Introduction: Gender dysphoria is a state in which the individual shows strong and persistent identification with the opposite sex. After thorough diagnostic assessment, the treatment includes gender confirming surgery (GCS). The efficacy and benefit of GCS has been advocated to effectively resolve the patient’s gender dysphoria as well as improve quality of life and psychosocial functioning. The aim of the studies described here was to assess surgical techniques, complications, quality of life and functional outcomes of GCS. Patients and Methods: Study I is a retrospective study of surgical outcomes for patients who underwent male-to female (MtF) GCS over a 14-year period (n=205). Study II describes a prospective study (n=80) of vaginal depth after vaginoplasty performed using solely penile skin for intra vaginal lining. Factors predicted to correlate with poor outcomes were analyzed using a multivariate regression model. Study III is a prospective study (n=193) examining patient-reported outcomes on health-related quality of life. We used the Swedish version of the Short Form-36 Health Survey (SF-36), which measures QoL across eight domains. The questionnaire was distributed to patients pre-operatively, as well as 1,3 and 5 years post-operatively. The results were compared between the different measure points, as well as between the study group and the general population. Study IV is a cohort study (n=22) of the sensitivity of the neoclitoris and its patient-reported functionality. Tactile and vibratory sensitivity was measured with the Semmes-Weinstein monofilaments and the Bio The siometer vibratory measurement device, respectively. A body image questionnaire was provided to patients and the patients were asked about orgasm, pain and general satisfaction with the surgery. Results: In study I, the most common short-term complications were bleeding (11%) and infection (10%). Other complications, such as wound dehiscence (2%), rectovaginal fistula (2%), pulmonary embolus (2%) and deep vein thrombosis (0%), were ...