Genital nullification (also known as nullo or neutering) is a gender-affirming surgery (GAS) that removes all or most of the external genitalia to create a smooth, flat appearance from the pubic bone to the groin. The result is a sleek, “Barbie/Ken doll” look.
Dr. MacPhee performs genital nullification surgery for patients who are assigned male at birth (AMAB). For patients assigned female at birth who are seeking nullification, Dr. MacPhee will refer to a gynecologist/urologist for the removal of internal organs.
Who seeks genital nullification surgery?
This procedure is most commonly sought by agender, non-binary or gender-neutral individuals who feel that neither male nor female anatomy aligns with their internal sense of self. Patients may also identify as null, ambiguous, eunuch, male or transgender.
Patients seek nullification for a variety of reasons, including:
- Relief from genital dysphoria
- Reducing hypersensitive erogenous zones
- Eliminating any sensation of erections
- Sexual aversion (strong psychological and physical repulsion toward sexual activity)
How is the procedure performed?
Depending on the patient’s desired outcome, variations of the surgery are possible. For AMAB patients, Dr. MacPhee typically removes the penis and testicles, then shortens and repositions the urethra to allow for seated urination. The remaining skin is used to create a smooth, flat surface.
Patients can choose from aesthetic options (smooth vs. vulvar) and functional options (preserving vs. removing sensation).
- External visual appearance may be smooth, achieved by a scrotectomy (removing the scrotal sac). Or, the scrotal skin can be used to construct a labia-like or vulvar-like surface (without creating a vaginal canal).
- Some patients want to preserve the sensory endings of a “neoclitoris” skin paddle to still have stimulation for sexual function. Other patients request the removal of all sensory endings.
Nullification is considered irreversible. Because the tissue is removed and smoothed, it is extremely difficult or impossible to perform a traditional vaginoplasty or phalloplasty later.
What is the recovery time for nullification surgery?
The recovery for genital nullification or a “Barbie doll” vulvoplasty is generally faster than traditional vaginoplasty because there is no internal vaginal canal to heal and no daily dilation required. Most patients find they can return to normal activities within 8 weeks.
