Vaginoplasty is the most common feminizing "bottom surgery": the surgical construction of a vulva and neovaginal canal from a male body. It is major, irreversible surgery with a lifelong maintenance requirement. This page covers how the main techniques work, what the research actually shows about complications and regret, and what trans-identified and detransitioned people say about their outcomes — including the people for whom it did not work.

The main techniques

There are four surgical approaches in current use. Penile inversion (PIV) is the most studied and most performed; the others are used as primary procedures or as revisions when PIV fails.

A 2025 systematic review of 7,338 patients found overall vaginal stenosis (canal narrowing) of 5.83%: 5.70% after PIV, 0.20% after intestinal vaginoplasty, and 8.10% after peritoneal techniques — with introital (opening) stenosis of 3.15% overall. A separate systematic review of neovaginal prolapse across 3,166 patients found an overall rate of 2.7%, rising to 3.5% for intestinal techniques, with high body mass index the only significant risk factor.

What the complication data shows

Complication rates vary enormously between studies because definitions and follow-up periods differ. The most comprehensive review of penile inversion outcomes reports the following ranges:

Two things stand out. First, the upper bounds are high: in the largest single series (Buncamper et al., 475 patients, median 8-year follow-up), minor necrosis occurred in 24.6% and urinary retention in 12.8%. Second, cosmetic revision rates of 20–54% mean that a large share of patients undergo at least one additional operation — a reality rarely visible in promotional material.

A 2025 single-institution patient-reported survey of penile inversion patients found major complications in 13.9% and revision surgery in 34.2%, most commonly for stenosis or depth concerns. 59% reported a misdirected urine stream, 43% vaginal dryness, and 44% painful intercourse — though most rated the bother as low.

Regret and detransition: what the research shows

The most-cited figure is a pooled estimate of about 1% regret after gender-affirming surgery across 27 studies (7,928 patients; Bustos et al. 2021), with vaginoplasty specifically estimated at 2% across 11 studies. A survey of 46 surgeons estimated regret at 0.2–0.3%. Sweden's 50-year registry found a 2.2% rate of formal regret applications among 681 surgically reassigned patients.

These numbers are contested. Cohn (2023) argues the detransition rate is unknown because existing studies have short follow-up (regret often emerges after 7–8 years on average), high loss to follow-up, and samples that do not match today's patients. In the Swedish data, 36% of patients were lost to follow-up — the regret status of more than a third of the cohort is simply unknown. Only 24% of detransitioners in Littman's 2021 survey of 100 detransitioners had told their clinicians they had detransitioned, which means clinic-based studies systematically miss them.

A survey of 46 surgeons (Narayan et al. 2021) classified the regret they did encounter as true gender-related regret (42%), social regret (37%), and medical regret (8%) — a reminder that "regret" is not one phenomenon.

Detrans perspectives

Detransitioner accounts on /r/detrans concentrate on three themes: the gap between what was expected and what the surgery delivers, the lifelong maintenance burden, and the permanence of the outcome when the underlying dysphoria resolves or the reasons for transition change.

The only surgery will remove your genitals, turn them inside out, and give you an inverted penile hole that you will have to painfully dilate every day for the rest of your life. You will not produce lubrication, you will not be able to give birth, and you will not menstruate. —scoutydouty, detrans female

Imma post op 4+ yrs, detrans for 2 y and I really really regret this surgery. ... my blunt message to u: plz don't do it. It's not worth your time, blood and tears (not to mention your 💲). —justme12345678900000, detrans male

I had bottom surgery in 2018, and for me that was the immediate realization that the whole thing was all bullshit that there was no magical surgery that can turn you into a woman. That a neo vagina is absolutely nothing like a real vagina... now I have this weird mutilated penis to look like a vagina that doesn't function like a vagina, can't function like a penis anymore, and barely has any sexual stimulation and very difficult to orgasm with. —deserTShannon, detrans male

I regret mine because its not a vagina but a hole. It just underlined to me im a guy in the end and there is no escape. ... I also hate how i was left on my own after the fact while everything hurt intensely. No help at all. ... Never felt this lonely in my life. —FallynFinder, questioning own gender identity

I was in my early 20's when I was mutilated, I had requested it because of complex childhood trauma that was never addressed... I think what I did to myself was just how I dealt with the trauma in my life, like getting to be someone else... it was a form of self harm, that's all it is. —GlitteringEffect9093, detrans male

Some detransitioners describe a specific post-surgical dysphoria — the surgery that was meant to end dysphoria producing a new form of it:

that's actually reverse dysphoria when u realise u want your genital back but u won't get them back. that's one of the reasons I don't like intimacy and sex anymore. —throwawayac101010, self-questioning

Reversal is possible but limited. Techniques include closing the canal (vaginectomy or conversion to zero-depth), and a small number of clinics — one frequently mentioned is in Belgrade — specialize in reversal. Reconstruction of the original anatomy is not possible; tissue that has been inverted, excised, or lined with intestine cannot be restored to its prior state. Some detransitioners choose to keep the surgery and live with it rather than undergo further operations.

Show details: detrans video accounts

• Detransitioner Interview: Botched Surgery, Regret, & the Social Contagion (Shape) — describes fistula after revision, loss of penetrative function, post-operative depression, and surgeon misconduct.
• My Detransition Story: The Dark Truth Behind Gender Dysphoria and Regret (Alexander L) — chronic bleeding for four years, catheter dependence, bowel pain.
• Doctors Pushed Me into Surgery (Ritchie Herron) — catastrophic complications and regret dismissed by a gender therapist as OCD.

Trans perspectives

Trans-identified people who are satisfied with vaginoplasty describe relief of genital dysphoria, improved sexual function, and — in some cases — resolution of long-standing identity doubt. These accounts are real and should be weighed alongside the complications data, not dismissed.

I had three goals going into surgery. In order, 1) eliminate dysphoria, 2) maintain sexual function, and 3) good aesthetics. And I met all of those goals. My bottom dysphoria is completely gone. I had my first orgasm one month post-op... It's a very invasive surgery that's a huge physical trauma on the body, the recovery time is long, and there is a large time commitment with dilation in the first year. It's not something to be undertaken lightly, but it's been absolutely worth it for me. —Id_like_to_be_a_tree, MTF

So I'm 2.5 years post op. ... I haven't regretted it for a second. 11/10. Dilating was far more tedious than painful. ... It breaks my heart to read the horror stories, and I think people should continue to share their experiences, good and bad. Those with negative outcomes need more support and shouldn't be condemned as fear mongering. —Vladd88, MTF

Notably, even satisfied patients describe significant burdens. One trans woman 2.5 years post-op noted that horror stories and positive outcomes both deserve space; another, several years post-op, described mixed results — no regret, but painful intercourse, dissociation during sex, and the difficulty of disclosing to partners:

Post-op trans ladies don't spend enough time talking about the shit bits. We don't want to scare people off. ... Would I do it again? 1000%. Had it made my life better? 1000%. Is sex better? 1000%. —AnnaRose96, MTF

What informed consent should include

The recurring complaint from both dissatisfied patients and clinicians is that consent processes understate the realities. Based on the evidence and the accounts above, a genuinely informed decision would engage with at least these points:

• Irreversibility. Original anatomy cannot be reconstructed. Reversal means closure or approximation, not restoration.
• Lifelong maintenance. Canal techniques require a dilation schedule — often multiple times daily in year one, tapering but never fully stopping — plus regular douching, because the canal has no self-cleaning mechanism.
• Complication probability. Using the reported ranges, the chance of at least one complication requiring attention is substantial; the chance of needing a second operation for cosmetic or functional reasons is 20–54% in the PIV literature.
• Sexual function uncertainty. Orgasm is possible for many patients, but sensation may be reduced, absent, painful, or hypersensitive. Rates of dyspareunia, incontinence and urinary stream problems are non-trivial.
• No guarantee of relief. Surgery resolves genital dysphoria for many and fails to resolve it — or creates new distress — for some. The research cannot reliably predict which outcome an individual will have.
• The regret data is weak. The often-quoted 1% figure comes from studies with follow-up shorter than the average time to regret. Honest consent means saying the rate is uncertain, not that it is negligible.

References

References

• Hontscharuk et al. (2021). Penile inversion vaginoplasty outcomes: Complications and satisfaction. Andrology. source.
• Ferrando et al. (2023). Updates on feminizing genital affirmation surgery (vaginoplasty) techniques. Neurourology and Urodynamics. source.
• Buncamper et al. (2016), reported in Ferrando et al. 2023. Penile inversion series, 475 patients, median 8-year follow-up. source.
• Systematic review of neovaginal prolapse after vaginoplasty (2024). Andrology. source.
• Vaginal stenosis after gender-affirming vaginoplasty: systematic review (n=7,338). source.
• Outcomes of gender-affirming sigmoid colon vaginoplasty: retrospective study of 119 patients (2025). JPRAS. source.
• Patient-reported outcomes of penile inversion vaginoplasty using the AFFIRM measure (2025). PubMed 42466234.
• Bustos et al. (2021). Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plast Reconstr Surg Glob Open. source.
• Narayan et al. (2021) / Danker et al. (2018). Guiding the conversation — types of regret after gender-affirming surgery and their associated etiologies. source.
• Cohn (2023). The Detransition Rate Is Unknown. Archives of Sexual Behavior. study page, source.
• Littman (2021). Individuals Treated for Gender Dysphoria... A Survey of 100 Detransitioners. Archives of Sexual Behavior. study page, source.
• Dhejne et al. (2014), as reviewed in Transition Regret and Detransition: Meanings and Uncertainties (2023). source.
• Horbach, S. E. R., Bouman, M.-B., Smit, J. M., et al. (2015). Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques. Journal of Sexual Medicine 12(6):1499-1512. source.