Feminizing gender-affirming surgery for transgender women and transfeminine non-binary people describes a variety of surgical procedures that alter the body to provide physical traits more comfortable and affirming to an individual's gender identity and overall functioning.

Often used to refer to vaginoplasty, sex reassignment surgery can also more broadly refer to other gender-affirming procedures an individual may have, such as permanent reduction or removal of body or facial hair through laser hair removal or electrolysis, facial feminization surgery, tracheal shave, vulvoplasty, orchiectomy, voice surgery, or breast augmentation. Sex reassignment surgery is usually preceded by beginning feminizing hormone therapy. Some surgeries can reduce the need for hormone therapy.

Gender-affirming surgeries for transgender women have taken place since the 16th century, though they became more notable in the 20th century. Most patients report greater quality of life and sexual health outcomes postoperatively.

There are a variety of genital surgeries available to trans women and transfeminine non-binary people. Genital surgery can be an effective way for an individual to ease or eliminate feelings of disconnection or discomfort with their natal genitals; for others, including those who do not feel strongly about their natal genitals, it can create feelings of connection or congruence with their genitals post-surgery. Following the removal of the testicles, the human body produces very little testosterone. This can reduce the need to take supplemental estrogen medication and eliminates the need to take antiandrogen medication.

Vaginoplasty is the process of constructing a neovagina and neovulva from existing genital or abdominal tissue. There are multiple techniques for performing vaginoplasty. Sexual sensation is typically retained following surgery, and the self-reported rate of personal satisfaction with surgical results across different vaginoplasty techniques is very high.

Penile inversion is a very common vaginoplasty technique. The testicles and scrotum are removed and the glans of the penis is made into a clitoris. A canal is surgically created between the bladder and the rectum. The foreskin of the penis is inverted to form the interior walls of the neovagina. If the patient had been circumcised before surgery, skin from the scrotum may also be used to construct the walls of the neovagina after cauterising the hair follicles. The urethra is shortened, and the mons pubis, labia majora and minora, and urethral opening are created using scrotal and urethral tissue.

Because this technique inverts the skin of the penis to form the walls of the neovagina, post-operative depth is limited by the length of the penis prior to surgery. Following surgery, a patient will need to dilate the neovagina with a vaginal dilator 1-2 times daily to prevent loss of vaginal depth. The need to dilate becomes less frequent with time, but is recommended at least once a week after the neovagina has healed completely. Having penetrative sex can affect the amount of dilation needed, but additional lubricant is required during penetrative sex as the neovagina created through penile inversion vaginoplasty is not self-lubricating.

In a small number of cases (roughly 0-5%), rectal injury can occur as an intraoperative complication. Other common complications include meatal stenosis, urinary retention, or haemorrhage.