For transgender, non-binary people, and gender non-conforming folks who want to undergo gender confirmation surgery, many will pursue a vaginoplasty. A vaginoplasty is when surgeons construct a vaginal cavity between the urethra and the rectum. In essence, vaginoplasty aims to create a vagina out of penile tissue. It also intends to have the depth and appearance of a biological vagina.
What Happens During a Vaginoplasty?
On the day of your surgery, you will meet with your surgeon and an anesthesiologist, who will provide an overview of what the day should look like. They may also give you an anti-anxiety medication or a sedative if you are feeling nervous. They will then take you to the operating room.
During your penile inversion vaginoplasty, they will put you under general anesthesia. You will be put in a position where you are lying on your back with your legs held in stirrups.
Vaginoplasty is a complex procedure since it involves delicate tissue and nerve fibers.
Here is how the procedure is performed:
- They remove the testicles and discard them.
- The new vaginal cavity is then carved out in between the urethra and rectum.
- A penile prosthesis is placed into the cavity and will then hold the shape.
- The penis skin is then removed and forms a sutured and inverted pouch.
- A triangular piece of the glans penis is removed and becomes the clitoris.
- The urethra is shortened, removed, and is ready to be repositioned before the other parts of the penis are amputated and thrown out.
After that, everything is sutured back together, and your team will apply the bandages. The bandages and a catheter will remain for four days.
Risks of Vaginoplasty
The risks of vaginoplasty include:
- Changes in the sensation that are permanent
- Chronic pain
For those considering vaginal surgery, it is best to discuss your questions and concerns with your doctor. You can talk about your feelings about your genitals and any other expectations for the procedure. Some surgeons may even have non-surgical options for you. For instance, targeted Kegel-like exercises can tone loose and delicate vaginal muscles. As a result, it can enhance sexual arousal. Also, your doctor may recommend counseling as it can help with issues of sexual self-esteem.
How many stages are there during the procedure?
Vaginoplasty is generally one stage. Later on, your doctor may recommend revisions to enhance aesthetic appearance; however, insurance does not often cover these revisions.
How long is the procedure?
Most vaginoplasty procedures are between seven to ten hours.
How long is the recovery period for surgery?
It takes approximately six to eight weeks for the recovery process. Each patient has a different recovery time; however, at-home hygiene and post-operative care are imperative as they will help accelerate the healing process.
Will the vaginoplasty be sexually functional?
Yes, a vaginoplasty is sexually functional. You can expect that 12-weeks following surgery that the vagina can be used for receptive intercourse. In addition, you may be able to feel sensations in the clitoris.
When can I start engaging in other types of sexual activity post-surgery?
It is important that you abstain from any type of sexual activity for 12 weeks following surgery. This is because sexual activity during the recovery period can make wound healing take longer and create various complications.
When will the sensation come back?
Every patient is unique in their recovery and is different when experiencing sensation coming back. Nerve regeneration can start as early as three weeks following surgery. However, sometimes it can take all the way up to a year or longer for the sensation to return. Sometimes, there are no guarantees for nerve sensation coming back.
When it does come back, it feels like a shooting/spark sensation as the nerves regenerate and build stronger connections. After some time, this type of tingling feeling will start to dissipate.
How will my vaginoplasty be impacted if my testicles are already removed?
Some patients have already undergone an orchiectomy, aka having their testicles removed before their vaginoplasty. However, this procedure is not required before a vaginoplasty. In fact, an orchiectomy can increase the chances of requiring skin grafts.
Is hair removal necessary, and when should this process start?
Yes, it is necessary to engage in hair removal before the surgery. Your surgeon will give you a template during your consultation that describes the areas that will need hair removal. Be sure to start the hair removal as soon you can since it can take three to six months.
What average depth of my vagina can I expect?
Vaginal depth depends on how much skin you have in the genital area before your vaginoplasty. Since every patient is different, some of them will require skin grafts. For an approximate number, the vaginal canal is generally between four to six inches deep.
How long will I be in the hospital?
After you have your vaginoplasty, you can expect to stay in the hospital for about five to six days. During that period, you will spend the majority of your time in bed recovering. When it gets closer to the time where you will be discharged, you will start sitting and walking around.
Will there be a catheter during the procedure and surgical drains?
During your inpatient stay, a catheter will be placed in the urethra. This catheter will be taken out before you are discharged.
You will also have a surgical drain that is put in while you’re in the operating room. Your medical team will remove this drain before you are discharged.