Vulvoplasty is a gender-affirming surgery for the lower body (bottom surgery). During the procedure, a surgeon will create the vulva (including the mons, labia, clitoris, and urethral opening) and remove the penis, scrotum, and testicles.

What Are the Steps of a Vulvoplasty?

The steps of a vulvoplasty follow the same ones as a vaginoplasty. So here is what you can expect during your surgery:

• Creation of a clitoris out of the glans or head of the penis.
• An inner and outer labia will be designed from the skin on the penis and scrotum.
• There will be an opening of the urethra created so you can urinate, as well as the introitus (vaginal opening).

What Is the Difference Between a Vulvoplasty and Vaginoplasty?

The only significant difference between a full vaginoplasty and a vulvoplasty is that there is no creation of a vaginal canal with a vulvoplasty, whereas one is made during a vaginoplasty. 

After the vulvoplasty procedure, you will not be able to engage in intercourse or have a penis inserted into your vagina.

Is Vulvoplasty the Correct Term?

Vulvoplasty is known by other names, most commonly as Zero Depth Vaginoplasty, Shallow Depth Vaginoplasty, and Limit Depth Vaginoplasty. It is also known as Cosmetic Vaginoplasty; No Cavity SRS, and Partial SRS.

Patients can agree to a suitable term in conversation with their medical provider. When speaking with their patients, the terminology used by surgeons is essential and should always be gender-affirming and culturally sensitive. However, some surgeons do not agree on the terminology for Vulvoplasty. According to Jiang et al:

“Gender-affirming vulvoplasty” is the authors preferred term to describe gender-affirming surgery that creates the vulva (including the clitoris, labia majora and labia minora, and female urethral position) without creation of a vaginal canal. We prefer “vulvoplasty” over other terms in common use, such as “zero depth” or “cosmetic” Vaginoplasty, as it more accurately reflects the anatomic intent of a surgery for which the goal is to form a vulva without creating a vagina.”

In addition, Garcia, et. al state:

“Various terms exist for Vaginoplasty without creation of a vaginal canal, including partial Vaginoplasty and vulvaplasty. These are technical, anatomic terms that are not part of lay language. The author believes that the use of such terms is purely academic and for patients, creates a false dichotomy. Such terms suggest that a patient is not undergoing creation of a “real vagina,” which itself can create dysphoria for patients.

While the term ‘zero-depth vaginoplasty’ is technically an accurate term for a neovagina without a true canal, the author has moved away from this term and instead now uses ‘shallow depth vaginoplasty.’ The decision to adopt the term ‘shallow-depth’ was based on feedback from a small subset of patients who found ‘shallow depth’ to be a more normalizing term than ‘zero depth.'” 

Is a Vulvoplasty the Right Fit for Me?

A vulvoplasty is a suitable option for the following patients:

• Those who are not interested in having penetrative vaginal sex.
• People who are concerned about their age and the recovery time.
• Folks who do not want to deal with a lifelong regiment of dilation required for a vaginoplasty. 
• Those who identify as non-binary and believe that a Vulvoplasty is more affirming for their gender.
• Patients are exposed to higher risks like previous radical prostatectomy, pelvic radiation, significant rectal injury, congestive heart failure, mental health conditions, or cannot perform self-care. 
• People who have concerns about timing, like impending loss of health insurance, wanting to have their surgery sooner since Vaginoplasty can be a long waiting list or hair removal needs since a Vulvoplasty doesn’t require this step.
• Folks who do not have insurance and are paying out of their own pocket for surgery, since vulvoplasty costs are less.
•  If you relate to any of the above points, then vulvoplasty may be a preferable option for you. Be sure to discuss all your options, questions, and concerns with your surgeon. 

When it comes to bottom surgery, making the right decision for you is essential. Vulvoplasty is a valid option over Vaginoplasty for many individuals. Even though it doesn’t involve creating a vaginal canal, it can result in aesthetically pleasing female genitalia that can be quite gender-affirming.

Every person is unique in their transition journey, and there is no single way to medical transition. However, Vulvoplasty is one option worth considering for those curious about bottom surgery or wanting to seek it out. 

Other Benefits  

Vulvoplasty provides patients with the option to urinate sitting down and no longer having to “tuck” their genitals. It can also result in people stopping or minimizing taking testosterone blockers or their estrogen doses.

What Is the Outcome of a Vulvoplasty?

Even though more studies need to be performed, vulvoplasty has been reported as having a high satisfaction rate. According to a 2018 study, 93% of respondents were satisfied with their procedure and with their decision to undergo it. If a patient later would prefer a vaginoplasty, a vulvoplasty can be converted to full depth Vaginoplasty. This can be done with a skilled surgeon who will use skin grafts or a section of the sigmoid colon.