“SRS” or sex reassignment surgery is an older umbrella term often used for gender-affirming genital surgery. There is no single best technique. The appropriate operation depends on a person’s goals, anatomy, previous surgery, tissue availability, health history and the functions that are most important to them.
Transfeminine genital surgery techniques
Penile-inversion vaginoplasty
Penile and scrotal tissues may be used to create the vulva and vaginal canal. Exact tissue use and achievable depth vary between patients. Some patients may need additional graft tissue depending on anatomy and the planned technique.
Vulvoplasty / zero-depth vulvoplasty
Vulvoplasty creates external vulvar anatomy without creating a full-depth vaginal canal. It may be considered by patients who do not want or cannot undergo a procedure requiring a vaginal canal and long-term dilation.
Intestinal or peritoneal approaches
Selected patients may be offered techniques using intestinal tissue or peritoneal tissue, particularly in specific primary or revision situations. These approaches have different benefits, risks and aftercare requirements and are not automatically preferable to penile-inversion vaginoplasty.
Transmasculine genital surgery techniques
Metoidioplasty
Metoidioplasty uses hormonally enlarged clitoral tissue to create a small phallus. Urethral lengthening, scrotoplasty and other procedures may be added depending on the patient’s goals and plan.
Phalloplasty
Phalloplasty constructs a phallus using tissue from a donor site such as the forearm or thigh. It may be performed in stages. Urethral lengthening, scrotoplasty, glans construction and erectile implants may be considered separately depending on goals and healing.
How is a technique selected?
Important factors can include desired appearance, vaginal depth or standing urination goals, sexual sensation priorities, donor-site preference, previous surgery, tissue availability, willingness to undergo staged procedures, dilation requirements and tolerance for procedure-specific risks.
Possible risks
Risks vary by operation and can include bleeding, infection, wound-healing problems, narrowing or stenosis, urinary complications, fistula, changes in sensation, donor-site issues and the need for revision surgery. A surgeon should explain the risks that apply to the exact technique being considered.
There is no universal “best” technique
Online comparisons cannot determine which operation is most appropriate for an individual patient. Technique selection should follow a detailed consultation, examination and informed-consent discussion.
For procedure-specific information, see our vaginoplasty information and phalloplasty information, or review the broader gender-affirming surgery overview.
This article is for general education and does not replace individualized surgical advice.
