This article focuses on the preoperative planning and surgical techniques for gender-affirming vaginoplasty. Vulvoplasty and full-depth vaginoplasty techniques are also discussed. Gender-affirming surgery (GAS), particularly vaginoplasty, is a vital intervention for transgender individuals, significantly enhancing mental health and quality of life. Studies show a rising trend in genital GAS, highlighting the need for standardized care protocols. Among various surgical techniques, penile inversion, intestinal, and peritoneal vaginoplasties are prominent. This article focuses on patient evaluation, surgical planning, and detailed steps of feminizing vaginoplasty, with an emphasis on the periotoneal flap approach to support safe and effective surgical outcomes.