Within male to female vaginoplasty, the clitoris is formed from the head of the penis during surgery. The external part of the clitoris is connected to a shaft which extends upwards internally toward the pubic bone. During surgery, the same shaft of nerves that extends through the penis is used to form a shaft that can be felt around the clitoris and sometimes on the upper side of the vagina.

Many transsexual women focus on vaginal orgasms (stimulation caused by penetration), however for most trans women and indeed most genetic women, it is much easier to have an orgasm through direct clitoral stimulation with a finger, vibrator, partner's tongue, etc.

The size and position of a clitoris created during vaginoplasty is an important aesthetic and functional consideration. Whilst genetic women vary greatly in clitoral size, it's not unusual for post vaginoplasty patients to have a larger than average clitoris, sometimes to the point where it is well outside the normally accepted female range. Most surgeons are well aware of this potential outcome and take steps to avoid it. However, it is also not unusual for the clitoris to be in a slightly unusual position, especially when a surgeon attempts to accommodate a patient's request for a deep vagina.

The function of erectile tissue is complex and cannot be covered fully here, but for the sake of completeness it will be mentioned in passing. Erectile tissue comprises those areas of the body which become engorged with blood during sexual arousal, and hence increase in size. Such tissue exists within the spongy corpus cavernosa of the penis (hence it’s ability to become erect) and, to a lesser degree, the clitoris which has two very similar structures.

During sexual arousal relaxation of the clitoral cavernosa artery and associated muscles allows an increased blood flow with consequent pressure increases, and the clitoris expands, increasing in both size and sensitivity. A similar process occurs within the two vestibular regions within the labia minora at the same time. But erection of the nipples in either males or females is due to a different mechanism.

The urethra is the tube down which urine travels which connects the bladder to the urethral opening. The urethral opening, through which urine is expelled, can be seen (see above) as is a small v-shaped dimple below the clitoris.

The vagina is the narrow muscular tunnel which leads up from the vaginal opening and, within a genetic woman connects to the uterus. It usually measures between three and six inches in length. Within genetic women, the vagina is soft and pliable and in the correct circumstances excretes lubricant to facilitate sexual intercourse. The vaginal opening is called the introitus, through which menstrual discharges flow.

Although vaginoplasty procedures are now capable of producing a highly functional vagina, the skin used in the graft is generally not as soft or flexible as that found within a genetic female. Also, it usually will not excrete much lubricant (see the vaginoplasty section), although the prostate gland will exude a small amount of fluid.

In male to female gender reassignment operations the vagina is formed by removing the spongy penile tissue and forming a pocket inside the body. This new pocket is then lined with skin from the penis and scrotum, which is turned inside out and tucked into the pocket. Generally, transsexual women seem to have stronger muscles in the vagina. Also for this reason, it is very important to dilate, not only to avoid losing depth but also width since it is this which will probably play a greater role in allowing comfortable intercourse.

The perineum is the area between the vagina and the anus.

The anus is the outer opening from the rectum. After puberty, pubic hair may grow around the anus, and the skin may darken in colour.

The hymen is a thin, delicate mucous membrane which surrounds and partially obscures the vaginal opening in young genetic females. It is stretched or broken when a finger, tampon, penis, or other object is inserted into the vagina. Despite myths to the contrary, it is not an indication of virginity. A hymen is not constructed during current vaginoplasty procedures. 
 
The skene's ducts and the barthlolin's glands are both located just under the skin and produce secretions believed to aid vaginal lubrication and to ward off infection. Vaginoplasty patients will not have either of these and therefore should take slightly more care concerning vaginal cleanliness than perhaps would be needed by a genetic female.

The following section on male anatomy has been included primarily for the benefit of those who have opted to undergo male to female sexual reassignment surgery. However, it is hoped that others will also find the information of interest.