Orientations & Identities – What does top surgery & bottom surgery mean?
Top Surgery & Bottom Surgery
Top Surgery and Bottom Surgery are everyday terms for gender-affirming operations, top surgery on the chest and bottom surgery on the genitals, for trans and non-binary people who want them.
What do top surgery and bottom surgery mean?
Both are casual terms from trans communities. Top surgery means the chest: a mastectomy with chest contouring for a flatter chest, or breast augmentation. Bottom surgery means the genitals, for example vaginoplasty to create a vagina and vulva, or phalloplasty or metoidioplasty to create a penis. Not every trans person wants surgery, and surgery doesn’t make anyone more or less trans. It’s also a private topic: asking someone you don’t know well about their genitals or operations is never okay.
Who pays for gender-affirming surgery in Germany?
Statutory health insurance can cover these operations under certain conditions. In practice, insurers have usually asked for a diagnosis, psychotherapeutic support or assessments and a medical recommendation. The rules are changing and have been the subject of court rulings, especially for non-binary people. Ask your insurer, a specialised clinic or a trans counselling service about the current requirements before you apply.
What is sex like after surgery?
First comes healing. Your surgical team tells you when sex is safe again, and after vaginoplasty regular dilation is needed to keep depth. Follow their advice closely. Sensation can change, and it may take time to learn what feels good. Many people can feel pleasure and orgasm after surgery, but experiences vary. Go slowly, use plenty of lube and explore with a patient partner.