Gender-affirming genital surgery in the Nordic countries: Narrative review of current practices and challenges

Genital gender-affirming surgery is a crucial yet often overlooked component of gender-affirming care for transgender individuals. Genital gender-affirming surgery is a rapidly evolving field, and it is not uncommon for surgeons — sometimes without prior experience in gender-affirming care — to encounter transgender individuals in clinical practice; hence, it is essential that all healthcare providers possess a foundational understanding of gender-affirming procedures and individual’s needs. Research has shown that genital gender-affirming surgery significantly improves the quality of life for transgender individuals by aligning their physical characteristics with their gender identity. It can offer substantial satisfaction, both aesthetically and functionally. For transwomen, genital gender-affirming surgery enables them to wear underwear aligned with their gender identity, facilitates sexual function and the potential for vaginal intercourse. For transmen, it provides a more masculine appearance in the groin area, allows for penetrative intercourse with a reconstructed penis (neophallus), and in some cases enables urination while standing when combined with urethral lengthening. Today, a wide range of surgical options exists for both transwomen and transmen. Thorough preoperative counseling is essential when selecting the most appropriate reconstructive method. Advances in plastic, reconstructive, and microsurgery continue to expand these options, offering greater personalization and improved outcomes. While genital gender-affirming surgery is complex and often irreversible, individuals are generally highly satisfied with the results, particularly when they have realistic expectations prior to surgery. The aim of this narrative review is to provide an overview of genital gender-affirming surgery from a Nordic perspective. In the Nordic countries, gender-affirming care is highly centralized and integrated into publicly funded healthcare systems. The care programs across these countries share many similarities and are largely comparable in structure and approach.