<p>For those seeking gender-affirming procedures, surgical modifications, particularly of the genital area, are an important option for alleviating psychological distress. Established techniques are available for vulvoplasty and vaginoplasty, and for the formation of a penis. The range of complications associated with genital-modifying surgery is generally very broad, with the most common complications occurring in the urinary tract in the form of sensory disturbances. Iatrogenic rectoneovaginal fistulas, which can occur following surgery in the pelvic region (colpectomy, tissue dissection for vaginoplasty), must be treated surgically. Equally important from a proctological perspective are diversion colitis and adenocarcinomas, which can develop in intestinal tissue used for reconstruction. Care of patients with gender incongruence requires an interdisciplinary approach, in which knowledge of anatomical changes is essential. In addition, the needs of the patient must be taken into consideration. Patients still encounter discrimination in the healthcare system, creating barriers for many seeking treatment.</p>