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Any surgery is a big deal, but surgery on particularly sensitive parts of the body—like the genitals—needs a lot of thoughtful consideration. Vaginoplasty, a surgery to repair or construct a vagina, can be used to repair medical problems like injury after childbirth or pelvic floor disease. It’s also used to construct a vagina in transgender women who decide reconstructive surgery is part of their journey.
Let’s delve into types of vaginoplasty and what to expect.
Types of vaginoplasty
Several different surgical techniques and types of vaginoplasty are available based on the goal of the procedure, including:
Vaginal rejuvenation surgery
Vaginal rejuvenation is a broad term that describes any repair of the vagina or labia (labiaplasty) to improve the appearance or function.
It can be done as cosmetic surgery to improve the appearance of the vagina or reduce the size of the clitoral hood. It can also be used as reconstructive surgery to correct incontinence, congenital abnormalities, or damage after vaginal delivery (Barbara, 2017).
Sometimes vaginal rejuvenations are done in the hopes it will increase sexual function and pleasure. However, there is little scientific evidence to support this claim.
Penile inversion vaginoplasty
Penile inversion vaginoplasty is the most common type of surgery used to construct a vagina in male-to-female gender affirmation surgery (Pariser, 2019). The constructed vaginal cavity is often called a neovagina.
During this procedure, the surgeon takes skin from the penis to create a vaginal opening between the urethra and rectum. If there isn’t enough penile skin to create the desired vaginal depth, they may use a skin graft from the hip, thigh, or abdomen. But this skin likely won’t be as sensitive and functional as skin from the genitalia.
The scrotal skin is used to create the labia majora and labia minora. The tip of the penis is used to create the clitoris. The prostate remains in place and serves as an erogenous zone.
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Penile preservation vaginoplasty
Penile preservation vaginoplasty is when the surgeon creates a vaginal cavity between the scrotum and rectum while maintaining the function of the penis.
This type of procedure—sometimes called phallus-preserving vaginoplasty—is similar to the penile inversion vaginoplasty, except that the vagina is formed using a skin graft from non-genital tissue.
After the surgery, testosterone cream is applied to the penis to preserve its function during hormone therapy.
An intestinal vaginoplasty uses tissue from the colon or small intestine to form a vaginal cavity. Research is limited about the long-term outcomes of this procedure, so it’s not usually considered the best first option for gender affirmation surgeries.
What to expect during a vaginoplasty
Your healthcare team will help you prepare for your vaginoplasty surgical procedure with any necessary tests and discuss the potential risks. Here’s some of what you can expect.
Depending on the complexity of the repair, they may do the surgery with local or general anesthesia. With local anesthesia, you’ll be awake, but the area being operated upon will be numbed; with general anesthesia, you are put to sleep for the procedure. The surgeon may remove excess skin, loosen tissue, tighten tissue, or reduce the opening size of the vagina.
Gender affirmation surgery
Gender affirmation surgeries, like vaginoplasty, are considered major surgery and require a longer recovery period. All types of vaginoplasty are complex and usually take around 2–5 hours.
During the procedure, you’ll lie flat on your back with your feet in stirrups while under general anesthesia. A catheter will be placed in the urethra for urination for about four days after the procedure.
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Be sure to follow the post-procedure care instructions from your surgeon. The aftercare instructions may include recommendations like:
- Avoid strenuous activity for at least six weeks.
- Don’t submerge in water for at least eight weeks (i.e., take a bath or go swimming).
- Do not have sexual intercourse for at least three months.
- Consider using a sanitary pad as vaginal discharge or bleeding may happen for about 4–8 weeks following surgery.
- Ice for about 20 minutes at a time when needed.
- Sit on a donut ring to reduce pressure and promote comfort while healing.
- Avoid riding a bike for at least three months.
- Avoid tobacco products.
After your bandages come off, your provider will typically instruct you to use a vaginal dilator to maintain the depth and diameter of the vaginal cavity created during the gender affirmation surgery. Your surgeon will provide you with a schedule for using the dilator. Your schedule may vary, but it may look like this:
- 0–3 months post-op: 10 minutes, three times a day
- 3–6 months post-op: 10 minutes, once daily
- 6–12 months post-op: 2–3 times per week
Potential risks and complications of vaginoplasty
With any surgery, there are risks of developing complications. Vaginoplasty surgery complications are uncommon, but here are some potential problems that could develop after this procedure:
- Urinary retention
- Urinary incontinence
- Vaginal prolapse
- Skin or clitoral necrosis, meaning the skin cells die
Erogenous zones for women and men
When to contact your healthcare provider after surgery
Contact your healthcare provider if you experience any unusual symptoms or signs of infection after surgery, such as:
- Excessive bleeding
- Yellow or greenish colored discharge
- Severe pain
- Blood clots
- Severe nausea and vomiting
The cost of a vaginoplasty depends on the type of procedure and whether your insurance covers it. Whether or not insurance covers it often depends on whether your plan deems the surgery cosmetic or plastic surgery or classified as medically necessary.
A vaginoplasty for a vaginal repair could cost around $4,000–12,000, depending on where you live, your insurance, and the type of procedure you have. A vaginoplasty for gender affirmation surgery could cost between $20,000–$25,000, depending on several factors, including the type and extent of the procedure and more.
- Barbara, G., Facchin, F., Buggio, L., Alberico, D., Frattaruolo, M. P., & Kustermann, A. (2017). Vaginal rejuvenation: current perspectives. International Journal of Women’s Health, 9, 513–519. doi: 10.2147/IJWH.S99700. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560421/
- Bouman, M. B., van Zeijl, M. C., Buncamper, M. E., Meijerink, W. J., van Bodegraven, A. A., & Mullender, M. G. (2014). Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function. The Journal of Sexual Medicine, 11(7), 1835–1847. doi: 10.1111/jsm.12538. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24697986/
- Pariser, J. J. & Kim, N. (2019). Transgender vaginoplasty: techniques and outcomes. Translational Andrology and Urology, 8(3), 241–247. doi: 10.21037/tau.2019.06.03. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626315/
- van der Sluis, W. B., Bouman, M., Meijerink, W., Neefjes-Borst, E. A., & van Bodegraven, A. A. (2016). Refractory diversion neovaginitis in a sigmoid-colon-derived neovagina: clinical and histopathological considerations. Frontline Gastroenterology, 7(3), 227–230. doi: 10.1136/flgastro-2015-100602. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369504/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.