Perineal surgeries are mostly private surgeries due to the special nature of the surgical site. Therefore, medical practitioners should grasp the surgical psychology of different patients and conduct adequate pre-operative assessment and communication to contribute to the success of this type of surgery. Perineal surgery is divided into two categories: plastic surgery and cosmetic surgery. Plastic surgery includes congenital malformations, such as hermaphroditism, congenital absence of vagina, cryptovagina, hypospadias, heterosexuality, as well as some of the traumatic deformities of the vulva, organ defects and so on. Cosmetic, refers to surgery to improve the quality of sexual life and cover up certain facts, such as hymen repair, vaginal tightening, labiaplasty, penis lengthening and so on. Due to the specificity of the disease, it brings a serious sense of inferiority to the patient, who is in a long-term situation of extreme dissatisfaction and unacceptability to her own gender and physiological status, worrying that her husband, boyfriend or the surrounding people cannot accept her. As a result, there are mostly medium to heavy psychological pressure before surgery. The main abnormal psychology includes: low self-esteem, withdrawn personality, humiliating mentality, language communication disorders, pessimism, depression, lack of survival skills, desire and fear of relationships, role conflict, self-image disorders and so on. (a) Low self-esteem and isolation of character Low self-esteem and isolation of character refers to the patient’s low self-esteem and despair due to extreme dissatisfaction with his/her own physical state as a result of the long-term effects of external genital deformity. It is more intense with age, manifested as loneliness, despair, withdrawn personality and non-conformity, no friends around, coupled with the parents’ psychological neglect and insufficient care, resulting in the lack of too much friendship and affection during the process of growing up, aggravating low self-esteem and withdrawn personality. Healthcare workers should actively communicate with their families to understand their learning environment, family, work, life situation, and relationship with colleagues and neighbors. Encourage and praise the patient’s work and study, so as to reduce the sense of low self-esteem; for the phenomenon of tension in their interpersonal relationships, guide the patient to self-adjustment; this will help the patient to overcome the low self-esteem, improve interpersonal relationships, correctly view life, and positively face the pressure of life. (ii) Shame mentality The shame mentality is caused by the patients’ insufficient knowledge of physical and mental health. With the onset of puberty, patients’ genitals, gonads also and secondary sexual characteristics are fully realized, so that the contradiction between the gender characteristics they have developed and the gender characteristics defined by their gonads are fully exposed. When discovering that they are different from people of the same age and gender, the patients are mostly afraid of contacting people and dare not get close to their peers, and they keep themselves closed for a long time, worrying that their body secrets will be discovered by their peers and be humiliated, and thus they have a stronger rejection of the people around them. (iii) Language communication disorder Language communication disorder, patients are afraid that their genital tract deformity will be discovered by others and be discriminated against or made fun of, and they are unwilling to come into contact with others. Most of them are not good at talking from childhood and have poor language communication ability. This causes the patients’ language communication ability obstacle. (iv) Pessimism and misanthropy Because of their physical illnesses, patients often complain about their misfortunes and the unfairness of fate. The patients have no confidence in life and have a negative attitude towards life; they are prone to suicidal thoughts and behaviors. (E) Depression The patients show that they have no choice but to accept the arrangement when they are admitted to the hospital; when they are asked about their condition, they are unwilling to reveal their true thoughts; they usually like to sit or lie down, their moods are low, and they lack corresponding emotional and behavioral responses to the surrounding environment and information; they show a serious depression. After the patients are admitted to the hospital, the medical staff should warmly receive them and help them familiarize with the environment of the ward so as to adapt to the hospital life as soon as possible; take the initiative to communicate with them and talk about the interesting things of the patients, so as to let them get comfort and happiness from them; provide psychological guidance to the patients with a kind attitude and cordial language, so as to make them have a sense of security and be able to speak out their true thoughts. In addition, doctors should pay attention to the psychological support of patients’ family members, because they know the patients’ psychological state, character traits, living habits, etc. best, and the care and attention given to the patients are in a sense irreplaceable by others. Therefore, the patient’s family members can be allowed to stay with the patient, not strictly regulate the visiting time, in order to increase the interaction between the patient and the society and family, and use the affection to impress the patient and alleviate his depression. (vi) Lack of survival skills Because of the effects of low self-esteem, isolation, and language communication disorders, patients do not complete their basic education and have no basic survival skills, and have no confidence in entering society to carry out their work, and there is a serious lack of psychological adaptation. (vii) Longing for and fear of emotions As the patient grows older, his or her need for affection from the opposite sex increases, and he or she hopes to find someone who cares for and understands him or her. However, because of the influence of the disease, the desire for the opposite sex has become a luxury, and with the deepening of the relationship, the desire has turned into a fear; because of the fear that the disease will be recognized, and the fear of the impact on others, thus causing the patient to have a serious psychological burden. (H) Role conflict When the patient’s psychological gender does not match his/her physical gender, it is easy to cause serious role conflict, and he/she cannot face the sudden role change and the different gazes of the surrounding people. (ix) Self-image disorders As patients have incongruous sexual characteristics, their self-understanding is confused, and they want to change the situation through surgery, but surgery has limitations. Therefore, before discharge, we should instruct the patients and their families to correctly understand their actual state of health, and explicitly tell the patients that they can get married but have no ability to bear children. Explain to the patient that although the external genital reconstruction surgery has reconstructed realistic external genitalia, continuous hormone therapy is still needed after the surgery to improve certain incongruous sexual characteristics to be close to normal, so as to resolve the psychological contradiction of the patient’s disorganized self-image. The correct understanding of the patient’s mind will help to face the pressure of future life. Psychotherapeutic measures Psychotherapeutic measures mainly include the following: establishing a good doctor-patient relationship; patient listening, encouragement of catharsis; appropriate explanation, response to the prudent; strict confidentiality, respect for the visitor; encourage the patient to establish a healthy outlook on love and life; and active support, build confidence. (A) Patient listening and encouraging catharsis Patients have low self-esteem when they are admitted to the hospital, they dare not look at the medical staff when they speak, and they stammer when they ask about their medical history, and they do not speak a word for a long time. To address this situation, healthcare professionals should be patient, give the patient sufficient time, provide linguistic guidance to the patient, encourage her to say what she feels in her heart, and alleviate the obstacles of the patient’s verbal communication ability. (ii) Establish a good doctor-patient relationship The establishment of a good doctor-patient relationship should start from every contact with the patient. When admitted to the hospital to give warm and thoughtful service, care for their lives; in the treatment, more communication with them, language to avoid causing harm to the patient, and gradually reduce the patient’s self-defense psychology. Positive support and confidence building. Patients usually have been to other hospitals for examination before consultation, and do not have enough confidence in the treatment of this disease. Healthcare professionals should sympathize, be considerate, encourage and comfort the patient, and alleviate the patient’s misgivings with skillful operation and rich professional knowledge, so as to give her a sense of security and trust. Correct the patient’s view of difficulties and setbacks, encourage the patient’s relatives and family members to care more about and help the patient, increase her sense of belonging, build up confidence in treating the disease and establish a positive attitude towards life. (iii) Appropriate explanation and cautious response After repeated examinations, the patient has a serious inferiority complex, still has insufficient knowledge of the disease, and has no confidence in the treatment and prognosis of the disease. To deal with this situation, the patient should be given appropriate explanations, so that he or she can further recognize his or her own disease and actively cooperate with the treatment to achieve a good prognosis. (iv) Respect for visitors and strict confidentiality The patient should be placed in a single room and strict confidentiality should be maintained to avoid psychological pressure from other patients and to respect the patient’s privacy. For her friends or other visitors, strict confidentiality should be kept to prevent psychological harm to the patient and aggravate the psychological burden. Medical and nursing staff do a good job of medical confidentiality for patients mainly include the following points: (1) Arrange a quiet and comfortable small room as much as possible, and use English abbreviations for all diagnostic names in the bedside card and hospitalization list to avoid arousing other people’s curiosity and discrimination, which will aggravate the patient’s psychological burden. (2) Avoid others when medical personnel ask about the medical history or talk about the condition; be sincere in conversation and keep the conversation confidential to eliminate the patient’s concerns; do not receive any visitors without the patient’s consent; minimize perineal examination and avoid participation of many people when examination is necessary. (E) Encourage the patient to establish a healthy outlook on love and life Understand the patient’s feelings and explain the normal physiological and life needs to the patient; tell the patient that everyone has the right to pursue beautiful love and let her build up her confidence and believe that her love will appear eventually. At the same time, combined with the characteristics of her disease, more publicity of rehabilitation knowledge, and gradually cultivate her ability to adapt to life, set up long-term rehabilitation and exercise confidence, explaining the life after treatment and emotional coping, so that the patient to face the reality and set up a new life goals. In conclusion, a good doctor-patient relationship is the basis for the success of surgical treatment. Respecting patients and keeping secrets are the guarantee of consolidating a good doctor-patient relationship; skillful operation and rich professional knowledge are a good medicine to comfort patients and help them build up their confidence; sympathy, care and help for patients should start from the little things in their life, so that the patients can experience the sincerity and love of the medical workers, which is conducive to positively coping with the psychological problems brought by the disease and life.