Orgasm After Gender Confirmation Surgery

by Cay Crow, M.A., LPC, AASECT-Certified Sex Therapist


Is It Possible To Have An Orgasm After Gender Confirmation Surgery?

Dear Cay,

I was wondering whether or not people who have gender confirmation surgery can still experience orgasm. These individuals are having their genitals surgically altered so can they still get off?

Inquiring minds want to know

Gender Transformation Process From Male To Female


The short answer is, yes absolutely! The complete answer is more involved.

Sexuality is inherently complex for anyone. Imagine if you are born in a body that does not fit who you know yourself to be. Folks who choose to have gender confirmation surgery go through their own developmental process adapting to the bodies they choose to live in; part of which is learning post-surgical sexual expression.

First, a foray into the mechanics of gender confirmation. Rather simplistically, to surgically create a vagina from a penis, the shaft with its internal erectile tissue is turned up inside the body to create the vaginal canal. The process involves sculpting the scrotal skin into the vulva once the testicles are removed. Typically, the oophorectomy (removal of the testicles) is done in a separate surgery 6 months to a year before vaginoplasty. Surgeons have their own methods of creating a clitoris from the sensitive parts of the penis. Sexual expression is still possible because the majority of the nerves are preserved. Post-surgical dilation of the vagina ensures that it remains a potential space should penetration be desired.

Gender Transformation Process From Female To Male

Female bodied folks adapting their bodies may begin with removal of breast tissue and chest reconstruction. Those that want to alter their genitalia typically start with a metoidioplasty, severing the ligament that keeps the clitoris close to the body. The hormonally enhanced clitoral head enlarges with the help of hormones and is then more accessible for sexual pleasure.

Phalloplasty, the surgical creation of a penis, is a more difficult process. There is not enough tissue in the female genitals to create a penis so the surgeon accesses other parts of the body. In one process, the inner thigh, abdomen, or forearm supplies a swatch of sensitive skin which is rolled into a phallus while still attached to the blood supply of the body. This is a long and painful procedure. Eventually, the phallus is permanently attached to the groin. Some processes create a functioning urethra however, the phallus does not have erectile tissue or nerve supply. The penis can be used but the owner cannot feel sensations from the created organ. Online photos demonstrate the amazing skills of these surgeons.

Most trans clients I have worked with tell me that there is nothing like having sex as the gender they know themselves to be. Finally having congruence between their gender identity and their body completes a circuit in their minds and allows them to fully enjoy sexuality as they have not before.


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