Last updated July 30, 2025 > [!important] This report was produced by Gemini Deep Research. It is for educational purposes only and should not be considered medical advice. - [[#Introduction]] - [[#Components of Nullification Surgery]] - [[#]] - [[#]] - [[#Scrotectomy]] - [[#Urethral Rerouting]] - [[#Customization Options in Nullification Surgery]] - [[#Benefits and Risks of Nullification Surgery]] - [[#Benefits]] - [[#Risks]] - [[#Recovery Process and Long-Term Outcomes]] - [[#Psychological and Emotional Considerations]] - [[#Conclusion]] ## Introduction Nullification surgery, also known as nulloplasty or genital nullification, is a gender-affirming surgical procedure for individuals who do not identify exclusively as male or female. The procedure removes or alters genital characteristics to align with the individual's gender identity, providing a surgical option for those who desire neither traditional male nor female genitalia. This surgery serves non-binary, agender, and gender non-conforming individuals seeking to achieve a physical presentation that matches their internal sense of self. The primary goal is creating a neutral, non-binary appearance in the genital area. For individuals assigned male at birth (AMAB), nullification typically involves removing the penis, testicles, and scrotum. The urethra is preserved and rerouted or shortened to enable urination from a seated position, similar to a "female" position. Each nullification procedure is highly personalized, tailored to the individual's unique gender identity and preferences. This distinguishes it from traditional gender reassignment surgeries, which align physical characteristics with binary male or female categories. The procedure is also known as "nullo" surgery or "nullectomy". The medical community's growing recognition of non-binary gender identities has improved the development and accessibility of nullification procedures. This progress reflects a broader shift toward more inclusive and individualized approaches to gender-affirming care, acknowledging that not everyone seeks to transition within a binary framework. Nullification surgery represents more than a physical change—it helps affirm an individual's deeply felt gender identity, often leading to significant improvements in mental health and overall well-being. ## **Components of Nullification Surgery** Nullification surgery for individuals assigned male at birth typically involves several key components, including penectomy, orchiectomy, scrotectomy, and urethral rerouting. Each of these procedures contributes to the overall goal of creating a smooth, neutral genital area. ### [[Penectomy]] Penectomy is the surgical removal of the penis, which can be either partial or complete based on individual goals. In nullification surgery, a total penectomy, which involves complete removal of the penis, is the standard approach. For individuals seeking to retain sensation, methods for nerve preservation in the glans are available. One common technique involves carefully dissecting and "burying" the sensate distal penile tissue, which includes the glans, under the skin in the lower mons area, just above the urethra. This creates something akin to a "hidden" clitoris. This approach allows for the preservation of a focused nerve center, potentially enabling orgasmic stimulation without compromising the desired smooth external appearance. Another option for glans placement is to leave it at the surface, creating what is sometimes referred to as an "outie". Depending on individual preferences, the penile nerve bundle can also be either buried within the mons or completely removed. If nerve preservation in the glans is not performed, it is likely that the individual will experience a loss of erogenous sensation in that area. Changes in sensation are a recognized potential risk associated with genitoplasty procedures, which include penectomy as a component. While nerve preservation techniques exist to maintain sensation, the extent and quality of the resulting sensation can vary among individuals. Therefore, it is important for those considering this option to have realistic expectations regarding the sensory outcomes following surgery. ### **[[Orchiectomy]]** Orchiectomy is a surgical procedure to remove the testicles through an incision in the scrotum or, occasionally, through the inguinal area. For nullification surgery, both testicles are removed, which effectively stops testosterone production and may eliminate the need for hormone-blocking therapy. The procedure is typically done on an outpatient basis under general anesthesia. Recovery usually takes a few days to two weeks, during which patients should rest and avoid strenuous activities. Like any surgery, orchiectomy carries potential risks such as bleeding, infection, nerve damage, and scar tissue formation. Orchiectomy has proven to be a safe and well-established procedure, used not only in nullification surgery but also as a treatment for various medical conditions including testicular cancer, prostate cancer, and male breast cancer, as well as for hormone management in other contexts. ### **Scrotectomy** Scrotectomy involves removing the scrotal sac and is commonly performed alongside orchiectomy during nullification surgery. This procedure is typically chosen by individuals with natal male genitalia who do not plan to pursue other bottom surgeries that would require scrotal tissue. For those considering vaginoplasty in the future, scrotectomy is generally not recommended since surgeons use scrotal skin to create the labia and vaginal canal lining. The procedure creates a smooth area where the scrotum was previously located. Like orchiectomy, scrotectomy carries risks including scrotal web formation, tissue tethering, and wound healing complications that may require skin grafting. The decision to include scrotectomy in nullification surgery depends heavily on future surgical plans, especially regarding vaginoplasty. This underscores the importance of thorough consultation with a surgeon to discuss all options and implications. ### **Urethral Rerouting** Urethral rerouting is another significant component of nullification surgery for individuals assigned male at birth. This procedure involves shortening and repositioning the urethra to a more downward position, enabling urination while sitting down. The surgical process involves shortening the existing urethra and relocating its external opening (meatus) to a downward-facing position in the perineum - the area between the scrotum and anus. In some cases, surgeons may need to create a new urethral opening through a procedure called perineal urethrostomy. Potential risks include urethral strictures (narrowing of the urethra), fistulas (abnormal tissue connections), and voiding dysfunction. After surgery, the new position of the urethral opening requires adjusting to different urination techniques. While urethral rerouting is essential for AMAB individuals seeking a non-binary or feminine genital presentation, it demands precise surgical technique and careful post-operative care due to its complexity. ## **Customization Options in Nullification Surgery** Nullification surgery offers extensive customization options, allowing individuals to align the outcome with their unique needs and desires. The procedure can be tailored in several key areas: - **Nerve Preservation**: Individuals can choose to preserve nerves in the glans to maintain sensation. Options include burying the sensate tissue beneath the skin for a smooth appearance or leaving the glans at the surface for more direct sensation. - **Glans Placement**: The glans can be positioned below the skin, kept at the surface as an "outie," or completely removed, based on individual preferences for sensation and aesthetics. - **Aesthetic Outcomes**: Patients work closely with their surgeon to achieve their desired appearance. While most seek a smooth transition from the lower abdomen to the groin area, some may opt for alternatives like a no-depth vaginoplasty, which creates external female genitalia without a vaginal canal. Additional customization options include combining nullification with other gender-affirming procedures like non-binary top surgery or incorporating specific preferences about labial folds and creases. This range of options emphasizes the patient-centered approach of nullification surgery. Surgeons work collaboratively with individuals to create a physical presentation that authentically reflects their gender identity. ## **Benefits and Risks of Nullification Surgery** Nullification surgery offers a range of potential benefits for individuals seeking to align their physical presentation with their non-binary or agender identity. These benefits extend beyond the physical realm, often positively impacting mental and emotional well-being. However, as with any surgical procedure, it is crucial to be aware of the associated risks involved in each stage. ### **Benefits** A key benefit of nullification surgery is the ability to align one's physical appearance with their deeply felt gender identity beyond traditional male-female categories. This alignment often provides significant relief from gender dysphoria, leading to improved mental health and overall well-being. The surgery represents a transformative moment of empowerment, enabling individuals to embrace their authentic selves and take ownership of their bodies. It allows people to define their gender expression on their own terms, free from binary gender constraints. Additionally, for those who undergo testicle removal as part of the procedure, there may be reduced or eliminated need for hormone therapy. ### **Risks** While nullification surgery offers significant benefits, it is essential to be aware of the potential risks associated with each stage of the procedure. As with any major surgical intervention, there are general risks to consider, such as bleeding, infection at the surgical site, and adverse reactions to anesthesia. Regarding penectomy specifically, potential risks include changes in sensation, which can range from numbness to altered sensitivity. Orchiectomy carries risks such as bleeding, infection, nerve damage, and potential hormonal changes due to the removal of testosterone-producing organs. Scrotectomy, though often performed for aesthetic reasons, has its own set of potential complications, including the possibility of scrotal web formation or issues with wound healing. Urethral rerouting, while essential for the desired outcome, can lead to complications such as urethral strictures, fistula formation, and changes in urinary function. Given the complexity of nullification surgery and the potential for risks at each stage, it is paramount for individuals considering this procedure to engage in a thorough and open discussion with a qualified and experienced surgeon. This dialogue will allow for a comprehensive understanding of the individual's specific risk factors, as well as the strategies that can be employed to minimize these risks and ensure the best possible outcome. ### **Recovery Process and Long-Term Outcomes** The recovery process following nullification surgery is gradual, with timelines varying based on individual factors and specific procedures performed. Initially, patients typically experience swelling, bruising, and mild pain, which are managed with prescribed medications. A Foley catheter is often used temporarily to assist with urination. Medical professionals generally advise limiting movement and avoiding heavy lifting and strenuous activities for several months to allow proper healing. Long-term outcomes typically include a flat groin area with a small urethral opening and minimal scarring. After complete healing, individuals can expect normal urinary function, though those with urethral shortening will need to urinate while seated. If nerve preservation was part of the procedure, sensory preservation may allow for continued sexual sensation through buried nerve endings. Notably, many individuals report significant improvement in their mental health and overall well-being following nullification surgery as part of their gender affirmation journey. It's important to understand that genitoplasty procedures, including nullification, are generally considered irreversible. Research indicates favorable long-term outcomes for nullification surgery, with high satisfaction rates reported in studies on gender-affirming surgeries generally. ### **Psychological and Emotional Considerations** The decision to undergo nullification surgery is a deeply personal and often profound one for individuals seeking to align their physical bodies with their genuine gender identity. This choice often stems from a desire to embrace their authentic selves and to reclaim ownership of their bodies, allowing them to define their gender expression on their own terms. For many, nullification represents a pivotal moment of empowerment, enabling them to live more comfortably and authentically in their true identity, independent of binary gender norms. Preparing for nullification surgery extends beyond the physical aspects and involves significant mental and emotional preparation. It is often recommended, and sometimes required, that individuals considering this procedure seek support from mental health professionals who specialize in gender-affirming care. This support can help address any concerns or anxieties and ensure emotional readiness for the transformative procedure. Surrounding oneself with a nurturing support system, including family, friends, or community resources, can significantly contribute to emotional well-being and resilience throughout the preparation and recovery phases. Many individuals who choose to undergo nullification surgery as part of their gender affirmation journey experience a notable improvement in their mental health and a reduction in gender dysphoria following the procedure. This surgery can provide a profound sense of affirmation and support for how they see themselves, leading to increased comfort and congruence in their lived experience. ## **Conclusion** Nullification surgery represents a significant and personalized option within the spectrum of gender-affirming care. For individuals who identify beyond the binary of male and female, this procedure offers a pathway to achieving a physical form that aligns more closely with their internal gender identity. The surgical process, involving penectomy, orchiectomy, scrotectomy, and urethral rerouting, is highly customizable, allowing for individual preferences regarding nerve preservation, glans placement, and aesthetic outcomes. While the potential benefits of nullification surgery, including the alleviation of gender dysphoria and improved mental well-being, are substantial, it is crucial for individuals considering this path to be fully informed about the risks associated with each stage of the procedure. The recovery process requires time and careful adherence to post-operative guidelines. Ultimately, the decision to undergo nullification surgery is a deeply personal one that should be made in consultation with experienced medical and mental health professionals to ensure a safe and affirming outcome. - **Works cited** 1. 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