Gender affirmation surgery is a series of surgeries that some transgender people use to help them feel more feminine. The most common gender affirmation surgeries include orchidectomy, vaginoplasty, and a clitoroplasty.
Typically, transgender women have very little or no depth in their vagina. This can make penetrative sex uncomfortable for some.
Clitoris
The clitoris is an erectile structure, homologous to the male penis. It is located inferior to the mons pubis, in the anterior part of the vulva. It consists of paired crura and a glans. When aroused, it swells up to nine centimeters in length. It plays a key role in sexual arousal and orgasm.
The upper part of the clitoris is covered by the skin, while the lower portion is covered with a layer of fat. It is surrounded by the labia majora and the urethra opening. Like most genital structures, the clitoral anatomy is unique to each individual.
Labia majora are the large outer lips of the vulva which extend down either side of the vulva canal. They are shaped, colored and sized differently in different people. The labia minora are the inner lips of the vulva, which are smaller than the outer lips and closer to the urethra opening. They are also covered by the pubic hair.
Some transgender women choose to have sex-reassignment surgery for gender affirmation. During this, they might have an orchidectomy and vaginoplasty, which creates a neovagina using tissue from the penis, testicles, scrotum, sigmoid colon grafts or a combination of techniques. After this procedure, they may need to wait for the surgical site to heal before having sex and use lubricant to reduce the risk of sexually transmitted infections (STIs).
Labia Majora
The labia majora, or “large lips,” are a prominent pair of rounded folds of skin and adipose tissue that form the external female genitalia. The labia minora are a smaller, less prominent, pair of rounded folds that are located inside the larger ones. The clitoris and labia majora form the vestibule of the vagina and receive additional innervation from the anterior labial nerves (branches of the ilioinguinal nerve).
The outer surface of the labia is covered with pubic hair after puberty, while the inner surface is devoid of hair and contains sebaceous glands and sweat glands. The labia are highly vascularized and become engorged with blood during sexual arousal.
Directly beneath the mons pubis is a small structure of erectile tissue that corresponds to the male penis, but on a much smaller scale. The clitoris is capable of some enlargement during sexual excitement and is sensitive to stimulation. It is attached to the glans clitoridis, which is a rounded elevation of tissue near the center of the body of the clitoris. The glans clitoridis is flanked by the beginning of the folds of the labia minora on both sides.
The labia majora are joined by a depression called the posterior commissure, which overlies the urethra and vestibule of the vulva. It is lined with a mucous membrane, which keeps the area moist and provides lubrication during sexual activity. The labia also have a rich supply of blood vessels, which makes them appear pink during sexual arousal.
Perineum
The perineum is a diamond-shaped area that sits below the pelvic diaphragm. It contains structures that help us pee and poop, as well as have intercourse. It also forms a foundation that supports the muscles in the pelvic floor, which hold important organs like the bladder and intestines in place.
During pregnancy, the perineum expands in preparation for childbirth. When a baby is born, the contractions that are part of natural birth cause a first-degree perineal tear. A second-degree tear goes deeper into the muscle tissue and can impact sphincter muscles that control bowel movements. A third-degree tear can be much more serious and may lead to a hernia.
A transgender vagina may have less of a perineum than a non-transgender woman’s, but it will still contain the genital raphe (or hymen). The hymen is a thin membrane surrounding the opening to the penis and scrotum, and it is easily broken when fingernails or tampons are inserted. It also can be ripped by a man’s penis during penetration.
People who have undergone an orchidectomy or vasectomy will need to use condoms for any type of penetration and regular testing to prevent STIs. If they do not, they should use the pill for contraception for any penetrative sex with partners who are able to get pregnant. When people do have sex, they should try to avoid rubbing the scrotum or touching the anus to reduce friction in the area.
Hymen
The hymen is a thin piece of membrane that is located at the top of your vaginal opening. The shape, size and thickness of your hymen are unique to you and can change over time. Some people’s hymens are ring-shaped, while others have a more crescent-like appearance. Your hymen can also tear or rupture, which may cause bleeding or spotting.
The hymen forms as the vagina develops during fetal development. At first, the vagina is a solid tube, but eventually the inner portion of this tube disintegrates and a rim of membrane remains at the vaginal opening. Over the years, the hymen can change from its original ring or doughnut-like shape to a crescent or cribriform one. A hymen that is annular has a doughnut-like shape, while a cribriform hymen has more of a crescent appearance.
Sometimes, the hymen can rupture or break, especially if you use vaginal lubricants or get a pelvic exam or Pap test. This can be painful and can result in spotting or bleeding. Other times, your hymen can tear on its own, and you won’t even realize it.
Your hymen is an important part of your body, and it can affect your sexual health and comfort. It is important to be aware of your hymen’s size and shape, and to know how it can change over time.
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