Vaginoplasty

Overview  

Vaginoplasty is a surgical procedure that repairs or reconstructs the vagina due to damage from medical conditions, injuries, or other factors. It can also be a gender-affirming surgery for transgender women, in which a vagina and vulva are created, and the penis, scrotum, and testicles are removed. 

This procedure plays a significant role in helping individuals align their physical appearance with their gender identity. For those seeking gender-affirming surgery, vaginoplasty allows the creation of female genitalia, providing both aesthetic and functional results that can enhance a person’s sense of well-being and self-identity. 

It’s essential to understand the distinction between the terms “vagina” and “vulva,” as they are often used interchangeably but refer to different parts of the anatomy. The vagina is the internal, muscular canal that isn’t visible from the outside, while the vulva refers to the external, visible genitalia of someone assigned female at birth (AFAB). Knowing this difference is important for understanding the specifics of the vaginoplasty procedure.  

Reasons for undergoing the procedure  

Vaginoplasty can be performed for both functional and cosmetic reasons. Functional purposes include improving sexual function or addressing issues such as urinary incontinence. Cosmetic reasons focus on aesthetic preferences or the emotional impact of appearance. There are various motivations for pursuing vaginoplasty, including: 

• Vaginal childbirth: Vaginal delivery can stretch and loosen the vaginal muscles. Aging can also contribute to a loss of vaginal tightness, which may lead to discomfort or affect sexual function. 
• Medical conditions: Vaginal reconstruction may be necessary after radiation treatment for cancer or following the removal of the vagina as part of cancer therapy. 
• Congenital conditions: Some congenital abnormalities, such as being born without a vagina or having an underdeveloped vagina that affects menstruation, can influence both the appearance and function of the vagina. 
• Gender affirmation: Vaginoplasty may be part of feminizing bottom surgery for individuals seeking gender affirmation.  

Risks

Depending on the degree of the operation and your reason for having it, the risks change slightly. Following a vaginoplasty to address an injury or a congenital problem, some hazards may include:  

• Infection.  
• Bleeding.  
• Dyspareunia, or painful sex.  
• Loss of feeling or numbness.  

A primary advantage is the alleviation of gender dysphoria. Following surgery, a person’s genitalia correspond to the gender they identify with. People’s quality of life and mental health both greatly benefit from this.  

Among the potential risks of vaginoplasty for gender affirmation are:  

• Excessive bleeding or infection.  
• Vaginal stenosis (too short and thin vagina).  
• A vaginal fistula, which is an irregular connection between the urinary tract and the vagina.  
• A rectovaginal fistula, which is an irregular junction of the vagina and the rectum.  
• Damage to the nerves.  
• Dissatisfied with the outcome.  

Before the procedure  

Examinations and tests are conducted prior to vaginoplasty to prepare for surgery. These may include: 

• A physical examination to assess overall health and determine suitability for surgery, as well as a review of medical history. 
• Information on the potential risks, benefits, and requirements for postoperative care. 
• Recommendations to minimize complications, such as smoking cessation. 
• For individuals Assigned Male at Birth (AMAB) undergoing vaginoplasty for gender affirmation, specific preoperative requirements may be discussed, such as genital hair removal. 

Detailed instructions will be provided based on individual circumstances to ensure proper preparation for the surgery.

During the procedure  

The purpose of a vaginoplasty determines the specific type of operation performed. 

For a vaginoplasty aimed at repairing damage or addressing looseness, the following steps are typically involved: 

• Removal of excess or drooping tissue or skin. 
• Stitching of loose tissue within the vaginal canal. 
• Reduction of the vaginal entrance size by eliminating extra tissue or tightening the surrounding area. 

In cases where vaginoplasty is performed to correct congenital anomalies, the procedure may involve: 

• Creation of a functioning vagina. 
• Removal of any extra tissue or deformities present from birth. 
• Prevention of blood clotting during menstruation. 

In a gender-affirming vaginoplasty (penectomy), most of the penile tissue is removed and rearranged. The surgeon creates a vaginal canal and labia using the skin from the penis and scrotum. The outer skin of the penis is reshaped, inverted, or turned “inside out” and inserted into the newly formed opening to create the vagina. The duration of the procedure varies, with some operations taking up to 10 hours, while others may require less time. 

After the procedure  

The surgeon will provide details on what to expect following vaginoplasty, including symptoms that may signal potential complications. Some patients may stay in the hospital for up to five days to recover, while others may be discharged earlier and return home. Antibiotics will be prescribed to prevent infection and help manage post-operative pain. 

The following can be expected after the procedure: 

• Mild bleeding for up to 48 hours. 
• Soreness or bruising around the vaginal area, with swelling that may take several weeks to subside. Swelling after gender-affirming vaginoplasty can sometimes cause dribbling or spraying during urination. 
• Numbness or itching as the nerve endings heal. 
• Scarring, which will fade or change color over time. 
• The use of a catheter to assist with urination, which may be required until the urethra has healed, typically taking up to a week. 

Outcome  

Recovery from vaginoplasty can take anywhere from a few weeks to several months, depending on the extent of the surgery. Different types of vaginoplasty come with specific postoperative protocols, which the doctor will explain in detail to ensure a clear understanding of what to expect during recovery. 

For the first few weeks, certain activities, such as sexual intercourse or using tampons, may be advised against. The doctor will also provide instructions on how to properly care for stitches and incision sites. 

Additionally, the use of a dilator may be recommended. This device gently stretches the interior of the vagina to help maintain its depth and width.