MTF bottom surgery includes four primary techniques: penile inversion vaginoplasty, peritoneal flap vaginoplasty, sigmoid colon vaginoplasty, and vulvoplasty. Each method differs in tissue source, vaginal depth creation, and maintenance requirements, allowing surgeons to match technique to individual anatomy and patient goals.
Penile inversion vaginoplasty remains the most widely performed approach, using penile and scrotal skin to line the neovagina while preserving sensation. The WPATH Standards of Care recognize this technique as standard of care, though it requires lifelong dilation to maintain depth. Facilities like Hospital de la Familia (4.1 rating, Mexicali) and José Cortés Institute (5.0 rating, Mexico City) perform this method, with costs in Mexico ranging $15,000–$27,000. Surgeons may add scrotal or extragenital skin grafts when penile tissue proves insufficient for desired depth.
Peritoneal flap vaginoplasty uses abdominal peritoneum harvested through robotic or laparoscopic approaches, reducing dilation needs compared to skin-based methods. Sigmoid colon vaginoplasty employs bowel segments to create self-lubricating canals with excellent depth, typically reserved for revision cases or patients lacking adequate genital tissue. The World Professional Association for Transgender Health (WPATH) emphasizes that intestinal techniques carry higher surgical complexity and longer recovery. Vulvoplasty constructs external genitalia without creating a vaginal canal, eliminating dilation requirements for patients not desiring penetrative function.
Verify surgeon credentials through the Mexican medical registry and confirm facility accreditations before selecting a technique, as approach suitability depends on prior surgeries, available tissue, and functional priorities. Complication rates vary by technique, with penile inversion showing lower surgical complexity than intestinal methods.