OHSU surgeons are leaders in gender-diverse care. We provide specialized services tailored to the needs and goals of each patient. We offer:

• Specialists who do hundreds of surgeries a year.
• A urologist who is a leading expert in vaginoplasty (bottom surgery).
• Plastic surgeons who are experts in chest feminization (top surgery) and gender-affirming face and body options.
• Physical therapists who are international leaders in caring for vaginoplasty patients.
• Vocal surgery with a highly trained ear, nose and throat doctor.
• Peer volunteers who can provide support during visits.
• Classes that help patients prepare for surgery and learn about fertility options.

Please see our patient guide to learn more about steps to surgery, WPATH standards of care, and the letter(s) of support needed for some surgeries.

Chest feminization

Estrogen therapy can produce breast development, but the chest may not have feminine proportions. Our plastic surgeons use implants and contouring to achieve these proportions. Our surgeons also use methods specific to chest-feminization surgery, which is not the same as breast augmentation for a cisgender patient.

At OHSU, our specialists do dozens of these surgeries a year. OHSU studies of outcomes have improved how we work with each patient to choose a technique.

Orchiectomy

At OHSU, expert urologists do orchiectomies (testicle removal). Patients may choose this option:

• To remove the body’s source of testosterone
• As part of a vaginoplasty or vulvoplasty (surgeries that create a vagina and/or vulva)
• To relieve dysphoria (some patients choose only this surgery)

Removing the testicles usually means a patient can stop taking a testosterone blocker. Patients may also be able to lower estrogen therapy.

How orchiectomy is done

The surgeon makes an incision in the scrotum. The testicles and the spermatic cord, which supplies blood, are removed. Scrotal skin is removed only if the patient specifically requests it. The skin is used if the patient plans a vaginoplasty or vulvoplasty.

Vaginoplasty

Vaginoplasty creates a vulva and vagina. OHSU’s Dr. Daniel Dugi and Dr. Geolani Dy, highly trained urologists and researchers, specialize in vaginoplasty. They also offer the option of robotic-assisted vaginoplasty. Drs. Dugi and Dy, along with the Transgender Health Program team are here to help you navigate the process and support you every step of the way. Read our vaginoplasty team handout

A vaginoplasty can allow patients to:

• Have a body more closely aligned with their gender
• Urinate while sitting
• Feel sexual sensation and have penetrative intercourse with a vagina

Before your consultation

We ask that you follow these five steps before your visit:

1. Read our vaginoplasty booklet

2. Watch this video on vaginoplasty and vulvoplasty at OHSU:

3. Write down your questions, and bring them to your visit.

4. Plan to discuss hair removal. Read our hair removal handout

5. Plan to discuss our strict nicotine restrictions.

Pelvic floor physical therapy

Our physical therapists are international leaders in caring for vaginoplasty patients and supporting successful outcomes. Before surgery, therapists show patients exercises to stretch and relax the pelvic muscles. After surgery, they show patients relaxation exercises and positioning to ease the use of dilators (devices inserted to stretch the vagina). Read our dilation handout

How vaginoplasty is done

Tissues of the penis and scrotum are used to make the vulva (the outer genitals — the labia, clitoris and urethra opening) and the vagina.

• The surgeon removes the penis and testicles, and creates the vaginal canal between the rectum and urethra.
• The vagina is lined with skin from the penis and scrotum, mostly with grafting and sometimes stretching the skin. If needed, the surgeon may also use skin from the hip or abdomen.
• Scrotal skin is used to make the outer labia. The inner labia are made from skin from the penis or urethra, depending on anatomy. The clitoris is created from a small piece of the head of the penis. The urethra is shortened and repositioned.
• The prostate is not removed. This avoids complications such as urinary leakage. The prostate can also provide sexual sensation.

Robotic-assisted vaginoplasty

This option is less invasive than traditional vaginoplasty.

Dr. Dy and Dr. Dugi work as a team. They create the vulva the same way as in a traditional vaginoplasty.

To create part of the vagina, Dr. Dy inserts robotic arms through two small incisions in the belly.

She creates space between your bladder and rectum for the vagina. Then she uses flaps of tissue from the lining of your belly, called the peritoneum, to create the deepest part of the vagina. Both robotic-assisted vaginoplasty and traditional vaginoplasty are done in one operation.

Vulvoplasty

Vulvoplasty creates a vulva — the outer genitals. It is similar to a vaginoplasty but without creating a vaginal canal. The outward appearance is almost identical, with a labia, clitoris and shortened urethra. 

Patients may choose this surgery over vaginoplasty because they have no interest in having a vagina. It also requires no hair removal or dilation. A surgeon may recommend vulvoplasty for patients with certain risks, such as having had treatment for prostate or rectal cancer.

See our vaginoplasty booklet to learn more about our surgeons and to understand restrictions and recommendations that also apply to vulvoplasty patients.

How vulvoplasty is done

The surgery is almost identical to vaginoplasty except for creation of a vaginal canal.

• The outer labia are formed from part of the scrotum.
• The inner labia are formed with skin from the penis or urethra, depending on anatomy.
• The urethra is shortened and repositioned.
• The clitoris is created from the head of the penis, allowing sexual sensitivity. Remaining parts of the penis and scrotum are removed.

Vocal surgery

Many patients find that hormone therapy and speech therapy help them achieve a voice that reflects their identity. For others, vocal surgery can be added to raise the voice’s pitch.

Voice therapy: Patients have voice and communication therapy before we consider vocal surgery. Your surgeon and your speech therapist will assess your voice with tests such as videostroboscopy (allowing us to see how your vocal cords work) and acoustic voice analysis.

Effective surgery: We use a surgery called a Wendler glottoplasty. It’s done through the mouth under general anesthesia. The surgeon creates a small controlled scar between the two vocal cords, shortening them to increase tension and raise pitch. Unlike techniques that can lose effectiveness over time, this surgery offers permanent results.

Face and body feminization

Estrogen and testosterone-blocking therapy usually soften facial features. They don’t change the underlying framework or remove hair follicles, though. At OHSU, a highly trained plastic surgeon, Dr. Jens Berli, and other specialists offer the following options. Patients usually go home the same day or spend one night in a private room.

• Forehead reduction, including Type 3 sinus setback and orbital remodeling
• Rhinoplasty (nose job)
• Cheek augmentation
• Jawline contouring
• Genioplasty (chin surgery, including reductive, implants or bone-cut options)
• Laryngeal chondroplasty (reducing the Adam’s apple)
• Hairline advancement (done with the forehead)
• Browlift (done with the forehead)
• Eyelid surgery
• Face-lift, neck lift
• Lipofilling (transferring fat using liposuction and filling)
• Lip lift and/or augmentation
• Hair removal (electrolysis with plastic surgery experts, or laser therapy with dermatologists)
• Laser skin resurfacing or chemical peels with dermatologists

Body: Hormone treatment may not result in fat distribution consistent with your gender. We offer liposuction and fat grafting to shape these areas of the body.