From now until sometime in early 2023, we’ll be writing about gender affirming procedures. We’re starting with bottom surgeries and will end with office visit procedures such as fillers and botox. To kick off the series, we’re going with one of the newer bottom surgery options available for gender diverse, expansive, and fabulous people: nulloplasty. You may have heard it referred to as nullification, nullectomy, or nullo. (Note: we previously used “nullectomy” as our main term for nullo, but have been advised that this term is contradictory and problematic.)
Content advisory: we will be using anatomical terms and discussing surgical procedures in this article and this series. External sites that we link to may contain graphic images.
What is Nulloplasty?
Nulloplasty is the removal of internal and external genital structures to create a smooth appearance from the abdomen to the groin. Glans (penile or clitoral) and nerve tissue can be “buried” in the mons to retain a focused nerve center for sensation while maintaining a smooth appearance, can remain present as an “outie,” or can be removed.
For someone starting with a penis and testicles, nulloplasty can include:
- penectomy (removal of the penis)
- orchiectomy (removal of the scrotum)
- scrotomectomy (removal of the testicles)
- urethral shortening
For someone starting with a clitoris, vulva, vagina, and uterus (if not already removed,) nulloplasty can include:
- hysterectomy with or without oophorectomy
- vaginectomy (if a vaginectomy is chosen, a hysterectomy is required)
- vulvectomy (partial or radical)
- clitorectomy
- urethral modification
These sets of surgeries can be customized for your goals. Some people choose to maintain a labial fold and crease, or to have no crease.
When: Expected prep and recovery for nullo
Prep for nullectomy should be similar to other bottom surgeries Hair removal requirements will depend on your goals for final appearance and the procedures chosen.
Recovery timelines depend on the procedures involved. A reasonable expectation is to plan for a 6 to 8 weeks. If hysterectomy and vaginectomy are part of your process, your recovery time will likely be longer than for a penectomy and orchiectomy, as more internal structures are moved and changed. Your surgeon can provide clarification of what you should expect and plan for in recovery. A general timeline would be up to a few days in the hospital, up to fours weeks of limited activity, and lifting restrictions and restrictions on strenuous activity and any activity that puts pressure on the groin (such as bicycling,) for a few months.
Who: Surgeons who offer nullo
These are the United States surgeons or surgical practices that we know of who offer nulloplasty/nullification. This list is for informational purposes and is not intended to be a recommendation or referral.
- MozaicCare, San Francisco, CA
- Align Surgical Associates, San Francisco, CA
- Crane Center, San Francisco, CA and Austin, TX
- Davis Plastic Surgery, Palo Alto, CA
- CME Constructive Urology, Columbus, OH
- Marin Health, Greenbrae, CA
- Dr. Shane Morrison, UW Medicine, Seattle, WA
- OHSU, Oregon
- Dr. Dany Hanna, The Hanna Gender Center, TX
- Keelee MacPhee, MD, Durham, NC
- Ohio Health
- Dr. Ramenini, Washington D. C.
- Dr. Daniel J Freet, UT, Houston, Texas
Do you know of other surgeons who offer nulloplasty?
Email us at facilitatorunicorn@queerdoc.com!
How: Common surgeon and insurance requirements to access
Like other bottom surgeries, you will likely need letters from your hormone provider, mental health providers, and your surgeon for insurance coverage. Insurance and your surgeon may also require that you have been on hormones for a specified length of time and/or have lived in a gender role consistent with your gender identity for a specified length of time. It may be more difficult to obtain nullification surgery than other gender affirming bottom surgeries due to the relative newness of the procedures.
Why: Some things to think about when choosing nullification
- Do you want to maintain orgasmic capacity?
- The position of your urethral opening will likely change – this may change how you pee.
- Hormone supplementation
- If your plan includes removal of testicles or both ovaries, and you are not already taking hormones, discuss your options for hormone therapy with your care team, as your body needs some sex steroid hormones for many bodily functions and bone health.
- If having a biological child is important to you, discuss fertility preservation options with your doctor.
Tip: our previous blog in this series discusses more general information about preparing for bottom surgery.
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