Managing the genitals is a complicated subject. There are many options to choose from. And, it’s important to remember that a reasonable choice is to not doing anything. They are not unhealthy.
Before we talk about these things, it’s important that you understand what genitals are meant for. Check out the Taking the Wheel section on “Sex” before going any further. You need to know what these parts are made for and what they might mean as you get older.
Here are some types that people discuss
Options for expanding the vagina (if desired) for those with a small or ‘dimple’ vagina
- Vaginal Dilation: Many women and experts recommend this as THE first and best way to expand the vagina. It is very effective—you just need to make sure you know the helpful tips in our new Dilation section and have the right tools and help from your doctors, psychologist, and even physical therapists.
- (Mainly in Europe) The Vechietti (a surgical/laproscopic form of rapid dilation): In Europe, many people use the technique of treatment called the Vechietti to help grow the vaginal area in a multi-day process, in the hospital. It’s a way that might be preferable to other vaginal surgeries if dilation isn’t possible or successful to start.
- Vaginoplasty: This is a surgery to enlarge the vagina. As with every surgery, this one carries risks and can be painful and leave scars. After surgery, you still need to use dilation to keep the vagina stretchy and working. This is not an “easy way out”—it’s a serious medical procedure and should be approached carefully.
Surgery to change the appearance of the clitoris (a.k.a. clitoroplasty)
- Doctors may discuss this as an option.
- Some people might have this sort of surgery as a small child, and if this is you, please check out the section on learning about your past care.
- For some women, a larger clitoris might make sexual intimacy more pleasurable, and other times, it might lead to uncomfortable erections (e.g. when a clitoris feels stretched and painful, like when it presses a bicycle seat or is pressed by tight jeans) or worries.
- Many of us (DSD or not) feel worried about our bodies fitting in. However, the clitoris plays a big part in enjoying your body sexually.
- Surgeries on this area have considerable risks and may cause irreversible damage to your ability to enjoy sexual pleasure. Because of this, we recommend that you learn more about sexual pleasure before considering surgical options.
- Also, if you are considering surgical options to manage the genitals, it is important to ask yourself the question of why you want it and who you are doing it for, especially because of the risks to sexual pleasure. We recommend talking to someone trained in DSD care and who can help you think through how you are feeling and what path to take—specifically, a psychologist, social worker, nurse, or peer support are people who could help you think through the options, risks, benefits, and the important things to consider. Ask your doctor to refer you to psychological support to you in this decision.
Surgery to change the appearance of the penis (k.a. hypospadias surgery and phalloplasty surgery)
- When you have hypospadias, the pee hole isn’t located at the tip of the penis, but somewhere below, on the shaft or even at the base of the penis. It is actually pretty common – 1 in 250-300 men has hypospadias.
- Most boys with hypospadias have no difficulty urinating, even if the urethra is at a different place. Some boys learn to pee standing up even with hypospadias, and some men and boys prefer to pee sitting down in any case.
- Some doctors will discuss hypospadias surgery as an option when the hypospadias is severe, if there is a problem with expelling urine out of the urine tube. If the penis is curved upwards or downwards (called chordee), erections can also become painful
- Surgery for severe hypospadias and chordee can make the penis look longer, but it cannot actually make it bigger.
- That is why doctors at some point can suggest a phalloplasty surgery, to make the penis larger if you have a small penis. This is a very difficult surgery (usually multiple surgeries) and can only be done in late adolescence/young adulthood
- Surgeries on this area have major risks, lead to big scars and could cause irreversible damage to your ability to enjoy sexual pleasure, because your penis plays a big part in enjoying your body by yourself and in intimate relationships.
If you are considering surgical options to manage the genitals, it is important to ask yourself the question of why you want it and who you are doing it for, especially because of the risks to sexual pleasure.
We recommend talking to someone trained in differences of sex development (DSD) care and who can help you think through how you are feeling and what path to take—specifically, a psychologist, social worker, nurse, or peer support are people who could help you think through the options, risks, benefits, and the important things to consider. Ask your doctor to refer you to someone who could give you psychological support as you approach this decision.
If you had genital surgery as a small child, please check out the section on learning about your past care. The results of these surgeries vary from person-to-person. Some have more noticeable scars than others. Some may have genital sensation and pleasure, others may not have as much. If you are thinking about this yourself, talking to a psychologist, sex therapist or counselor may be valuable. Or get in touch with support groups. They might be of huge help in addressing any concerns you have.