Vaginectomy is a type of bottom surgery for female-to-male sex reassignment. It involves the surgical removal and closing of the vagina. Sometimes there is a partial opening in the vaginal mouth for the dissemination of menses if the uterus and ovaries are still intact.

This surgery involves two steps:

1. Colpectomy (removal of the vaginal mucosal lining)
2. Colpocleisis (suturing the vaginal openings to create support for the artificial male organs)

Vaginectomy is generally combined with metoidioplasty, breast surgery or hysterectomy.

Types of Vaginectomies

• Total Vaginectomy: This is a surgery that obliterates the vagina which may require a combined operation with radical Wertheim hysterectomy and total abdominal hysterectomy.
• Partial Vaginectomy: Mostly performed by removing a part of the vagina in cases of vaginal cancer
• Radical Vaginectomy: Removal of the vagina as well as the tissues surrounding the vaginal walls

Reasons why trans men undergo vaginectomy

The most common goal for a vaginectomy is to eliminate the female organs and have male genitals instead. After a vaginectomy, you will not need to go for pap tests and speculum exams. It is known that this surgery decreases the risk of urethroplasty.

The surgical procedure

A vaginectomy surgery is performed under general anesthesia. An incision is made around the vagina, deepening the cut through the pubocervical fascia. Using an excision or cautery laser, the surgeon removes the vaginal mucosa lining. The vaginal walls are then sutured or stitched together; this procedure is called perineoplasty. Meticulous care is taken not to injure the blood vessels in the surrounding area.

After obliterating the whole vagina or a partial area, it is removed without wounding the parts nearby. Vaginectomy is also combined with metoidioplasty, phalloplasty, or hysterectomy.

Recovery after vaginectomy

The recovery time of vaginectomy will depend on whether it was done as a standalone surgery or combined with other surgeries.  You will need to stay in the hospital for at least a week. You should be able to return to normal activities and resume your work after two weeks as the pain reduces. But you should avoid heavy lifting and stressful activities.

Your doctor might give restrictions based on activities like heavy exercises, cycling, swimming, and sexual activities. Initial pain will be normal, but if the pain and discomfort prolongs, consultation with your doctor is highly advised.

How safe is vaginectomy?

Vaginectomy has been considered a risky surgery citing the risk of excessive bleeding and ruptured bladder during operation. You may come across surgeons who are reluctant to perform this surgery and even discourage their patients from undergoing this surgery.

Some specialized surgeons have performed vaginectomy with successful results. Go to such medical expertise if at all you decide to go for vaginectomy for your sex reassignment.

Every surgery has risks to some extent, and the good news is, with vaginectomy the complications are not many and easy to handle. Most patients get satisfactory results regarding appearance, sensation, and orgasm.

Does vaginectomy reduce the risks of urethral lengthening?

Going for urethral lengthening after a vaginectomy has low rates of complications. Vaginectomy surgery closes the vaginal walls which stop vaginal secretion and improve the blood flow to the urethra. This makes quickens the healing in the urethral area after a urethral lengthening.

References:

https://www.metoidioplasty.net/procedures/ftm-vaginectomy.htm

http://marcibowers.com/ftm/ftm-services/vaginectomy/