{{short description|Surgical procedure}} {{Use dmy dates|date=April 2026}} [[File:AMAB nullification 1 year in 1.jpg|thumb|A person assigned male at birth one year after genital nullification surgery]] [[File:Psychedelic666 - Genital nullification.jpg|thumb|A person assigned female at birth four weeks after genital nullification surgery]]
'''Genital nullification''', also known as '''gender nullification surgery''' or simply '''nullification''', refers to surgical procedures which result in the removal of all genitalia. It may be performed as a form of gender affirming care for transgender and gender diverse individuals, as body modification for aesthetic purposes, or as a sexual practice. Genital nullification is an uncommon procedure for which limited scientific literature is available. It may take place as a single or multi-stage procedure, with surgical methods varying based on patient anatomy and goals – a nullification procedure may involve penectomy, orchiectomy, scrotectomy, vaginectomy, hysterectomy, salpingo-oophorectomy, and/or urethrostomy. Genital nullification is an irreversible procedure with significant impacts on sexual, reproductive, and urinary function. Individuals who have received or wish to pursue nullification are sometimes known as '''nullos'''.
==Procedure== thumb|A diagram illustrating one method of nullification for patients assigned male at birth using a midline incision
Genital nullification procedures vary by patient anatomy, patient goals, and surgical methods. Nullification may be performed as a single procedure or over multiple stages.<ref name="Ramirez-2025">{{Cite journal |last1=Ramirez |first1=Mayra Lucas |last2=Wangamez |first2=Maria |last3=Huynh |first3=Rachel |last4=Butler |first4=Christi |year=2025 |title=Surgical considerations for genital reconstruction options for gender-diverse individuals assigned male at birth |journal=Plastic and Aesthetic Research |doi=10.20517/2347-9264.2025.10 |issn=2347-9264 |oclc=896972841 |doi-access=free}}</ref>
In individuals assigned male at birth, genital nullification involves a combination of penectomy (removal of the penis), scrotectomy (removal of the scrotum), and orchiectomy (removal of the testicles).<ref name="Ramirez-2025"/><ref name="Ascha-2024">{{Cite journal |last1=Ascha |first1=Mona |last2=Rigsby |first2=Siri |last3=Shoham |first3=Maia |last4=Akhavan |first4=Arya Andre |last5=Swanson |first5=Marco |last6=Streed Jr |first6=Carl G. |last7=Gurjala |first7=Anandev |last8=Morrison |first8=Shane D. |last9=Pang |first9=John Henry |last10=Satterwhite |first10=Thomas |year=2024 |title=Individually customized gender affirming genital procedures: techniques and considerations |journal=The Journal of Sexual Medicine |volume=21 |issue=9 |pages=827–834 |doi=10.1093/jsxmed/qdae075 |issn=1743-6109 |lccn=2004243877 |oclc=56519822}}</ref><ref name="Akhavan-2025"/>{{rp|277}} The urethra is shortened and a urethrostomy can be created to allow the patient to more easily urinate while sitting. Patients may opt to preserve or remove the nerves of the penis – if preserved, the glans may be de-epithelialised and placed beneath the skin or left exposed to attempt to maintain sexual sensation.<ref name="Ramirez-2025"/><ref name="Ascha-2024"/> The prostate is typically left intact during nullification procedures, as prostatectomy carries the risk of complications relating to urinary function. Patients with intact prostates may still be capable of the production and ejaculation of seminal fluid and of achieving prostate orgasms.<ref name="Akhavan-2025"/>{{rp|277}}
In individuals assigned female at birth, genital nullification involves a combination of vaginectomy (removal of the vagina), hysterectomy (removal of the uterus), salpingo-oophorectomy (removal of the ovaries and fallopian tubes), and removal of the labia and/or clitoris. Patients may opt to remove or preserve the clitoris – if preserved, the clitoris may be de-epithelialised and placed beneath the skin to attempt to maintain sexual sensation.<ref name="Ascha-2024"/>
Genital nullification is an irreversible procedure that permanently impacts sexual, reproductive, and urinary function and carries a risk of complications including nerve damage, infection, chronic pain, and scarring.<ref name="Ramirez-2025"/> Patients who undergo nullification have limited options for future genital reconstruction surgeries and require life-long hormone replacement therapy.<ref name="Ramirez-2025"/><ref name="Ascha-2024"/><ref name="Akhavan-2025">{{Cite book |last1=Akhavan |first1=Arya Andre |title=Gender Affirming Vaginoplasty |last2=Quint |first2=Meg |last3=Satterwhite |first3=Thomas |publisher=Academic Press |year=2025 |isbn=978-0-443-21776-0 |editor1-last=Selvaggi |editor1-first=Gennaro |pages=265–280 |chapter=Chapter 23 - Individually customizable procedures for patients Assigned Male at Birth (AMAB) |doi=10.1016/b978-0-443-21776-0.00023-6 |oclc=1513132611 |editor2-last=Djordjevic |editor2-first=Miroslav L.}}</ref>{{rp|276}} Due to the rarity of nullification procedures, limited patient outcome and complication data is available.<ref name="Ramirez-2025"/><ref name="Ascha-2024"/><ref>{{Cite journal |last1=Claeys |first1=Wietse |last2=Wolff |first2=Dylan T. |last3=Zachou |first3=Alexandra |last4=Hoebeke |first4=Piet |last5=Lumen |first5=Nicolaas |last6=Spinoit |first6=Anne‐Françoise |year=2025 |title=Variant genital gender‐affirming surgery: a systematic review |journal=BJU International |volume=135 |issue=1 |pages=40–53 |doi=10.1111/bju.16513 |issn=1464-410X |oclc=610415745|hdl=1854/LU-01KES7E8FWGSJTECJQX3VCY6KX |hdl-access=free }}</ref>
==Patient demographics== Transgender, gender non-conforming, and/or non-binary individuals may seek genital nullification as a form of gender affirming care, however, the procedure is not exclusive to these demographics.<ref name="Ramirez-2025"/><ref name="Akhavan-2025"/> Patients may seek nullification to alleviate gender dysphoria in relation to the presence of genitalia, erogenous sensation, or erectile tissue function.<ref name="Akhavan-2025"/> Others may simply desire a more neutral external appearance.<ref name="Ramirez-2025"/><ref name="Akhavan-2025"/> Individuals pursuing genital nullification for the purpose of gender affirmation may also pursue mastectomy or nipple removal procedures.<ref name="Stitt-2020">{{Cite book |last1=Stitt |first1=Alex L. |title=ACT for Gender Identity: The Comprehensive Guide |date=2020 |publisher=Jessica Kingsley Publishers |isbn=978-1-78592-799-7 |location=London and Philadelphia |oclc=1089850112}}</ref>{{rp|43}}
In the context of gender affirming care, genital nullification is sometimes referred to as a form of non-binary genital gender-affirming surgery; it is considered a non-standard surgical option compared to the binary vaginoplasty or phalloplasty procedures that are traditionally offerred to patients seeking genital gender-affirming surgery.<ref name="Ascha-2024"/><ref>{{Cite journal |last1=Van Sickels |first1=Nicholas |last2=Wong |first2=Jennifer W. H. |last3=Villacorta-Cari |first3=Evelyn |last4=Lee |first4=Steph E. |last5=Fallin-Bennett |first5=Keisa |year=2025 |title=State-of-the-Art Review: Data and Trust to Improve Care for Transgender and Gender-Diverse Patients |journal=Clinical Infectious Diseases |volume=80 |issue=2 |pages=e16–e30 |doi=10.1093/cid/ciae480 |issn=1537-6591 |oclc=24308833 |doi-access=free}}</ref>
Some patients seeking genital nullification identify as eunuchs, a subculture of individuals assigned male at birth who wish to remove their genitals or make them non-functional, typically through castration or emasculation.<ref name="Agapoff-2024">{{Cite book |last1=Agapoff |first1=Jamie |title=Encyclopedia of Sexual Psychology and Behavior |last2=McCoy |first2=Ruby T. |last3=Bongar |first3=Bruce |publisher=Springer |year=2024 |isbn=978-3-031-08956-5 |editor1-last=Shackelford |editor1-first=Todd K. |location=Cham, Switzerland |pages=1–4 |chapter=Eunuchs |doi=10.1007/978-3-031-08956-5_2516-1 |oclc=1525656907}}</ref><ref name="Coleman-2023">{{Cite journal |last1=Coleman |first1=E. |last2=Radix |first2=A. E. |last3=Bouman |first3=W. P. |last4=Brown |first4=G. R. |last5=de Vries |first5=A. L. C. |last6=Deutsch |first6=M. B. |last7=Ettner |first7=R. |last8=Fraser |first8=L. |last9=Goodman |first9=M. |last10=Green |first10=J. |last11=Hancock |first11=A. B. |last12=Johnson |first12=T. 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A. |last119=Arcelus |first119=J.|pmc=9553112 }}</ref> This group should not be confused with individuals who solely fantasise about castration or emasculation or who may instead be experiencing a paraphilia, body integrity dysphoria, body dysmorphia, or a religious fervor.<ref name="Stitt-2020"/>{{rp|267–268}}<ref name="Agapoff-2024"/><ref name="Wassersug-2012">{{Cite journal |last1=Wassersug |first1=Richard J. |last2=McKenna |first2=Emma |last3=Lieberman |first3=Tucker |year=2012 |title=Eunuch as a gender identity after castration |journal=Journal of Gender Studies |volume=21 |issue=3 |pages=253–270 |doi=10.1080/09589236.2012.681178 |issn=0958-9236 |lccn=2001238211 |oclc=321078833}}</ref> Eunuchs may or may not identify as transgender or gender diverse, with some identifying their gender simply as eunuch, and nullification procedures sought by this demographic may or may not be considered gender-affirming care.<ref name="Agapoff-2024"/><ref name="Coleman-2023"/><ref name="Wassersug-2012"/> Not all eunuchs pursue full genital nullification, and not all individuals who have undergone castration or nullification identify as eunuchs.<ref name="Wassersug-2012"/>
Some individuals may pursue genital nullification as a form of body modification for aesthetic purposes and/or as part of a sexual practice such as BDSM. These individuals may self-identify using the term "nullo" and are considered rare within the extreme body modification community.<ref name="DeMello-2007">{{Cite book |last1=DeMello |first1=Margo |title=Encyclopedia of Body Adornment |publisher=Greenwood Press |year=2007 |isbn=978-0-313-33695-9 |location=Westport, Connecticut |pages=9, 55–58 |lccn=2007016304 |oclc=181159689}}</ref>
Being an uncommon procedure with little description in medical literature, few medical practitioners are willing or able to perform genital nullification.<ref name="Ramirez-2025"/><ref name="Akhavan-2025"/><ref name="Stitt-2020"/>{{rp|267–268}}<ref name="DeMello-2007"/> Some patients are hesitant to pursue the procedure or express their wishes to medical staff out of fear of discrimination or denial of care.<ref name="Akhavan-2025"/> Some individuals instead seek out unlicensed surgeons, known in the body modification community as "cutters", or attempt self-surgery.<ref name="Stitt-2020"/>{{rp|267–268}}<ref name="DeMello-2007"/>
==See also== * The Skoptsy, a Christian sect in the Russian Empire known for removing breasts and genitalia for religious reasons
==References== {{Reflist}}
==External links== * {{Wiktionary-inline|nullo}} * {{Commons-inline}}
Category:Surgical removal procedures Category:Reproductive system Category:Genital modification and mutilation Category:Transgender health care Category:Plastic surgical procedures