Vaginoplasty is the construction or reconstruction of the vagina through skin inversion. In a male-to-female sex reassignment surgery, this procedure is used to change the male genital into a vagina not only for aesthetic purposes but also for function and sensation. Vaginoplasty aims to create a vagina that is flexible, hairless, secretory, and pink in color.
The procedure involves sculpting an artificial clitoris from the head of the penis. The erectile tissue and organs of the penis are removed, and the tissue is used to create the vaginal opening, labia, and the clitoris. For urination, the surgery leaves the urethra, and for clitoris sensation, the glans of the penis is retained.
Preparing For The Surgery
Being born a male may result in hairy donor areas for the skin graft. If you desire for a hairless vagina, you have the option of electrolysis to discourage the hair growth on your new vagina. The procedure may take several weeks or even months.
Make sure you religiously follow instructions from your surgeon before and after the surgery. You need to take an informed decision when it comes to the sex- reassignment procedure. Talk to your doctor about your fertility and future reproductive prospects.
What Happens During The Surgery
As with any surgery, you will be going through an overview of the procedure with your surgeon and anesthesiologist. It is usual for patients to experience anxiety and stress right before the surgery. Anti-anxiety medications and other sedatives can be taken to ease the tension.
This surgery entails handling delicate tissue and nerves which is complex. Your testicles will be removed, and a new vagina is created between your urethra and rectum. The skin pouch left after removing the penis is sutured and inverted. Clitoris will be carved from the tips of the penis, which is triangularly called glans penis. Your urethra and other parts of the penis are removed and prepared for positioning. The whole surgery will take two to five hours.
Procedures For Vaginoplasty Surgery
Penile Skin Inversion
This approach is referred to as the standard technique for MTF Vaginoplasty. It is usually done as a one-stage procedure including partial penectomy and orchiectomy which will incorporate dissection of penile dissection and creation of a vaginal cavity. If you have a sufficient amount of tissue left over to construct the clitoral hood and inner labia, your surgeon will include labiaplasty and clitoroplasty in the first stage itself. These are otherwise performed in a stage-two operation.
The creation of the vagina is performed by inverting the shaft of the penis which is used as the vaginal cavity lining. If you have insufficient tissue for the vaginal construction, your surgeon will harvest skin grafts from the scrotum (testicles) or your abdomen.
Sexual arousal may cause narrowing of your vagina and protrusion of the clitoris and urethra; this can be corrected by removing the erectile tissue.
To obtain a female urethra, your natural urethra will be shortened, and your urethral meatus relocated.
The tip of your penis-glans is left attached to its nerves and blood supply to be used to create the sensation of a clitoris. Further, the labia minora and Majora are constructed from your penile and scrotal skin.
Since a hormone therapy before any sex reassignment surgery is needed, the therapy usually withers the male prostate. The prostate gland is thus left untouched for future examination of the prostate via the vagina.
Vaginoplasty operation usually takes two to four hours. After the surgery, vaginal dilators are required to use for at least six months to maintain the diameter and the depth. Compared to other techniques, the penile inversion method is considered to have a lower risk of vaginal contraction.
Sigmoid Colon Vaginoplasty
Also known as Rectosigmoid Vaginoplasty is a method where a section of the sigmoid colon instead of the penile skin is used to create the lining in the vagina. This procedure often results in a well-lubricated and well-proportioned vagina which usually doesn’t require postoperative dilators. This technique is suited for patients with a short penis.
Your surgeon will harvest a section of sigmoid colon measuring three to four inches long for the pedicle flap through laparoscopy or incision through the abdomen. This is followed by connecting the sigmoid colon to the perineum using genital flaps.
The sigmoid colon Vaginoplasty is often combined with clitoroplasty, penectomy, labiaplasty, and orchiectomy depending on the requirements.
The section of the colon harvested is thick-walled and has a large diameter, which lowers the risk of bleeding after sex.
Vulvoplasty or Zero-depth Vaginoplasty
Vulvoplasty is chosen by patients who do not want penetrative intercourse or does not desire to maintain the dilation process that comes with Vaginoplasty. The candidates for this technique do not receive a vaginal canal.
This method removes the testicles, scrotum, and the penis, it carves the labia and clitoris, and it also repositions the urethra by shortening the urethral opening. In vulvoplasty instead of creating a vaginal canal, the surgeon will carve a small dimple less than an inch deep where the vagina is placed.
In appearance and function, this method will give the same result except for the absence of a vaginal canal. This procedure is chosen for its low risk on the structure of the rectum.
If you develop the desire to have Vaginoplasty, the vulvoplasty surgery can be converted to a full-depth Vaginoplasty by using skin grafts or sigmoid colon.
Urethroplasty is the surgical creation of the female urethra in the male body. Other reasons for urethroplasty would be for urethral stricture treatment or fixing a urethral fistula.
Complications And Risks
Vaginoplasty carries general surgery risks such as infection of the incision area, hemorrhage, and reaction to anesthesia. Scarring will result from incisions and cuts which will prevent you from having future corrective surgeries. Blood clots may form deep vein thrombosis. Besides the general risks, few complications may follow a Vaginoplasty surgery.
- A common risk is vaginal stenosis (narrowing or flexibility loss of the vagina). This will affect sexual intercourse.
- While dissecting the tissues in the pelvic area, nerves surrounding the perineal area may get damaged causing hypoesthesia or dysesthesia. This will result in chronic pain.
- Dissatisfaction with the outcome may be because of narrowness or excessive laxity of the vagina. While a narrow opening may interfere during penetrative sex, the stretchy walls will be disappointing in the aesthetic sense.
- Activity: Avoid heavy exercise and strenuous work for at least six weeks. Avoid cycling and swimming for three months.
- Sitting: For the first month sitting will be uncomfortable. You can use a donut ring for sitting.
- Swelling: Applying ice on the swell for twenty minutes can offer some relief to the swollen area.
- Sex: Depending on your doctor’s instruction, you can have sexual intercourse three months after the surgery.
- Diet: After the surgery, it is advisable to begin your diet with liquids. Nausea and constipation can be eased with medication.
- Pain: Experiencing pain after the operation is regular and can be relieved with prescription medication.
- Dilation: Except for vulvaplasty, other procedures will demand a long-term dilation period to maintain the diameter of your neovagina for which dilators will be provided.
Can I have children after a Vaginoplasty?
A: No, you will not be able to conceive after a Vaginoplasty. This surgery is mainly to obtain a natural looking vagina, but to have a child you also need an uterus, eggs cells, ovaries,… which is impossible at this time.
Does the surgery create a vaginal cavity?
A: Depending on your choice and your doctor’s consent, the creation of a vaginal cavity will vary depending on the procedure you decide.
Will the length of my penis determine the depth of my vaginal cavity?
A: Having a large penis will mean there is sufficient skin to cover the vaginal cavity completely. However, insufficiency of skin from a short penis will call for skin grafting from other donor areas to create a satisfactory vaginal cavity depth.
Will a circumcised penis affect the surgery?
A: Circumcision of the penis will not affect the surgery whatsoever.
When will I begin to feel the sensation in my clitoris?
A: In about eight weeks, you can begin to feel your clitoris simulation. After the surgery, your nerves are disturbed diminishing the sensation. With constant touch and massaging, your nerve endings should be connected for arousal.
When can I start having penetrative sexual intercourse?
A: Normally, you will be advised to wait for at least three to four weeks before engaging in any form of sex, be it oral or penetration in the vagina or anus. Initially, you will experience pain in your pelvic region as long as it involves straining your pelvic muscles.
Will my vaginal cavity tear on having sex after the surgery?
A: After complete recovery, your vaginal cavity will not tear on having penetrative sex.
Can I remove my pubic hair after the surgery by shaving, electrolysis, hair removing cream, or laser?
A: After six weeks, your wounds are expected to heal which means you can start shaving or use hair removal creams. Using a laser to remove pubic hair should be done at least eight weeks after the surgery