Speech Therapy or Surgery?

Secondary Effects, Risks, Pieces of Advice…Find out everything you need to know about the current treatments of voice feminization.


An experimental technique


Nowadays, surgery is performed at a vocal folds level in order to increase voice tone (fundamental frequency) and feminizing it. However, surgery does not offer any kind of guarantees since it is still experimental, so the results can considerably vary from one patient to another. As it is an invasive and aggressive surgery for the vocal folds, Femivoz only recommends it in very specific cases. In fact, there is no turning back once you perform surgery because, once you operate on them, voice will never be the same.

Are you thinking about surgery?

We recommend to our patients who are interested on surgery to inform themselves about the problems, disadvantages and risks that are involved before doing it. We advise them to ask to the speech therapist to evaluate their vocal potential, and in the case of having chosen surgery, we will recommend them the best speech therapy treatment before and after surgery for improving its results.

Speech therapy

A complete training


Femivoz does not simplify women’s voice only to its high-pitch; in fact, we daily work with women who have a low fundamental frequency (tone of voice); however, they do not lack of womanliness. It is true that the vocal extension of women seems to cover a higher frequency range than men, but the true essence of a feminine voice is determined by its melody, modulation, expressivity and intonation. It is about an emotional voice whose aural features cover a wide range of elements, all of them trained thanks to speech therapy.

Speech Therapy after surgery

Postoperative speech therapy means to reeducate voice as consequence of the negative effects of surgery. In the case of those voices which increase their fundamental tone with the operation, voice feminization treatment focuses on melody as well as all the prosodic elements which intervene in speech, although some patients tend to have some difficulties in modulating and raising their tone of voice.

Surgery Secondary Effects

It is very important to bear in mind the impact that surgery will have on healthy vocal folds. Currently, we can appreciate the following:

> A decrease in the maximum phonation time (MPT) as a consequence of the reduction in the larynx gap situated between the vocal folds, which equally decreases the airflow from lungs to mouth.

> This MPT decrease implies a reduction in the vocal projection capacity, an increase in the subglottic pressure and muscles tension, altering all patient’s vocal mechanism.

> In some patients, it has been observed several difficulties in reaching high-pitched sounds or even head voice. This hinders patient’s voice intonation and melody during speech.

> At an organic level, there can be some injuries or inflammatory diseases as a consequence of muscles imbalance and the modification of the vocal gesture after surgery; also there is a narrowing of the gap where the airflow passes.

There are some patients whose surgery has failed and they present an aphonic, dysphonic or even a dyplophonic voice in the case that they have an anterior muscle strain on the sutures (listen to the audios).


What is a feminine voice?


Surgery bets for a frequency gain, merely reducing womanhood to a high-pitched voice.

On the contrary, speech therapy bets for exalting femaleness in all its aspects, not only at a vocal level.

Femivoz firmly believes in the exaltation of patients’ femininity in all senses, so it works not only at a vocal level but also at all levels involved in communication.

Suggestions and Pieces of Advice

In both cases, it is recommended to all patients who wish to feminize their voices to do a speech therapy treatment before surgery in order to discover and train all their vocal potential since many patients, who at the beginning were decided for surgery, changed their minds after reaching the same results they were looking for only with a logopedic treatment. Certainly, speech therapy involves additional motivation, dedication and time, but the results obtained are more efficient, natural and persistent on time than the ones achieved with surgery.

Surgery simply offers an increase in the fundamental tone; that is to say, more high-pitched notes, but it does not train the rest of the aspects related with womanhood or feminization. Nowadays, speech therapy is the most reliable and complete procedure for voice feminization. Currently, there is a great debate among speech therapists, vocal coaches, otolaryngologist and surgeons, since surgeons are only focused in the frequency gain that surgery achieves, while speech therapists are centered on exalting femininity on the whole, which implies not only voice but also body language, emotions and gestures. These points are not treated by surgery at all.


Wendler Glottoplasty

Nowadays, it is the most used surgical technique for increasing tone of voice. It was described by Wendler in 1989, and performed by endoscopy (through mouth) under general anesthesia. This surgery consists in to shorten the vocal folds and reduce their vibratory mass. It is recommended a vocal rest of 10 days after this surgery, and then start postoperative speech therapy sessions. Surgery is extremely invasive and irreversible, so it is advised to start a logopedic treatment before choosing any kind of surgery since there are no guarantees in the results(listen to the surgery audios).


It begins with a de-epithelization of the free edge of the vocal folds in their anterior third, frequently done with cold instruments or laser.


Once they have been de-epithelized, the vocal folds are sutured at the level of their anterior commissure.


In the third stage, the vibratory mass of the vocal folds is reduced by using CO2 laser over their anterior surface.


Further information

Femivoz works in the Voice Unit of the Quiron Malaga Hospital with ENT specialists in voice tone surgery.


Further information

Femivoz advices to begin a speech therapy treatment before doing an irreversible surgery which has no guarantees in its results.

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