The Transgender Dictionary
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Penile-Preserving

(also: bottom surgery, lower surgery, phallus-preserving, salmacian, vaginoplasty)

Table of Contents

Introduction

Many transgender women, and some transfeminine nonbinary people, experience gender dysphoria regarding the lack of a vulva and/or vaginal canal. Having a vulva and/or vaginal canal procured through surgical means can be a great source of gender euphoria. This page will be discussing the technique known as "penile preservation vagnioplasty." For general information on vaginoplasty, click on the underlined word to go to the general vaginoplasty page, or navigate to it using the alphabet menu at the top of this page.

This is the least common variation of vaginoplasty, typically reserved for those who are nonbinary (though not all nonbinary people want salmacian results - some nonbinary people opt for non-phallus preserving variants of vaginoplasty). It can sometimes be more difficult to convince a surgeon to perform this procedure, so it may require more searching for a provider than other, more typically and gender-conforming variants.

General Information

This variation of vaginoplasty perserves the existing penis. This surgery is an important option for those who wish to preserve their penis and the functions that come along with it. This surgery is an optimal choice for nonbinary people who are looking to retain their penis for sexual function, fertility preservation, urinary function, and individual personal identity. The goal of any skilled surgeon while performing this procedure is to create a functional and aesthetically pleasing vagina while maintaining the original genital structure.

The neovagina is created using the penile skin and scrotal tissues while retaining the penis. These tissues are reshaped (the penile skin is inverted) and repurposed to create a vaginal canal. A skin graft sourced from the hip, lower abdomen, or inner thigh may be used if there is not enough skin available from the penis and the scrotum to achieve the desired depth of the vaginal canal.

The glans of the penis may be repurposed to create a clitoral hood, simulating the appearance of a clitoral area.

This is an inpatient procedure. Pain and discomfort are normal post-op. Swelling and bruising around the surgical site are normal and should go away over time. A temporary urinary catheter may be placed. Caring and cleaning the surgical site as instructed by the surgical team is crucial for proper recovery. Restrictions on things such as strenuous exercise, heavy lifting, and sexual activity will be set by the surgeon. It is extremely important to follow your surgeon's instructions. Regular follow-up appointments will be scheduled to monitor the healing process.

How It Works

Techniques such as peritoneal pull-through or rectosigmoid may be used. The primary difference is that when the phallus is preserved, there is no or limited construction of a vulva.