The most common vaginoplasty technique is some variation of the penile inversion procedure. In this technique, a vaginal vault is created between the rectum and the urethra, in the same location as a non-transgender female between the pelvic floor (Kegel) muscles, and the vaginal lining is created from penile skin. An orchiectomy is performed, the labia majora are created using scrotal skin, and the clitoris is created from a portion of the glans penis. The prostate is left in place to avoid complications such as incontinence and urethral strictures. Furthermore, the prostate has erogenous sensation and is the anatomic equivalent to the “g-spot.” Great care is taken to limit the external scars from a vaginoplasty by locating the incisions appropriately and with meticulous closure.
What is vaginoplasty?
Vaginal rejuvenation is a general term for procedures that can tighten vaginal muscles and structures. The goal is to improve vaginal health and function, and it can be done for cosmetic reasons or to treat age-related issues.
What are the different types of vaginoplasty?
There are two main surgical approaches for this gender affirming surgery.
Vaginoplasty
Vaginoplasty is a surgical procedure that tightens lax vaginal muscles to achieve a narrower and tighter vaginal canal and smaller opening. This procedure can help address vaginal widening caused by aging or childbirth, which can lead to reduced sexual pleasure. The procedure typically takes 60 minutes, can be performed under general or local anesthesia, and uses a laser device for precision and minimal incisions.
Vaginoplasty with Canal
Vaginoplasty, also known as full depth vaginoplasty, is a surgical procedure that creates a vaginal canal, enabling individuals to engage in receptive vaginal intercourse. This procedure involves constructing the outer vulva and a complete vaginal canal. To ensure a functioning vagina suitable for penetrative sex, dilation is necessary during the recovery process. There are two approaches to this surgery, one being penile inversion vaginoplasty, where surgeons utilize the skin surrounding the penis and scrotal skin to create the vaginal canal. In some cases, skin grafts from the abdomen or thigh may be required to construct a full vaginal canal.
Robotic-assisted peritoneal flap vaginoplasty is a newer surgical approach that utilizes a single-port robotic system to create a vaginal canal. This technique enables surgeons to access deep into the body through a small incision near the belly button, providing clearer visualization of the pelvis. The robotic system facilitates a more precise and shorter surgery, reducing the risk of complications. Additionally, this approach can create a full-depth vaginal canal regardless of the amount of preexisting tissue available. However, access to this procedure may be limited due to the requirement of a single-port robotic system, which not all surgical centers possess.
Robotic-assisted peritoneal flap vaginoplasty is a newer surgical approach that utilizes a single-port robotic system to create a vaginal canal. This technique enables surgeons to access deep into the body through a small incision near the belly button, providing clearer visualization of the pelvis. The robotic system facilitates a more precise and shorter surgery, reducing the risk of complications. Additionally, this approach can create a full-depth vaginal canal regardless of the amount of preexisting tissue available. However, access to this procedure may be limited due to the requirement of a single-port robotic system, which not all surgical centers possess.
Vulvoplasty
A specific type of vaginoplasty involves creating feminine external genitalia without forming a vaginal canal. This approach, known for its simplicity, results in a shorter operation and hospital stay, as well as a faster recovery. The procedure includes constructing the labia, clitoris, and vaginal opening. While it eliminates the possibility of receptive vaginal intercourse, it also reduces the risk of complications and doesn’t require hair removal or postoperative dilation.
Do I need to have hair removal before vaginoplasty? When should I start?
To achieve optimal results from vaginoplasty, permanent hair removal is recommended prior to surgery. This process, which can take three to six months, removes hair follicles to prevent regrowth. Early initiation of hair removal is advised, as it prepares the tissue used to create the internal vaginal canal. Failure to complete hair removal before surgery may result in residual hair within the canal after the procedure.
How long is vaginoplasty surgery?
Most vaginoplasty surgeries last between four and six hours. Recovery in the hospital takes three to five days.
Is vaginoplasty surgery painful?
Not at all. The vaginoplasty treatment is not painful, and our staff takes great care to help decrease anxiety and discomfort during surgery. Our patients describe feeling very comfortable and feeling only occasional pressure after receiving relaxing medications, long-lasting numbing medicine, and ProNox gas (relaxing laughing gas) during vaginoplasty surgery.
Recovery After Vaginoplasty
Following vaginoplasty surgery, hospital admission typically lasts one to five days for recovery and monitoring. The average recovery time is six to eight weeks, with proper home hygiene and postoperative care being crucial for a faster recovery. Patients are required to stay within a 90-minute drive of the hospital for four weeks post-surgery for follow-up care. Consistent daily dilation for the first three months is essential for optimal results. Before discharge, patients are taught how to use dilators, which are provided for at-home use.
What is dilation after vaginoplasty?
After vaginoplasty, dilation is a crucial part of the healing process. This involves inserting a medical-grade dilator into the vagina to maintain the vaginal canal’s openness during healing. A healthcare professional will provide guidance on dilation techniques and supply a set of dilators in varying sizes. Initially, dilation may be challenging, but with support and guidance, patients become accustomed to the process. The dilation routine typically begins with the smallest dilator, with gradual progression to larger sizes as cleared by the care team. During the initial post-operative period, dilation is required three times a day for at least 20 minutes to prevent loss of vaginal depth and width. Patients may need to continue dilation for an extended period, and in some cases, for their entire life, as recommended by their care team.
Is dilation after vaginoplasty painful?
Dilation should be a pain-free process, although some initial discomfort may occur as you learn the most comfortable angles and techniques for your body. If severe pain is experienced during dilation, stop immediately, adjust the dilator, and reposition your body for comfort. Using lubricant during dilation is also essential. For support, a pelvic floor therapist can work with you to help you become accustomed to dilation as part of your recovery.
Vaginoplasty Complications
- Bleeding
- Slow wound healing
- Narrowing of the vaginal canal (regular dilating as prescribed can lower this risk)
- A fistula (an abnormal connection between the new vagina and the rectum or bladder)
- Injury to the urethra, which may require surgery or a suprapubic catheter
- Rectal injury (very rare) may require a low-fiber diet, a colostomy or additional surgery.
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