal on a regular schedule to maintain its depth and width. The typical schedule looks like this:
- First 3 months: three times a day for about 10 minutes each session
- 3 to 6 months: once a day
- 6 to 9 months: two to three times a week
- 9 months onward: once or twice a week, continuing long-term
Most people find the frequency becomes routine over time, but it is a lifelong maintenance practice. Hair removal in the genital area is also required before surgery to prevent complications inside the canal.
Vulvoplasty (Zero-Depth)
Vulvoplasty creates the external genitalia, including a clitoris with sensation, but without a vaginal canal. Some people choose this option because they have no interest in penetrative intercourse, prefer a simpler recovery, or want to avoid the ongoing dilation schedule. The surgical technique is nearly identical to vaginoplasty minus the canal creation. Recovery is generally shorter, and there is no dilation requirement.
Transmasculine Bottom Surgery
For transgender men and transmasculine individuals, the two main options are metoidioplasty and phalloplasty. These differ substantially in size, sensation, number of surgical stages, and functional outcomes.
Metoidioplasty
Metoidioplasty works with tissue that has already been enlarged by testosterone therapy. The procedure releases and repositions this tissue to create a small penis. It typically requires fewer surgical stages, preserves strong erogenous sensation, and carries a lower complication rate than phalloplasty. The tradeoff is size: the result is smaller, which can make standing urination more difficult without a modified technique, and penetrative intercourse may not be possible.
Phalloplasty
Phalloplasty constructs a full-sized penis, most commonly using tissue from the forearm (a radial forearm flap) or thigh. It’s a complex, multi-stage process. A typical staged approach involves creating the shaft and urethra first, then performing additional procedures about five months later: urethral connection, repositioning of sensitive tissue from the clitoris, and shaping of the head and scrotum. Some people also later have testicular implants and an erectile device placed.
Phalloplasty creates a penis that generally allows standing urination at a urinal and penetrative intercourse (with an implanted device). However, it often involves more stages, may provide less erogenous sensation than metoidioplasty, and has a higher complication rate. Urethral complications are particularly common: one review found that narrowing of the urinary opening occurred in 40% of patients, though this was typically correctable in a follow-up procedure.
Complications and Risks
Like any major surgery, gender-affirming procedures carry risks. For vaginoplasty, a 13-year review of outcomes found minor wound healing issues in about 33% of patients, narrowing of the vaginal opening in 15%, vaginal stenosis (tightening of the canal) in 12%, and loss of vaginal depth in 8%. Rectal injury, a more serious complication, occurred in about 3% of cases. Many of these issues can be addressed with revision procedures or adjusted dilation.
For phalloplasty, urethral stricture (narrowing that makes urination difficult) is the most frequently reported complication, and stricture recurrence after correction was seen in about 15% of cases. The multi-stage nature of phalloplasty means patients should expect a longer overall surgical journey, often spanning a year or more from start to finish.
Satisfaction and Quality of Life
The research on post-surgical satisfaction is consistently positive. In a retrospective study of over 100 transgender women who had vaginoplasty, 87.4% were satisfied or very satisfied with their outward appearance. About 72% were satisfied or very satisfied with functional outcomes. When asked whether life had become easier since surgery, 68.4% said clearly yes, and another 14.7% said somewhat easier. Over half rated their overall life satisfaction in the top third of the scale.
Perhaps the most telling finding: in one cited population, 96% said they would choose to have surgery again. Regret rates across the literature remain low, though individual experiences vary, and expectations going in play a significant role in satisfaction afterward.
What Recovery Looks Like
Recovery timelines depend heavily on which procedure you’re talking about. Vulvoplasty has the shortest recovery of the bottom surgeries. Vaginoplasty typically involves several weeks of limited activity and months of dedicated dilation. Most people take four to six weeks off work for vaginoplasty, though full healing continues for months.
Phalloplasty recovery stretches longer because of its staged nature. Each stage has its own recovery period of several weeks, with months between stages for healing. The donor site (often the forearm) also needs to heal and may require physical therapy. From first stage to final result, the full process commonly takes 12 to 18 months or longer.
For all bottom surgeries, follow-up care is essential. Surgical teams typically schedule multiple post-operative visits to monitor healing, address complications early, and adjust care plans. Sensation often continues to develop and improve for a year or more after surgery, so early results don’t represent the final outcome.