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Ramirez et al. Plast Aesthet Res. 2025;12:16 Plastic and
DOI: 10.20517/2347-9264.2025.10
Aesthetic Research

Perspective Open Access

Surgical considerations for genital reconstruction
options for gender-diverse individuals assigned

male at birth

Mayra Lucas Ramirez, Maria Wangamez, Rachel Huynh, Christi Butler
Department of Urology, University of California, San Francisco, San Francisco, CA 94143, USA.
Correspondence to: Dr. Christi Butler, Department of Urology, University of California, San Francisco, 400 Parnassus Ave #
A610, San Francisco, CA 94143, USA. E-mail: christi.butler@ucsf.edu

How to cite this article: Ramirez ML, Wangamez M, Huynh R, Butler C. Surgical considerations for genital reconstruction options
for gender-diverse individuals assigned male at birth. Plast Aesthet Res. 2025;12:16. https://dx.doi.org/10.20517/2347-9264.
2025.10

Received: 24 Jan 2025 First Decision: 22 Mar 2025 Revised: 23 Apr 2025 Accepted: 29 Apr 2025 Published: 28 May 2025
Academic Editor: Gennaro Selvaggi Copy Editor: Ting-Ting Hu Production Editor: Ting-Ting Hu

Abstract
Information available on gender-affirming surgeries is often limited to those classified by the binary standard of
masculinizing or feminizing genital aesthetics. Scant information is available on surgical options for non-binary and
gender-diverse individuals who may opt for less frequently requested surgeries. We discuss preoperative
counseling, surgical techniques, and postoperative care of such procedures, including a discussion of scrotectomy,
penile-sparing vaginoplasty, and nullification procedures for non-binary and gender-diverse individuals assigned
male at birth (AMAB). Frequent and open discussions are key to helping manage expectations of surgical
outcomes. Creating an inclusive and safe environment is pivotal in understanding the needs and goals of all gender-
diverse patients.

Keywords: Nullification, penile sparing vaginoplasty, scrotectomy, gender diverse

INTRODUCTION
Over the last decade, there has been an increase in the number of gender-affirming surgeries (GAS)
performed. Recent data on temporal trends on GAS in the United States (U.S.) suggest that the number has
nearly tripled from 2016 to 2019 . Genital reconstruction is the second most common GAS in a cohort of
[1]

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0
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