Vulvoplasty

Overview 

A vulvoplasty is a gender-affirming surgery that constructs a vulva, which is the external genitalia of individuals assigned female at birth (AFAB). This procedure involves creating a mons pubis, clitoris, and inner and outer labia for people assigned male at birth (AMAB), using tissue from the penis, scrotum, and surrounding genital structures. 

For transgender and nonbinary individuals who are AMAB, a vulvoplasty helps align the appearance of their genitals with their gender identity. It allows individuals to feel more comfortable and authentic in their bodies by reshaping their genitalia to reflect their understanding of their gender. Vulvoplasty is just one of the many gender-affirming surgical options available to help people live more fully as their true selves. 

While vulvoplasty is most commonly performed for gender affirmation, there are also cases where individuals assigned female at birth may choose to undergo this procedure. Whether for aesthetic, functional, or medical reasons, the surgery can help improve a person’s comfort and confidence with their genital appearance.

Reasons for undergoing the procedure  

A vulvoplasty can be an advantageous option for those dissatisfied with the appearance of their genitals and seeking to make them resemble a vulva more closely. It may also be a preferred choice for individuals looking for a less invasive procedure with fewer risks compared to vaginoplasty, which not only creates a vulva but also constructs a vaginal canal. Each person’s gender journey is unique and should be approached individually.

For individuals assigned female at birth (AFAB) who have experienced vulvar damage due to trauma or congenital conditions, a vulvoplasty may help alleviate painful symptoms and enhance overall quality of life.

Since a vulvoplasty is a significant and irreversible procedure, it’s essential to have a reliable care team. This team should consist of experienced surgeons and behavioral health specialists well-versed in transgender care. They will assess your physical and mental health to determine if a vulvoplasty is appropriate for you, ensuring that you are well-prepared for the surgery.  

Physical health evaluation  

A physical examination will be performed by your doctor to ensure your suitability for surgery. They’ll:  

• Examine your past medical records.  
• Perform a complete physical examination.  
• Place an order for laboratory testing to determine your organ health and hormone levels.  
• Make a note of any infections or other medical conditions you may have had, and get help managing them if necessary.  
• Make sure you abstain from tobacco use and certain drug usage, and provide assistance and resources when required.

Your doctor will also discuss with you the potential long-term health effects and implications of vulvoplasty on your family planning objectives. You won’t be able to conceive naturally after the procedure. You can save your sperm for a time when you’d like to become pregnant.  

Behavioral health evaluation  

Two distinct mental health professionals that specialize in transgender health will consult with you. They will collaborate with you to ensure that getting a vulvoplasty is a good choice for your mental health as well. The subjects you talk about could be:  

• How you feel about the discrepancy between your gender identification and the way your body appears.  
• The acceptance and prejudice you’ve encountered on the basis of gender in social settings, such as the workplace, school, and home.  
• Your objectives for the vulvoplasty, together with the resources and support system available to you to assist you during the entire surgical process, from planning to recuperation.  
• Any past history of mood disorders or mental health issues.  
• Your past experiences with self-harm or other high-risk behaviors.

Before you can be approved for a vulvoplasty, a letter of support from both specialists is required. Your letters need to attest to your compliance with the World Professional Association of Transgender Health’s (WPATH) surgical care standards. The correspondence ought to attest to the following:  

• You have been receiving hormone therapy for a minimum of a year, excluding any medical circumstances that might have prevented it.  
• For a minimum of a year, you have been living in accordance with your gender identification.Lastly, you must attest to your comprehension of the risks, advantages, and expenses associated with vulvoplasty. Due to its high cost, not all insurance policies will pay for a vulvoplasty. Additionally, you have to agree to the surgery.  

Risks

There are dangers associated with any procedure. However, the risk of problems is minimal if your vulvoplasty is performed by a skilled doctor. Inform your doctor of any observations you make of the following:  

• Paresthesia in your limbs.  
• An abscess, or pus-filled mass, at the surgical site.  
• A hematoma, or blood collection at the surgical site.  
• A seroma, or collection of transparent pus, at the surgical site.  
• Infection symptoms, including as fever, edema, and warmth around your wounds.  
• Indications of a blood clot, such as redness or soreness in the genital, knee, thigh, or calf.

Individuals who have undergone vulvoplasties may experience decreased libidinal feeling and difficulty experiencing an orgasm. However, this is not common. Alternatively, they could not like how their vulva appears. Consult your doctor about surgical alternatives if you’re dissatisfied with the appearance of your vulva.  

Before the procedure  

The best source of advice for preparing for vulvoplasty is the attending doctor. They will provide detailed guidance on how to prepare, including what to bring to the hospital and which medications to avoid in the weeks leading up to the surgery. It’s also important to plan for the recovery period. 

Addressing workplace responsibilities is a key step. Taking eight to twelve weeks off from work is necessary for recovery, so it’s important to verify approval for the absence. If the job involves hard labor or heavy lifting, arranging for a reduced workload upon return can be beneficial. 

Caring for physical and mental health is crucial during this period. A balanced diet, consuming wholesome meals daily, supports quicker recovery. Staying active can also aid in recovery, and discussing the ideal workout regimen with a healthcare provider is advisable. Smoking or using other tobacco products should be avoided, as they can hinder the recovery process and lead to complications. 

Therapy and mental health care play a critical role in the preparation. Keeping in contact with a therapist or counselor in the days, weeks, and months before surgery can help in processing emotions. Therapy can also provide support by connecting to resources that alleviate concerns about the procedure or transitioning to life after vulvoplasty.

Preparing a comfortable environment at home is essential before surgery. Finishing any pending errands or duties, purchasing groceries, and planning meals can make the recovery period smoother. Comfortable, loose-fitting clothing and non-slip footwear are recommended, and it’s helpful to arrange essential items within easy reach to avoid bending or stretching. 

Support from friends and family will be invaluable during the recovery process. Having assistance with housework and errands is especially important in the first two weeks when energy levels may be low. Providing a spare key can make it easier for loved ones to come and go as they offer help. A supportive network of caring individuals can also have a positive impact on emotional well-being during recovery. 

During the procedure  

During the vulvoplasty procedure, your doctor will construct a vulva using tissue from your genitalia. The steps involved include:  

• Removal of the testes, scrotum, and penis.  
• Utilizing the tissue from the head of the penis to form the clitoris.  
• Shortening the urethra, the tube through which urine exits your body.  
• Creating the remaining parts of your vulva using tissue from the urethra, penis, and scrotum.

To assist with urination after surgery, a urinary catheter will be inserted. You may go home with this catheter, which your doctor will remove at a later date.

The procedure typically lasts between two to four hours, though the exact duration may vary.  

After the procedure  

Following surgery, your medical professional will closely monitor you to make sure there are no problems with your recovery process. For the next several nights, you will probably remain in the hospital so that your doctor can keep an eye on your recovery.

You will receive medication from your doctor to reduce discomfort and stop infection. Even yet, unpleasant side effects are possible and are all a part of the healing process. Any of the following symptoms could appear in the days, weeks, and months following your vulvoplasty:  

• Swollen from your wounds. After surgery, you can bleed for up to two days.  
• Itching where the incision was made. Itching is a sign that the wound is starting to heal.  
• Dribbling or spraying after urinating. With time and healing from your wounds, this should become better.  
• Electrical feelings at the site of the operation. Just your nerve endings repairing, that’s all.  
• Bruising on your thighs, abdomen, and genitalia. It can take up to a month for the bruises to go away.  
• Inflamed lower lips. Up to six months may pass before the swelling goes away.  
• Scars that could be purple, crimson, or dark pink. It could take up to a year for these to go.  
• Sensitivity in your penis. It can take up to 18 months to regain full sensation, however the numbness normally goes away over the course of the following few months.  
• Throughout your rehabilitation, you will be physically limited for a minimum of six weeks or more. This may entail refraining from having sex, working out, climbing and descending stairs, driving, and other activities. Make careful to abide by the advice from your doctor regarding these and other limitations.

Plan to attend routine checks so that your doctor can make sure you’re healing as it should be, in addition to adhering to any after-care recommendations they may supply you. 

Outcome 

After the first two weeks post-surgery, you should start to feel better. By the four-month mark, you should have healed enough to visualize how your vulva will look once all the swelling has subsided. Most individuals can expect to return to work within eight to twelve weeks.

Complete healing may take a bit longer, potentially up to a year. It’s essential to follow your provider’s recommendations for care and attend all scheduled follow-up appointments during this time. Pay close attention to your doctor’s guidance regarding physical activity, including sexual activity.

Ultimately, the decision to undergo the procedure is yours. However, many individuals who choose gender-affirming surgery report satisfaction with their decision, noting improvements in their daily and sexual lives as they feel more comfortable in their bodies. It’s crucial to take your time in selecting a qualified surgeon for your vulvoplasty to minimize the risk of complications and enhance your satisfaction with the results.