Purpose of ReviewThere is a significant rise in the interest in genital gender affirmation surgery (gGAS), which is increasingly offered and performed throughout the world. While gGAS is not new, the expansion of gGAS is associated with progressive societal acceptance of transgender and gender non-conforming individuals. There is a clear role for gGAS in the management of gender dysphoria, and with the prevalance of gGAS it is important for physicians to be familiar with the altered anatomy and potential complications of gGAS. In this review, we summarize the literature on the outcomes and complications associated with gGAS. Recent Findings Fifty-five studies were utilized in this review, encompassing meta-analyses, literature reviews, retrospective primary studies, and case reports. Summary gGAS is a complex procedure with a variety of techniques that each carry their own strengths and weaknesses. Current gGAS procedures deliver predictable results with high patient satisfaction despite high complication rates for gGAS. Further research is needed to refine gGAS techniques in order to to minimize complication rates and to improve the management of complications when they do occur.