Narratives of Mexican transgender women after feminizing genital gender-affirming surgery: Care practices, agency, and resilience—“It’s my body, it’s mine, and I decide”

Background Feminizing genital gender-affirming surgery (FG-GAS), including vaginoplasty, can support embodied congruence, gender affirmation, and wellbeing; however, its benefits depend on access to surgery, sustained postoperative care, and non-stigmatizing follow-up. Evidence from Mexico remains limited on how transgender women narrate the meanings of surgery and the care practices that follow.Methods We conducted an interpretive qualitative study grounded in a constructivist epistemology. Semi-structured interviews were conducted in Spanish with eight Mexican transgender women with a neovagina who had attended gynecology/colposcopy follow-up at Clínica Especializada Condesa-Iztapalapa in Mexico City. Interviews were audio-recorded, transcribed verbatim, de-identified, and analyzed using reflexive thematic analysis.Results Participants described FG-GAS as a life-marking milestone associated with relief, pride, and gender congruence, while emphasizing that surgery requires sustained care work, including dilation, lubrication, symptom monitoring, and continuity of gynecologic follow-up. Three themes were developed: (1) pathways to FG-GAS, shaped by access routes, psychological accompaniment, economic resources, follow-up care, and support networks; (2) identity-related meanings of FG-GAS, including the fulfillment of a long-held dream, emotions, gender dysphoria/euphoria, social positioning, and erotic–sexual–affective experiences; and (3) recommendations informed by lived experience, including affirmative psychological support, interdisciplinary care pathways, collective self-care and peer education, recognition of activism, and policy actions to reduce inequities. Across themes, agency was articulated both as bodily self-determination—“it’s my body, it’s mine, and I decide”—and as community-based care.Conclusions FG-GAS was narrated as affirming and agency-enhancing; however, equitable benefits depend on intersectional conditions of access and on structured, non-stigmatizing postoperative and gynecologic follow-up. Findings support interdisciplinary, rights-based models that integrate surgery, gynecology/colposcopy, sexual health, and affirmative mental health care with patient education and peer-informed resources.