Introduction: I Did This#

On August 9, 2024, I became a nullo.

I walked into Saint Francis Memorial Hospital in San Francisco carrying decades of dysphoria, months of preparation, and a certainty that had only grown stronger the closer I got to this moment. I walked out without a penis, testicles, or scrotum. In their place: smooth skin, a small urethral opening, and a body that finally felt like mine.

I'm not writing this guide as a medical professional describing a procedure I've studied from a clinical distance. I'm writing it as someone who lived through this surgery, recovered from it, navigated complications, underwent revision surgery, survived sepsis, and came out the other side more certain than ever that becoming a nullo was the right choice for me.

That distinction matters. When I was researching nulloplasty, I found plenty of clinical descriptions—lists of surgical components, recovery timelines, potential complications rendered in detached medical language. What I couldn't find was someone saying: Here's what this actually felt like. Here's what I wish I'd known. Here's what the first weeks were really like when the swelling was alarming and the catheter was uncomfortable and I couldn't tell if what I was experiencing was normal or catastrophic. The absence of those voices nearly derailed my journey more than once.

So let me be that voice for you.

Nulloplasty—also called nullification, genital nullification, or nullo surgery—aims for a smooth, neutral genital appearance. For those of us assigned male at birth, the proposed operation may remove the penis, testes, and scrotum and relocate the urinary opening, but the components and nerve choices vary. MoZaic Care describes one approach; WPATH SOC8 includes a chapter on eunuch-identified people and their individualized health needs. Neither source defines a universal nulloplasty operation or outcome.

The medical terminology makes it sound simple. It's not simple. It's one of the most profound decisions a person can make about their body, and it deserves to be discussed with the weight and care it requires.

This guide will give you everything I wish I'd had when I was where you might be now: considering whether this path is right for you, preparing for surgery, understanding what recovery actually looks like, and knowing what can go wrong—and what to do when it does. I'll draw from clinical resources and surgical center protocols where they exist, but I'll also draw from what I learned in my own body, in my own recovery room, in my own hospital bed when things went sideways.

If you're reading this and considering nulloplasty, I want you to have all the information I can give you. Not sanitized, not softened, not written by someone who's never felt what you might be feeling. Real.

Let's begin.

What Nulloplasty Is#

The Basics#

Nulloplasty creates a smooth, neutral genital appearance by removing external genital structures. For those of us assigned male at birth, a plan may combine penectomy, orchiectomy, scrotectomy, and urethral rerouting; someone who has already had an orchiectomy will have a different sequence. MoZaic Care's description of its nullification procedure shows one approach and the choice to preserve nerves under the skin or remove them. Ask your surgeon which components and sensation options fit your goals.

Penectomy removes penile tissue. For a smooth nulloplasty contour, the plan usually includes total rather than partial removal, while decisions about preserving sensate glans tissue belong to the nerve options below. Ask your surgeon exactly what will be removed and what can be retained; penectomy covers the related choices in more detail.

Orchiectomy removes both testicles through an incision in the scrotum. This is called bilateral orchiectomy. It stops testicular testosterone production, but the plan for any anti-androgen or hormone replacement is individual. OHSU's orchiectomy guidance says people can usually stop a testosterone blocker and may be able to lower estrogen; make those changes with your prescribing clinician. If you weren't on hormones before surgery, or if you're like me and plan to continue testosterone as your hormone replacement therapy, discuss what you will need afterward before the operation.

Scrotectomy removes the scrotal sac. This distinguishes nulloplasty from orchiectomy alone (where the testicles are removed but the scrotal sac remains) and from procedures like vulvoplasty (where scrotal tissue is often used to create labia). In nulloplasty, we don't need that tissue—we want it gone. The skin is removed, and the area is closed to create a smooth appearance.

Urethral rerouting shortens and repositions the urethra to create an opening for seated urination. One method is a perineal urethrostomy, described in Cleveland Clinic's general urology guide; its technique and outcome figures are not nulloplasty-specific. Ask where your own opening will sit, how urinary flow will be checked, and how your team handles narrowing or other healing problems.

The planned result is a flat genital area with a small urinary opening. Scars and contour can keep changing for months; the final look depends on the technique and your healing. My own result felt dramatically right. Ask your surgeon to show healed examples of the exact operation they propose and explain what may remain visible.

What It Actually Looks Like#

I remember spending hours searching for images before my surgery. I needed to see what I was choosing. Clinical descriptions weren't enough. I needed to know what I'd look like when I woke up, what I'd look like healed, what my body would be.

Pause here. What you see immediately after surgery will not be what you live with. Swelling, bruising, and stitches are temporary stages of healing, not your final result. The most important thing right now is understanding that the body you're imagining and the body you'll have are separated by a healing process that takes months. Everything else can wait.

The immediate post-surgical appearance is swollen, bruised, and frankly alarming if you're not prepared for it. Everything is puffy—significantly more swollen than you might expect. There are stitches. The skin looks angry, purple-red with bruising spreading outward. This is normal. Your body just went through significant trauma, and it's doing what bodies do: inflaming, protecting, beginning to heal.

The first time I looked at myself after surgery, I felt a confusing mixture of relief and alarm. Relief because the wrongness was gone—I reached down and felt smooth bandages instead of what had been there, and something in me finally unclenched after decades of tension. Alarm because what I could see looked nothing like the healed results I'd seen in photos online. I had to remind myself repeatedly: this is day one. This is what day one looks like. The photos you saw were months or years into healing.

In my recovery, the swelling changed gradually over several weeks. At two weeks I still saw a lot of it; by four weeks it had improved, and at six weeks I could start to imagine the healed contour. That was my sequence, not a timetable for every body. Ask your team what amount of swelling it expects and which changes need a call.

The bruising follows the usual pattern: purple, then green-yellow, then fading away. Some people bruise more dramatically than others. I had significant bruising that spread down my inner thighs—which looked terrifying but was apparently normal given the extent of the surgery.

The stitches dissolve or get removed depending on your surgeon's technique. Mine dissolved on their own over the first few weeks, though I noticed small pieces of suture material working their way out for longer than I expected.

By a few months out, the area is smooth. There's a small urethral opening—mine looks like a tiny slit, barely noticeable unless you're looking for it. There may be some scarring, depending on surgical technique and your body's healing tendencies. My scars have faded significantly but are still visible if you know where to look. They continue to mature for up to two years.

What you're left with is nothing. And for those of us who needed this, that nothing is everything.

What It Means to Live Without External Genitalia#

The psychological experience of nulloplasty deserves honest discussion. For me, the relief was immediate and profound. The moment I woke up from anesthesia and reached down to find smooth bandages instead of what had been there—I can't fully describe what that felt like. Years of dysphoria, decades of something being wrong in my body, and suddenly it wasn't there anymore. I cried. Not from pain, not from regret. From relief so profound it overwhelmed me.

Daily life changed in ways both significant and subtle. Getting dressed became neutral instead of triggering. The daily negotiation with underwear—trying to arrange things so they didn't show, trying not to think about what I was arranging—just... stopped. Catching sight of myself in the mirror stopped producing that jolt of wrongness. I could look at my reflection without that immediate visceral recoil.

Urination, which had been a regular reminder of the body I didn't want, became just urination. Unremarkable. I sit, I pee, I wipe, I'm done. The mechanics are slightly different—I'll talk about the learning curve later in this guide—but what matters more is that it's no longer loaded with dysphoria. It's just a bodily function, the way it should have always been.

The permanence of this choice deserves careful thought. Removing tissue may change later reconstruction options, including techniques for creating vaginal depth or a phallus. Ask surgeons who perform those later procedures what your proposed nulloplasty would leave available, what alternatives they could use, and what cannot be reversed. Wanting a smooth contour is a valid goal without needing to promise yourself a future operation.

This is irreversible. That's not a reason to avoid it. It's a reason to be certain.

For me, certainty came from decades of knowing something was wrong and years of understanding what I actually wanted. I didn't arrive at nullification casually. I arrived after exploring every other option, after sitting with this desire through different phases of my life, after confirming repeatedly that this was what I needed. The fear I felt before surgery was about the surgery itself—the anesthesia, the recovery, the pain—not about the outcome. Underneath the fear, the conviction remained solid.

If your fear is about the surgical process, that's normal. Surgery is scary. Pain is unpleasant. Recovery is hard. But if your fear is about whether you actually want this outcome—whether you'll regret not having genitalia, whether this is the right choice for your body—that's worth sitting with longer. Nulloplasty is irreversible. There's no shame in taking more time to be certain.

Who Nulloplasty Is For#

Beyond the Binary#

For decades, gender-affirming surgical options assumed everyone wanted to move from one end of the binary to the other. Trans women would want vaginoplasty. Trans men would want phalloplasty or metoidioplasty. The surgical establishment was designed around this framework, and those of us who didn't fit it were often left without options—or without the knowledge that options existed.

Nulloplasty exists because not everyone's gender identity fits the binary.

Nonbinary individuals may experience profound dysphoria about their genitalia without feeling aligned with the "opposite" binary option. If you're assigned male at birth and experience distress about having a penis, but a vagina doesn't feel right for you either, nulloplasty offers a third path: neither male nor female genitalia. A body that reflects a gender beyond the binary.

Agender individuals may not experience gender identity at all. For some agender people, the absence of gendered genital structures feels most authentic—a body that isn't marked by either category.

Some transgender women pursue nulloplasty instead of vaginoplasty for various reasons. Some are asexual and have no interest in penetrative intercourse. Some want to eliminate testosterone production and genital dysphoria without the demanding recovery that vaginoplasty requires—the dilation schedules that last for life, the longer initial healing timeline, the different complication profile. Some simply feel that a smooth appearance aligns better with their sense of self than a vulva would. There's no wrong reason to choose nulloplasty over vaginoplasty if it's what feels right for your body.

Some eunuchs identify with this pathway as well. WPATH Standards of Care version 8 explicitly recognizes eunuch as a gender identity, noting that some individuals specifically desire the physical and hormonal characteristics of someone without testicles (Coleman et al., 2022). This recognition was significant—it acknowledged that the eunuch identity has existed across cultures and throughout history, and that contemporary individuals who identify this way deserve access to appropriate medical care.

The key question isn't which label fits you best. It's whether the outcome of nulloplasty—smooth genital area, seated urination, cessation of gonadal hormone production, the specific changes to sexual function—aligns with what you genuinely want for your body and life.

Those Who Don't Want What's Typically Offered#

Many people assigned male at birth who experience genital dysphoria initially assume vaginoplasty is their only surgical option. When they realize they don't want a vagina, they may conclude that surgery simply isn't for them—that they're stuck with a body that causes them distress because the available solutions don't match what they need.

I spent years in that position. I knew I hated my genitals with a visceral intensity that made daily life difficult. I also knew, with equal certainty, that I didn't want a vagina. For a long time, I thought that meant I just had to live with what I had. Learning that nullification existed—that I could simply have neither—was one of the most significant moments in my journey. Suddenly there was a path forward that actually matched what I wanted.

I want to speak directly to anyone who's been in that position: nulloplasty exists. You have options beyond the binary.

If you've explored vaginoplasty and felt like it wasn't right, but you still experience significant genital dysphoria, please don't give up. Keep researching. Keep looking. The surgical landscape is broader than the mainstream narrative suggests, and somewhere in that landscape, there may be an option that fits you.

The Identity Question#

Some people ask whether nulloplasty is about gender identity or about something else—body modification, personal preference, aesthetic goals.

My answer: it doesn't matter which category it falls into. What matters is whether it's right for you.

For me, becoming a nullo was absolutely about my gender identity. I'm nonbinary. I never wanted a penis, never identified with having one, and spent decades dissociating from that part of my body. Removing it aligned my physical form with my internal sense of self. That's textbook gender-affirming surgery.

But even if someone pursued nulloplasty for reasons unrelated to gender identity—if they simply wanted a different body and this was the body they wanted—I would defend their right to make that choice. Bodily autonomy is bodily autonomy. Adults have the right to make informed decisions about their own bodies, full stop.

A diagnosis and surgical documentation may matter to a particular insurer or program, but the rules vary. The truth underneath the paperwork remains simple: some of us need our bodies to be different, and we deserve access to care that helps us live in them. Ask your program and insurer which current written requirements apply to you.

Variations and Customization#

Nulloplasty isn't one-size-fits-all. Surgeons offer various options to customize the outcome to your specific goals. Understanding these variations helps you articulate what you want during consultations.

Nerve Preservation: Keeping Sensation#

The most significant customization decision is whether to preserve erogenous sensation. There are several approaches, and the one you choose shapes your sexual future in fundamental ways.

Buried glans involves carefully dissecting the glans (the head of the penis, which contains the highest concentration of nerve endings) and repositioning it beneath the skin of the mons—the area above where the genitalia used to be. This creates an invisible sensate nodule. You can't see it from outside, but you can feel it when the area is stimulated through the skin. Essentially, it creates something like a hidden clitoris.

This is what I chose. The glans was carefully separated from the rest of the penile tissue and buried beneath the surface of my mons. From the outside, there's nothing visible—just smooth skin. But when pressure is applied to that area, there's sensation. Erotic sensation. The nerves survived the surgery and continue to function, just in a different configuration. I'll talk more about what that means for sexual function later, but for now: it works. It's different than before, but it works.

Surface glans leaves a small portion of the glans visible at the skin surface. This maximizes access to sensation—you can stimulate it directly rather than through overlying skin. But it does mean there's a visible structure, which defeats some of the "smooth" aesthetic that draws many people to nullification. Some people specifically prefer this configuration; others find it defeats the purpose of the surgery for them.

Complete removal removes genital erectile tissue and the penile nerve tissue a surgeon might otherwise preserve. It may remove a valued source of genital sexual sensation; it does not tell you everything about pleasure in the rest of your body. Some people specifically want this option. Ask your surgeon to explain exactly which tissues and nerves they would remove and what is known, and unknown, about sensation afterward.

There's no wrong choice here. What matters is that you understand the implications of each option and choose what aligns with your goals. During consultation, your surgeon should explain what each option involves and help you think through which approach serves your needs. If they seem dismissive of your questions about nerve preservation, or if they assume you want a particular configuration without asking, that's worth noting—a good surgeon takes the time to understand what you're seeking.

Urethral Positioning#

The location and construction of the urinary opening depend on the operation. Cleveland Clinic describes a perineal urethrostomy in general urologic care, while your surgeon must explain the exact opening planned for you. Ask how its position could affect stream direction, emptying, comfort, and later revisions.

If the location of the urinary opening matters to you—perhaps because of how you sit, spray, mobility, or access to a toilet—say so during consultation. Ask which positions the surgeon can offer and which tradeoffs each creates. Once healing is complete, changing the opening may require another procedure, so request a drawing before you decide.

Aesthetic Considerations#

Different surgeons have different techniques, and the final appearance varies somewhat depending on approach. Incision placement affects where scars end up. Closure technique affects how smooth the final result appears. Individual healing affects scar visibility.

Surgeons may place incisions in skin folds or other less prominent areas, but scars remain. Their appearance changes over time and varies with technique, skin, and healing. Ask to see healed results and discuss scar care and revision options with the team doing your surgery.

If you have concerns about scarring—whether for aesthetic reasons or because visible scars might create safety issues in certain contexts—discuss this explicitly with your surgeon during consultation. Ask to see photos of healed results from other patients (with their permission, of course). Get a realistic sense of what to expect.

My scars have faded significantly but are still visible if someone is looking closely. In my daily life, this hasn't been an issue. But if you're in a situation where scarring might matter—perhaps you're in communities where nudity is common—it's worth understanding what to expect.

Candidacy: What You Need Before Surgery#

The Clinical Requirements#

Nulloplasty is a significant, irreversible surgical procedure. Surgeons and insurance companies have requirements designed to ensure patients are making informed decisions.

The WPATH Standards of Care version 8 provide guidance for gender affirming genital surgery and include a chapter on eunuch-identified people. They do not supply a single nulloplasty checklist. Ask your surgeon and payer what their current requirements are for the components of your proposed operation.

Documentation and assessment. A surgeon, program, or payer may request assessment or written documentation. Confirm that organization's current criteria, including the information and credentials it requests. SOC8 recommends assessment by a health-care professional competent in transgender health; if written documentation is required, one assessment letter from a competent professional can be sufficient. It does not set a universal one- or two-letter rule for nulloplasty (Coleman et al., 2022).

SOC8 does not establish a universal one-letter rule or a universal two-to-one-letter reduction for adult genital surgery. It recommends assessment by a health-care professional competent in transgender health and says that, if written documentation is required, one assessment letter from a competent health-care professional can be sufficient. A surgeon, program, or insurer may have different requirements, including which credentials or documentation it requests (Coleman et al., 2022).

Payer and program paperwork can be frustrating, and the current rule may differ by procedure, jurisdiction, plan, and surgeon. Obtain the exact current written criteria before arranging documentation; do not assume that a historical two-letter or doctoral-credential pattern applies. My own paperwork process is lived experience, not a transferable authorization checklist.

If you're nonbinary or pursuing nulloplasty rather than a binary surgical option, seek mental health professionals who understand nonbinary identities. Some providers still operate from a binary framework and may not know how to assess someone whose goals don't fit the traditional narrative. You deserve providers who understand that nonbinary people exist and that our surgical goals are valid.

Ask the surgical program which evaluation, tests, and specialist consultations it needs for your operation and health history. Chronic conditions may change preparation and follow-up; they do not by themselves decide whether you can have surgery. Get the specific checklist in writing rather than treating a generic blood-test or EKG list as mandatory.

Hormone plans before and after nulloplasty vary with the organs removed, your goals, and your health. SOC8 discusses stable treatment where it fits the person and allows for hormones being unwanted or contraindicated. Ask both the surgeon and prescriber for a plan, including bone-health follow-up if orchiectomy is part of the operation; do not assume a universal waiting period.

I was on estrogen before my surgery. Afterward, I transitioned to testosterone as my hormone replacement therapy—which might surprise some people, but it's what works for my body and my identity. Nulloplasty is available to people with various relationships to hormone therapy. The key is that you'll need some form of HRT after surgery since your body will no longer produce its own sex hormones.

Health Considerations#

As with any major surgery, certain factors affect your candidacy and risk profile.

Smoking and nicotine. The American College of Surgeons explains that stopping smoking around an operation can reduce wound problems. Your surgeon may have a specific rule about cigarettes, vaping, and nicotine replacement. Ask for that rule in writing, how long it applies, and what cessation support is available; do not assume one timeline or product rule fits every operation.

BMI. Some surgeons have BMI limits for surgery. Excess weight can complicate anesthesia, increase surgical difficulty, and impair healing. If you're above a surgeon's BMI limit, you may need to lose weight before becoming a candidate. Different surgeons have different thresholds, so if one surgeon's requirements don't work for you, others may be more flexible. But be honest with yourself about the medical reality: higher BMI does correlate with higher complication rates.

Chronic conditions. Diabetes, hypertension, bleeding disorders, immune conditions—these don't automatically disqualify you, but they need to be stable and well-managed. Your surgeon needs to know about everything, because these factors affect surgical planning and recovery. Uncontrolled diabetes, for example, significantly impairs wound healing. Getting your conditions under good control before surgery is part of preparation.

If you live with HIV or another condition that may affect surgical planning, ask the program how it assesses your current health and coordinates with your treating clinician. Do not assume a universal viral-load or CD4 cutoff or a standard antibiotic plan from this page. Your team should explain any requirement and how it applies to your situation.

Previous surgeries. Prior genital surgery may affect your candidacy or surgical approach. If you've already had an orchiectomy, that changes what the nulloplasty procedure involves—you won't need that component, but your surgeon needs to know to plan around existing scar tissue. If you've had other pelvic surgery, that's also relevant information.

Hair Removal: Not Required#

Hair preparation depends on where your surgeon will place the urethral opening and which tissue will remain. A nulloplasty plan that removes scrotal skin may need different preparation from one that reuses tissue. Ask for a written map of any required treatment before starting hair removal; vaginoplasty has a different tissue plan again.

Ask your specific surgeon whether any perineal or donor area needs hair treatment, which method it accepts, and how completion affects scheduling. Avoid assuming that nulloplasty requires no preparation or that another procedure always requires a fixed number of months of electrolysis.

The Mental Readiness Question#

Beyond the clinical checkboxes, there's the question of whether you're genuinely ready for this change.

I can't tell you how to know if you're ready. But I can tell you what readiness felt like for me: certainty that persisted through doubt. I had moments of fear before surgery—everyone does. But underneath the fear, the conviction remained. I wanted this. I had wanted it for as long as I could remember wanting anything about my body. The fear was about the surgery itself, not about the outcome.

If your fear is about the surgical process—the anesthesia, the recovery, the pain—that's normal. Surgery is scary. Pain is unpleasant. Recovery is hard.

If your fear is about whether you actually want this outcome—whether you'll regret not having genitalia, whether this is the right choice for your body—that's worth sitting with longer. Nulloplasty is irreversible. There's no shame in taking more time to be certain.

Finding a Surgeon#

Who Performs Nulloplasty#

Not all surgeons who perform gender-affirming surgery offer nulloplasty. It's less common than vaginoplasty or phalloplasty, and some surgeons simply don't do it.

I describe my own surgery and recovery later in this guide. If you are comparing programs, ask whether they currently offer your exact version of nulloplasty, how they handle sensation and urethral placement, and who manages revisions. MoZaic Care describes one nullification approach, while OHSU describes its gender-neutral genitoplasty program; neither page establishes what another team offers today.

This list isn't exhaustive, and the landscape changes. New surgeons enter the field; others retire or change their practice. Do your own research into current options. The bottomsurgery.info website that I maintain includes updated information on surgeons offering various procedures.

When researching surgeons, look for experience specifically with nulloplasty (not just vaginoplasty or general urology), before and after photos of their nulloplasty results, patient testimonials or reviews from people who've had this specific procedure with them, and clear communication about their techniques and customization options.

What to Ask During Consultation#

Consultations are your opportunity to evaluate surgeons and ensure they understand your goals. Think about questions in several categories.

Regarding their experience, ask how many nulloplasty procedures they've personally performed, what their complication rate is for this specific surgery, whether they can show you photos of their results at various stages of healing, and how many of their nulloplasty patients have needed revision surgery.

Regarding the procedure itself, ask about their specific surgical technique, what nerve preservation options they offer, where the incisions will be and what scarring will look like, how long the surgery typically takes, and what type of anesthesia they use.

Regarding recovery, ask what their expected recovery timeline is for returning to work, exercise, and sexual activity, how long you'll need a catheter, what follow-up appointments you'll need, and how accessible they are if complications arise—what's the after-hours contact process?

Regarding your specific situation, ask if they have concerns about anything in your medical history, what the specific risks are for someone with your health profile, and what their revision rate is and what's included in the surgical fee if revision is needed.

Trust your instincts. If a surgeon feels dismissive, if they don't seem to understand nonbinary identities, if they're rushing you through the consultation—those are red flags. You're trusting this person with irreversible surgery on one of the most intimate parts of your body. You deserve someone who takes that seriously, who answers your questions thoroughly, and who makes you feel respected.

Insurance and Cost#

Coverage for nulloplasty depends on your current plan, location, and the exact procedures proposed. Ask the surgical program for the planned codes and a written itemized estimate, then ask the payer for its current coverage, prior-authorization, network, and appeal rules. Insurance, costs, and documents offers a fuller path for that conversation.

The billing codes depend on which components the surgeon actually proposes and how the facility bills them. Request the complete code list, including any urinary reconstruction, from the billing team before asking your insurer for a coverage determination. A generic CPT recipe here could lead you to the wrong answer.

My surgery was covered by insurance, but obtaining the documents and waiting for authorization took months. If your plan denies your request, get the reason in writing and check the deadline and instructions on the notice. HealthCare.gov's internal-appeal guide explains one federal appeal process and the records to keep; the route for your own plan may differ. My fight for coverage is a reason to document yours, not a prediction that an appeal will succeed.

If you're paying out of pocket, ask the surgical program for a current written estimate that separates the surgeon, facility, anesthesia, travel, follow-up, and possible revision costs. Prices and financing terms change, and a broad dollar range here could mislead you. Insurance, costs, and documents covers questions to take to your insurer and care team.

Preparing for Surgery#

The Weeks Before#

Once you have a surgery date, preparation begins in earnest.

Plan for smoking cessation. The American College of Surgeons links quitting around surgery with fewer wound complications. Ask your surgical team which tobacco or nicotine products it restricts, when to stop and restart, and how it can help you quit. The answer should come from your team's written plan rather than a universal four-to-six-week rule here.

Adjust medications. Your surgical team will give you specific instructions about which medications to stop and when. Blood thinners, certain supplements (fish oil, vitamin E, some herbal supplements), NSAIDs like ibuprofen—various things can increase bleeding risk. Don't stop any prescription medication without discussing with your prescribing doctor, but do follow your surgical team's instructions precisely.

Arrange caregiving. Ask the surgical team what help you may need with movement, meals, medication, catheter care, transport, and urgent problems, and for how long. Write down who can cover those tasks and a backup contact. My own recovery made me grateful for hands-on help, but the amount and duration will depend on your operation and support system.

I was incredibly fortunate to have my husband KJ handling logistics, emotional support, and physical caregiving simultaneously during my recovery. He tracked medications, helped me shower, kept me company during long hours of limited mobility, and never once made me feel like a burden. Having that level of dedicated support shaped my recovery profoundly. Not everyone has a partner who can take weeks off work, but everyone needs some form of support system in place.

Prepare your recovery space. Stock up on supplies: comfortable loose clothing (dresses or loose shorts work well since you won't want anything pressing on the surgical area), a donut cushion for when you're able to sit, medications you'll need, easy-to-prepare foods, entertainment for long days of rest. Set up a space where you can rest comfortably with everything within reach.

If you travel for surgery, ask the program how long it wants you nearby, which follow-up visits are essential, and who will assess a complication after you return home. Book transport and lodging around that written plan, with room to change them if healing or a revision changes the schedule.

I stayed in San Francisco for a month after my initial surgery. This turned out to be crucially important when I developed complications after my revision surgery a year later—I was still there, still had access to my surgical team. Geography matters during recovery more than I initially understood.

The Days Before#

Preoperative tests. Ask the surgical team for its current written testing and clearance checklist, who orders each item, and when results are due. The tests depend on your health and the proposed operation; a generic bloodwork or ECG schedule here would be unreliable.

Ask your surgeon whether your exact procedure needs any bowel preparation and, if so, get the steps in writing. Do not start a clear-liquid diet or laxative from a generic pelvic-surgery checklist; the plan may differ when no vaginal canal is created.

Follow the anesthesia team's current fasting and medication instructions for your operation. Ask specifically when to stop solid food and each kind of liquid and which usual medicines to take; a universal midnight cutoff can conflict with an individual anesthesia plan.

The Day Of#

You'll arrive at the surgical center, complete check-in and consent forms, change into a hospital gown, and meet with your surgical and anesthesia teams. There's usually a period of waiting while everything gets prepared—the surgical suite, the anesthesia equipment, the team.

Then they take you back to the operating room. The anesthesiologist puts you under, and when you wake up, your body is different.

I remember the last moments before anesthesia with surprising clarity. Fear, excitement, surreal certainty that this was actually happening. Years of wanting, months of planning, and suddenly the needle was in my arm and I was counting backward and then I was waking up and it was done.

The Surgical Process#

What Happens in the Operating Room#

Nulloplasty is performed under general anesthesia. You'll be unconscious throughout the procedure, breathing with the assistance of a ventilator. The anesthesiologist monitors your vital signs continuously.

Ask the surgical team to explain the actual sequence planned for you, including position, incisions, tissue removal or preservation, urethral construction, and closure. These steps differ by technique; a generic sequence cannot tell you exactly what will happen in your operation.

The orchiectomy removes the testicles through scrotal incisions. The penectomy removes the penis with careful management of blood vessels. If you've chosen nerve preservation, the glans is carefully dissected and set aside for repositioning. Urethral rerouting shortens the urethra to appropriate length and creates the new opening (meatus) in the perineal position. If applicable, the nerve preservation step repositions the glans or nerve bundle beneath the skin of the mons and secures it in place. The scrotectomy removes excess scrotal skin. Finally, closure involves closing the incisions in layers, possibly placing drains to prevent fluid accumulation, and placing a Foley catheter to drain urine while the urethral site heals.

Operating time depends on the components, anatomy, technique, and any revision. Ask your surgeon for the estimate for your own plan and what might extend it. Do not use a generic two-to-four-hour range to arrange pickup or support.

Hospital Stay#

The discharge plan depends on the exact operation, anesthesia, catheter, travel distance, and your health. Ask whether your team expects an outpatient stay or overnight observation and what milestones must be met before you leave. Arrange transport and nearby support around that written plan.

I stayed overnight in the hospital after my initial surgery, which I'd recommend if it's an option. That first night, I was exhausted, still processing anesthesia, and needed the nursing staff's help with basic tasks. By morning, I was stable enough to be discharged to my hotel room, but those overnight hours of professional monitoring and care made a real difference.

I needed hands-on help after my surgery. Ask your team what support you will need during the first days, how long someone should stay with you, and what would change that plan. Make arrangements before surgery, especially for transport, catheter care, medication, food, and a way to reach the team after hours.

Recovery: What It's Actually Like#

The First Days#

Waking up from anesthesia is disorienting. You're groggy, probably nauseous, aware that something significant just happened to your body but not quite processing it yet. There are bandages. There's pain—dulled by whatever medications they're giving you but definitely present. There's a catheter, which is uncomfortable in ways that are hard to describe until you've experienced it.

The first time I reached down and felt smooth bandages where my genitals used to be—I cried. Not from pain, not from regret. From relief so profound it overwhelmed me. After all those years of wrongness, there was nothing there. Finally.

The first few days are about rest, pain management, and basic bodily functions. You need to eat (even when you don't feel hungry—your body needs fuel to heal), drink (hydration is crucial), manage the catheter, and take medications on schedule. You need to monitor for signs of complications. You need to let your body begin healing.

Pain: I had significant discomfort and took prescribed opioid medication during my first week. My team gave me a schedule; I followed their instructions and later switched to over-the-counter medicines when they said it was appropriate. By two weeks my pain had eased substantially, and by four weeks I rarely needed medication. That was my course, not a dosing schedule for you. Ask your team how to use your own prescriptions and when worsening pain needs review.

Pain can change during healing, and my own difficult first days did improve. If yours worsens, becomes unexpectedly severe, or comes with another worrying change, call your surgical team. You do not have to decide from a generic recovery calendar whether a symptom is normal.

Swelling and bruising: My surgical area became dramatically swollen and bruised. It looked alarming to me, then gradually changed over the following weeks. Ask your team what it expects for your operation and what signs would make swelling, bleeding, or pain an urgent concern.

Bruising follows the usual pattern: purple, then green-yellow, then fading away. Mine spread down my inner thighs, which looked terrifying but was apparently just how my body processes trauma. It was gone within a few weeks.

The catheter: Ask your team whether you will have one, how long it expects to keep it, and how to care for it. Managing mine was annoying—the bag needed regular emptying, clean handling, and a position below my bladder. Sleeping with a catheter was uncomfortable; I found it helped to tape the tube to my leg to prevent tugging.

My catheter was removed at a follow-up visit. It was brief and uncomfortable, but less difficult than I feared. Ask your team how your catheter will be removed and what to do if you cannot urinate or develop worsening pain afterward; do not wait for a generic hours-long resolution promise.

Emotional intensity: The days immediately after surgery are emotionally intense. Relief, fear, joy, doubt, grief, gratitude—they cycle through unpredictably. Anesthesia affects your mood and cognition. Opioid pain medications can cause emotional lability. Your hormones may be shifting. You're processing a major life change in the midst of significant physical discomfort.

Give yourself grace. Let the emotions come without judging yourself for having them. Cry if you need to. Sleep when you can. The emotional volatility settles as your body heals and you adjust to your new reality.

The First Weeks#

After the initial acute phase, recovery becomes a matter of gradual improvement and patience.

Activity restrictions: Follow your team's written limits for lifting, exercise, sex, and pressure on the surgical site. I was told to limit walking to 2,000 steps a day for my first four weeks; that was a rule for my case, not a general nulloplasty standard. Ask how and when your limits will be reassessed.

The temptation to do more appears around week two or three, when you start feeling better and getting restless. Resist it. Your tissues are still healing even when you feel fine. Overdoing it at this stage can set back your recovery.

Wound care: Your surgeon will give you specific instructions for cleaning and caring for the surgical area. Mine involved gentle cleaning during showers with mild soap, patting dry (not rubbing), and keeping the area clean and dry. No baths, no swimming pools, nothing that would submerge the healing incisions.

Watch for signs of infection: increasing redness, warmth, swelling that's getting worse rather than better, discharge that's cloudy or foul-smelling, fever. If you notice any of these, contact your surgical team immediately.

Learning to urinate: After the catheter comes out, you need to learn to urinate through your new urethral opening. This takes adjustment. The stream may be different than you expect—weaker initially due to swelling, possibly spraying in unexpected directions, requiring different positioning on the toilet.

I spent the first few post-catheter bathroom visits figuring out how to sit, which direction to lean, how to relax properly. The stream sprayed a bit at first; I learned to sit further back on the toilet. Within a few weeks, it became automatic. Now I don't think about it at all—it's just how I pee.

Follow-up appointments: You'll have scheduled appointments with your surgical team to check healing. Keep these appointments even if everything seems fine. They're how your surgeon monitors for complications and catches problems early. My follow-up visits included examination of the surgical site, assessment of urinary function, and opportunities to ask the questions that inevitably arise during recovery.

Emotional processing: The weeks after surgery can be emotionally complex. Relief is the dominant feeling for many of us, but it's not the only one. You might experience joy at finally having the body you wanted, grief for reasons you might not expect—grief is part of major life transitions even when those transitions are positive, fear about whether you made the right choice especially on hard days, and adjustment as you learn to inhabit your body in its new configuration.

These feelings can coexist. Having moments of doubt doesn't mean you made the wrong choice. Having moments of grief doesn't mean you regret it. You're integrating a profound change into your sense of self. That takes time.

The Following Months#

Healing continues for months after surgery. The swelling fully resolves. The scars begin to fade. You settle into your new body.

As healing continues, ask your surgeon when you can resume exercise and sex and how to increase activity safely. A calendar date alone does not show that wounds and urinary function are ready; the answer depends on your own healing and any complications.

Over the following months, my surgical site stabilized and urination became familiar. That was when I started to feel the peace I'd hoped for—when the demands of healing eased and I could simply live in a body that felt right. Your timing may differ; persistent urinary symptoms deserve a call to the surgical team.

Later on, my scars continued changing. If nerves were preserved in your operation, ask what your surgeon knows about the range of sensory outcomes and how they assess a change that concerns you. Neither a timeline nor another person's experience can promise sensation.

Urinary Function Post-Nulloplasty#

Learning the New Normal#

A relocated urinary opening changes how you direct the stream. Sitting may be easiest, while an assistive device may help someone who needs or prefers to stand. Ask your surgeon where your opening will be and what daily positioning, mobility, and bathroom access may be like; my own experience follows below.

For me, this was never a significant issue. I'd been sitting to pee for years before surgery because it helped with my dysphoria. The physical necessity after surgery simply matched what I was already doing.

For some people, a new urinary opening requires changing bathroom habits or planning around public restrooms and travel. Ask what position and supplies would help you, and give yourself time to learn. I cannot promise how quickly anyone else will adapt.

The mechanics depend on where the opening sits and how the stream heals. Ask the surgeon how to position yourself, how to keep the area clean, and what change in stream or emptying needs review. My own method involved sitting farther back and experimenting with angles; it may not be yours.

Learning the new urinary position took me a few weeks. Early on, my stream sometimes sprayed, and I experimented with where to sit and how to lean. If your flow weakens, emptying feels incomplete, or a change persists, ask the team to assess it rather than assuming it is a normal phase.

After my healing, urinating while seated became ordinary for me. Another person's urinary flow may differ, especially if the opening narrows or healing is complicated. Ask your team what to watch for and where to report a change.

When to Seek Help#

Call your surgical team promptly if you cannot urinate, develop fever, have worsening pain or bleeding, notice a sharply weaker stream, or cannot empty your bladder. Cleveland Clinic lists flow and emptying changes as reasons to seek assessment after perineal urethrostomy. Ask your team which symptoms warrant emergency care for your operation; do not assume any amount of blood or pain is automatically expected.

Some urinary changes ease as swelling settles; persistent difficulty may need assessment for narrowing or another problem. Do not wait for a presumed recovery deadline if flow, emptying, pain, or infection symptoms concern you. Ask the team how quickly it wants to hear from you.

Sexual Function and Sensation#

What Changes#

The impact of nulloplasty on sexual function depends significantly on whether you chose nerve preservation.

With nerve preservation, a surgeon may retain sensitive tissue under the skin. MoZaic Care describes that option, but there is no robust nulloplasty-specific rate or promise of orgasm. My own experience with external stimulation and orgasm is described below; ask your surgeon what tissue they would retain and how sensation may differ.

My experience: orgasm is absolutely still possible. The sensation is different than before—less localized, requiring different types of stimulation to build—but it's there. I'd describe my current orgasms as satisfying, if sometimes requiring more patience and exploration than they did before.

Without nerve preservation, some people choose to remove penile nerve tissue because it better fits their goals. That may greatly change genital sensation, but it cannot predict every form of pleasure or orgasm in the rest of the body. Ask the surgeon exactly which tissue would remain and what is known and unknown about later sensation.

Hormones and libido are individual. Bilateral orchiectomy removes testicular testosterone production, but libido, sensation, hormone choices, and monitoring remain individual clinical questions. My testosterone regimen and sexual experience are mine; they are not a forecast for another person.

Intimacy and Disclosure#

Sexual intimacy after nulloplasty involves navigation of disclosure and potentially different sexual practices than before.

Disclosure: You decide when and how to discuss your anatomy with a sexual partner, with your safety and the kind of intimacy you want in mind. Some people share early; others wait until trust grows or until a conversation is relevant. You do not owe anyone your full medical history.

There's no single right approach. What matters is your safety and comfort. Consider how this partner might react and whether there are red flags that suggest they might react badly, what you need to feel safe and respected during disclosure, and how much detail you want to share. "I've had surgery" is a valid level of disclosure; you don't owe anyone a medical history.

Navigating changed sexual practices: If you previously engaged in penetrative sex involving your genitals, that's no longer possible. This may require mourning for some people, adjustment for others, and exploration of different sexual practices. Many nullos find satisfying sexual expression through external stimulation of the buried nerve bundle (if preserved), anal sex (either giving or receiving, depending on preference and anatomy), oral sex (giving or receiving), full-body sensuality and touch, and whatever else feels good for you and your partners.

The loss of one option doesn't mean the loss of sexual satisfaction. It means exploration of what works now.

Long-Term Sexual Satisfaction#

There is no robust nulloplasty-specific dataset establishing sexual-satisfaction rates. Bustos et al. pools other gender-affirming procedures and cannot determine a nulloplasty outcome. The next passage is lived experience: being present in one's body during sex can matter deeply, but no study here predicts how that balance will feel for another person.

What I can tell you from my own experience: being at home in my body has made intimacy better, not worse. The dysphoria that used to intrude on any sexual situation is gone. I'm present in a way I couldn't be before. For me, that matters more than any specific function I might have lost.

Complications: What Can Go Wrong#

I'm going to be honest about complications because I think the alternative—minimizing or glossing over what can happen—does a disservice to anyone considering this surgery. You deserve to know the risks.

Common Minor Complications#

Wound healing issues are probably the most common complication. Incisions may open partially (dehiscence), heal slowly, or develop areas of granulation tissue. These usually resolve with conservative management—keeping the area clean, following your surgeon's instructions, giving it time. Sometimes minor revisions are needed.

Infection is always a risk with surgery. Signs include increasing redness, warmth, swelling, discharge that's cloudy or foul-smelling, and fever. Mild infections can be treated with antibiotics. Severe infections may require hospitalization. I'll talk about my experience with severe infection later in this guide.

Hematoma (blood collecting under the skin) and seroma (fluid collecting under the skin) can occur. Small collections often reabsorb on their own. Larger ones may need to be drained.

Urinary issues in the early post-operative period are common. Difficulty urinating, spraying, weak stream—these usually improve as swelling decreases and you learn your new anatomy. Persistent urinary problems may indicate stricture (narrowing) or other issues requiring intervention.

Serious Complications#

Urethral stricture occurs when the urethra narrows due to scar tissue formation, making urination difficult or impossible. Signs include weak urinary stream, straining to urinate, feeling of incomplete emptying, and in severe cases, inability to urinate at all. Minor strictures may be managed with urethral dilation—a procedure where progressively larger instruments are passed through the urethra to stretch it. More significant strictures may require surgical revision.

Fistula is an abnormal connection between the urethra and another structure (typically the skin), causing urine to exit from somewhere other than the intended opening. Fistulas typically require surgical repair. If you notice urine coming from somewhere unexpected, contact your surgical team immediately.

Severe infection can become life-threatening if it spreads beyond the surgical site into systemic infection (sepsis). This is what happened to me, and I'll describe it in detail below.

Tissue loss occurs when tissue doesn't survive due to compromised blood supply. This is rare but serious and may affect final appearance or require additional surgery. Risk factors include smoking, diabetes, and previous radiation to the area.

My Experience: When Things Went Wrong#

I want to tell you about my revision surgery and its aftermath, because I think it's important for you to understand that complications can happen even when you do everything right—and that they don't mean you made a mistake.

My initial nulloplasty on August 9, 2024, went smoothly. Recovery proceeded normally. By a few months out, I was living in my new body and loving it. The peace I felt was everything I'd hoped for.

But then I noticed something wrong: palpable densities under my skin. Hard spots that caused pain during sexual activity and, worse, triggered the dysphoria I thought I'd left behind. What should have been smooth and neutral had lumps that shouldn't have been there.

In November 2025, I underwent revision surgery with the surgeon to remove these masses. The pathology showed calcifications, an epithelial inclusion cyst, and excessive scar tissue—why not have all the possibilities at once? The revision itself went smoothly. I was discharged to recover at my friend's home in San Francisco.

The two weeks that followed seemed normal. Incisional pain that was manageable. Gradual improvement. Thanksgiving was approaching.

Then everything changed.

The background pain that had been steadily improving suddenly worsened. Not just discomfort—acute, escalating pain that my usual medications couldn't touch. Overwhelming fatigue hit me like a wall. I slept all night and all day and still felt exhausted. Even under all my blankets, I was freezing—telltale signs of a fever. I asked if they had a thermometer. Sure enough: 103 degrees.

On the Friday evening after Thanksgiving, we went to the emergency department.

The triage nurse noted my vitals: heart rate 105, low-grade fever. The sepsis screening triggered immediately. Within minutes, I was moved to a bed and hooked up to monitors.

The CT scan revealed the full picture: a rim-enhancing fluid collection measuring up to 3.8 centimeters—an abscess, sitting right where my revision surgery had been. Extensive subcutaneous edema and fat stranding indicated cellulitis had spread through the tissue.

My white blood cell count was 21.2, more than double the normal upper limit. The diagnosis: sepsis. The infection had moved beyond local containment into systemic threat. My body was fighting for its life.

They started IV antibiotics immediately—vancomycin and cefepime, broad-spectrum coverage for whatever bacteria had colonized my surgical site. Morphine for the pain. IV fluids. Continuous cardiac monitoring.

The ED physician called my surgeon, the surgeon. The abscess needed to be drained. After coordination between hospital campuses and transfer to a facility with interventional radiology, it was.

I spent two nights in the hospital on IV antibiotics while my body fought the infection. I lay in that hospital bed, septic, thousands of miles from my husband, missing our five-year anniversary, wondering if I would make it through. In my darkest moments, hopped up on IV opioids while still in recovery from years of alcohol dependence, I didn't want to be alive anymore.

I would become a nullo all over again, knowing everything I know now. The sepsis wasn't proof that I'd made the wrong choice. It was proof that bodies are unpredictable and medicine involves risk. The surgery itself was exactly what I needed. The complication was a thing that happened—terrible, yes, but not a reason to regret the choice that brought me to it.

What I Learned About Navigating Complications#

Listen to your body. When I noticed the pain worsening instead of improving, when I felt exhausted beyond what seemed normal, when my body told me something was wrong—I took my temperature, found the 103-degree fever, and went to the ER. That responsiveness may have saved my life. If I'd ignored those signals, or if I'd waited until I was back home in Wisconsin instead of getting care in San Francisco where my surgeon could coordinate, the outcome could have been very different.

Complications don't mean failure. My body developed an infection. That's not a moral failing. It's not evidence that I made the wrong decision. It's a thing that sometimes happens after surgery. You can do everything right and still have complications.

Geography matters during recovery. I was still in San Francisco when the infection developed, which meant I had access to my surgical team and could be seen quickly by people who knew my case. The entire Internal Medicine department worked on my case. the surgeon himself visited me in the hospital. If I'd been back home in Wisconsin, coordinating care would have been harder and slower. Consider this when planning your recovery location and timeline.

Have support systems in place. I was fortunate to have people helping me. Not everyone does. If something goes wrong, you need to be able to get to emergency care, communicate with medical teams, and take care of yourself during extended recovery. Plan for this before surgery.

Mental health during crisis is its own battle. The physical infection was one thing. The emotional devastation was another entirely. Being alone, being far from my support system, being in recovery from drinking while receiving IV opioids, maxing out my finances, missing my anniversary—these factors compounded into something that nearly broke me. If you face complications, please know that struggling emotionally doesn't mean you're weak. It means you're human, facing something genuinely hard.

Revision Surgery: Expect It Might Happen#

Here's something most resources don't emphasize enough: you may need more than one surgery.

Revisions are common in gender-affirming surgery—not because surgeons are incompetent, but because bodies are complex and healing is unpredictable. Issues may emerge months or years after the initial procedure. Aesthetic concerns may develop. Functional problems may arise.

When I developed calcifications and cysts at my surgical site, revision was the appropriate response. The initial surgery hadn't failed; my body had done something unexpected. The revision addressed it. That the revision then led to infection was a further complication—terrible, but not evidence that the revision was wrong.

Revision can be part of surgical care, but no robust nulloplasty-specific dataset supports treating it as an expected second operation for an individual. Before surgery, ask the program how it defines revision, its denominator and follow-up period, its complication-management pathway, and its cost policy. My revision history is mine; it is not a prediction for another person.

Some surgeons include revision in their initial surgical fee if needed within a certain timeframe. Others charge separately. Understand your surgeon's policy before your initial surgery.

Long-Term Living as a Nullo#

Daily Life#

Day-to-day life after nulloplasty is, for the most part, unremarkable—and that unremarkability is the point.

Urination happens seated. You sit, you pee, you wipe, you're done. After the initial adjustment period, it becomes automatic. I don't think about it anymore. It's just how I use the bathroom—unremarkable in the way all bodily functions should be.

Clothing fits differently. Underwear lays flat. Pants don't require accommodation for anything. This might sound trivial, but if you've spent your life hating how your body looked in clothes, negotiating with underwear to minimize what you didn't want to see, the relief of clothes simply fitting is significant. Getting dressed stopped being a daily confrontation with dysphoria.

Physical activity proceeds normally once you're healed. Exercise, sports, whatever you want to do. Nothing about having a smooth genital area prevents any activity. I've returned to all my normal physical activities without limitation.

Medical care requires some disclosure. When you see new healthcare providers, they need to know your surgical history—it's relevant to your care. How much you disclose beyond that is up to you. I've found most medical providers respond professionally once I explain my anatomy clearly.

Hormones Long-Term#

With both testicles removed, your body no longer produces testosterone. You need to replace sex hormones through either estrogen or testosterone therapy—going without isn't an option for long-term health.

Most nullos who were already on feminizing hormone therapy continue estrogen after surgery, often at lower doses since they no longer need to counteract testosterone production. Anti-androgens like spironolactone become unnecessary.

Some nullos who weren't on hormones before surgery start estrogen after. Some start testosterone. I continue testosterone injections weekly—which might surprise people who associate nulloplasty with feminization, but it's what works for my body and my nonbinary identity. The point is that you have options; nulloplasty doesn't lock you into any particular hormonal path.

The key point: hormone therapy becomes a lifelong consideration. You'll need regular monitoring (bloodwork every few months initially, then annually once stable), prescription access, and attention to your levels over time. This is a commitment, but it's manageable—millions of people take hormone replacement therapy for various reasons, and the infrastructure for providing it is well-established.

The Peace of Living in the Right Body#

What I want most to convey about long-term life as a nullo is the peace.

The dysphoria that plagued me since childhood is essentially gone. Not diminished, not managed, not coped with—gone. The daily experience of inhabiting my own skin transformed from something I endured to something I can simply do. I wake up, I exist in my body, and there's no wrongness screaming at me. The background noise of dysphoria that I'd lived with for so long I didn't fully realize it was there—it's silent now.

This is what I hoped for when I pursued surgery. This is what I got. Even with the complications, even with the sepsis, even with the hardest moments of recovery—I would do it again without hesitation.

Satisfaction and Outcomes#

What the Research Shows#

Peer-reviewed research specifically on complete nulloplasty is sparse. A robust cohort does not establish procedure-specific satisfaction, regret, sexual-function, complication, or revision rates for this configuration. Provider descriptions and community accounts can describe choices and lived experience, but they are not independent outcome evidence.

Bustos et al. is a mixed-procedure meta-analysis with a correction; its pooled result is not a nulloplasty rate. This guide therefore does not use a general gender-affirming-surgery percentage to predict a nulloplasty outcome.

The WPATH Standards of Care notes that outcomes for gender-affirming surgery are generally positive, with improvements in gender dysphoria, body image, and quality of life (Coleman et al., 2022).

What My Experience Shows#

I would do this again. Without hesitation. Knowing about the complications, knowing about the sepsis, knowing about the hard days in the hospital—I would still become a nullo.

The peace in my body is worth everything I went through to get here. The dysphoria that plagued me for decades is gone. The daily experience of inhabiting my own skin transformed from something I endured to something I can simply do. That change is profound and permanent.

My experience isn't universal. Your experience will be your own. But I share this to say: even with serious complications, even with revision surgery, even with life-threatening infection—I don't regret this choice. The surgery wasn't the mistake. The complications were things that happened. And I'm still here, in a body that finally feels like mine.

Reflection Questions#

As you consider whether nulloplasty might be right for you, sit with these questions:

  1. When you imagine your ideal body, what does your genital area look like? Does the thought of a smooth, neutral appearance feel right—or does something else feel more aligned with who you are?

  2. How do you feel about permanence? What comes up when you consider making an irreversible decision about your body?

  3. What aspects of having external genitalia cause you distress? How do you imagine daily life would be different without them?

  4. Have you explored other surgical options—vaginoplasty, vulvoplasty, orchiectomy alone? Why don't those feel right for you?

  5. How do you feel about seated urination? If you've tried it, what was that experience like?

  6. What role does genital sexual sensation play in your life? Would you want nerve preservation, or would complete removal feel more aligned with your goals?

  7. What support systems do you have in place? Who would help care for you during recovery? Who would be there if something went wrong?

  8. How would you handle disclosure to partners, healthcare providers, or others who might need to know about your surgical history?

  9. What fears or concerns do you have? Have you discussed them with a therapist, a surgeon, or others who've had this surgery?

  10. If you could wake up tomorrow with a smooth genital area, how would you feel? What would your first thought be?

Take time with these questions. There's no rush. And if you need to talk through your answers with someone—a therapist, a trusted friend, people in the community who've walked this path—reach out. You don't have to figure this out alone.

References#

Bustos, V. P., Bustos, S. S., Mascaro, A., Del Corral, G., Forte, A. J., Ciudad, P., Kim, E. A., Langstein, H. N., & Manrique, O. J. (2021). Regret after gender-affirmation surgery: A systematic review and meta-analysis of prevalence. Plastic and Reconstructive Surgery - Global Open, 9(3), e3477. https://doi.org/10.1097/GOX.0000000000003477

American College of Surgeons. (n.d.). Quit smoking before your operation. https://www.facs.org/for-patients/preparing-for-surgery/quit-smoking/

HealthCare.gov. (n.d.). Internal appeals. https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/

Cleveland Clinic. (2026, July 13). Perineal urethrostomy. https://my.clevelandclinic.org/health/treatments/16565-perineal-urethrostomy

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., ... Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(S1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644

MoZaic Care. (n.d.). Nullification. https://www.mozaiccare.net/nullification

Oregon Health & Science University. (n.d.). Gender-affirming surgery. https://www.ohsu.edu/transgender-health/gender-affirming-surgery

Continue exploring#