Gender Affirmation Surgery

At Mount Sinai, we are experts in helping patients who choose to affirm their gender identity through surgery. Gender affirmation surgery can include surgically altering genitalia to support the patient’s gender identity. Yet, much more than surgery is involved. At Mount Sinai Doctors-445 East 77th Street, Urology, we also provide counseling on fertility preservation, provide second opinions, do repair procedures, and help fix complications. These procedures can help improve quality of life, comfort, confidence, and emotional well-being.

Our two expert gender affirming surgeons, Dr. Rajveer Purohit and Dr. Miroslav Djordjevic, both Professors of Urology at the Icahn School of Medicine at Mount Sinai, have performed more than 2,000 gender affirmation surgeries. These surgeries include vaginoplasty, metoidioplasty, phalloplasty, orchiectomy, correction of complications such as urethral strictures, and placement of a penile prosthesis. They are co-editors of a textbook, Atlas of Operative Techniques in Gender Affirmation Surgery, published by Elsevier.

The reconstructive urology team uses a holistic approach as part of the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) to make sure you are fully cared, for before and after any surgical procedures. We understand that preparation for gender affirmation surgery can be difficult. The team will help you with details informed by the World Professional Association of Transgender Health’s Standards of Care Standards of Care. Our primary goal is protecting your health and safety.

We have vast experience working with insurance companies. We can help you get clearance for surgery and get the information for obtaining coverage from your insurance carrier. We accept most major insurance plans, including Medicaid and Medicare.

Procedures We Offer

Our urologists are experienced surgeons. We can construct or reconstruct your genitalia to align with your gender identity. We perform a wide variety of procedures, including both trans-masculine and trans-feminine surgeries. The most common procedures include the following:

Feminizing Procedures

Orchiectomy
Trans women who want to decrease hormone requirements may consider removal of the testicles (called an orchiectomy). The testicles produce the masculinizing hormone testosterone. Most people recover quickly and leave the hospital the day of surgery. You can still have a vaginoplasty in the future, after an orchiectomy.

Vaginoplasty
We offer multiple approaches to vaginoplasty, the removal of penile and testicular tissues and construction of a vagina. One approach is the penile inversion, called vaginoplasty. Alternatively, we can use a small piece of colon to create the new vagina. We can also use other approaches, such as taking skin from the abdominal (peritoneal) lining or from outside the scrotum.

Our approach offers many benefits after surgery. For example, most surgeons leave a long sliver of erectile tissue called the corpora cavernosa behind. Our urology team’s approach is to remove all penile erectile tissue while preserving the neurovascular bundle. This approach can decrease pain with arousal, while preserving clitoral sensation and orgasm. It also ensures that you do not have a swollen mass in the vagina after surgery.

Trans-Masculine Procedures

Metoidioplasty
Metoidioplasty is the creation of a new phallus using a hormonally enlarged clitoris. This procedure has a low complication rate when performed by an expert. It provides excellent sensation and the ability to orgasm. However, because the size of the new penis ranges from four to nine centimeters, most patients cannot penetrate during sexual intercourse. A variation of the surgery may permit urination while standing.

Phalloplasty
Phalloplasty involves creating a new penis, using tissue from outside the genitalia. Most surgeons use tissue from the forearm, however this can leave a significant scar on the arm. At Mount Sinai, we can take tissue from the lateral chest wall to create a new penis. This results in a less obvious scar. Another option is the suprapubic or abdominal phalloplasty, where we use skin and fatty tissue from the area above the groin. The donor site is chosen in consultation with you, your preferences, and what your body will permit.

Penile Prosthesis Insertion After Phalloplasty
Once we have built a penis, it needs help to become erect. Often, we insert a penile prosthesis. We usually insert this as a final-stage surgery, once you’ve healed from earlier procedures. Two kinds of prosthesis are most commonly used. The first is a malleable prosthesis, which stays partially stiff at all times. The second is an inflatable prosthesis that you pump to achieve an erection. Generally, we prefer the inflatable prosthesis, because it looks more natural when flaccid and more rigid when erect. But you make the final decision, based on your desires and body structure. Both prostheses have a significant risk of complications, such as infection

Other Considerations

We often see patients who have undergone surgery elsewhere. They come to us for a second opinion or repair, such as fixing a urethral stricture or fistula. In addition, we can help trans men who have retention of vaginal remnants. We can also help trans women with misdirected urine stream, as well as incontinence.

Patients can have other complications of vaginoplasty. These include poor aesthetic outcome, residual painful erectile tissue, a misplaced or buried clitoris, and a misplaced urethral opening with excessive urethral remnant. Vaginal stenosis and shrinkage can also be an issue. Our team has experience with surgical repair of all these complications.

Fertility Preservation
Some trans patients choose to preserve their eggs or sperm prior to surgery. We can help guide you with the range of options available to you.

Meet Our Team

Rajveer Purohit, MD, MPH joined Mount Sinai in October 2017 as the Director of Reconstructive Urology and has extensive experience with complex cisgender and transgender reconstructive surgeries.

Miroslav Djordjevic, MD, a renowned gender affirming surgeon based in Serbia, joined our department in August 2019. People who formerly had to travel to Belgrade for his world-leading care can now have their surgeries done closer to home but still be monitored postoperatively here in New York.