A vaginoplasty is a surgical procedure where a vagina is created. It involves removing the penis, as well as the testicles and scrotum, if an orchiectomy was not previously performed. A vaginoplasty involves rearranging the current tissue in the genital area to create the vaginal canal and external genitalia, the labia. To create the vaginal canal, the surgeon uses a combination of the skin surrounding the existing penis in addition to the scrotal skin. Sometimes, an additional skin graft from the abdomen or thigh is needed to achieve a full vaginal canal.
What determines if an extra skin graft is needed?
An extra skin graft may be needed depending on how much existing skin is in the current genital area.
How many stages is the procedure?
Vaginoplasty is typically a one stage procedure. Revisions can be done later to increase aesthetic appearance, but they are not typically covered by insurance.
Vaginoplasty Procedure (Slideshow)
Vaginoplasty Procedure (Slideshow)
How long is the surgery?
Most surgeries last between 7-10 hours.
How long does it take to recover from surgery?
On average, it can take 6-8 weeks to recover. Every patient’s recovery is different, but emphasis on home hygiene and post-operative care will help to speed up your recovery.
Is the vaginoplasty sexually functional?
Yes. 12-weeks after surgery, the vagina can be used for receptive intercourse. Additionally, the clitoris may have sensation.
When can I begin engaging in other forms of sexual activity after surgery?
You must abstain from any form of sexual activity for 12 weeks after surgery. Sexual activity during your recovery period can delay wound healing and cause a variety of complications.
How long does it take for sensation to come back?
Every patient has a different experience when it comes to sensation. Nerve regeneration can begin as early as 3 weeks post-operatively. Sometimes sensation can take up to a year or longer. We cannot guarantee return of nerve sensation. It typically begins as a shooting/spark feeling as your nerves regenerate and build stronger connections. As time goes on, the tingling feeling may begin to subside.
How will my vaginoplasty be affected if I already had my testicles removed?
Some patients have already had their testicles removed (orchiectomy) prior to vaginoplasty; it is important to note this is not required. This prior surgery can increase the likelihood of needing skin grafts.
Do I need to do hair removal? When should I start?
Yes, you will need to engage in hair removal prior to surgery. We will provide you with a template during your consultation for the areas that require hair removal. We recommend you start hair removal as soon as possible, as it can take 3-6 months on average.
What will be the average depth of my vagina?
Vaginal depth is dependent on the amount of skin in the genital area prior to your vaginoplasty. This can vary between patients, as some patients also need skin grafts. On average, the vaginal canal is between 4-6 inches deep.
How long will I be in the hospital?
After your vaginoplasty, expect to be in the hospital for approximately 5-6 days. During that time, you will be spending most of your time in bed recovering. As you get closer to discharge you will begin sitting and walking around.
Will I have a catheter?
During your inpatient stay, you will have a Foley catheter in the urethra that will be taken out prior to your discharge.
Will I have surgical drains?
Yes, you will have a surgical drain that is placed in the operating room. This drain will be removed prior to your discharge.
What is dilation?
Dilation is the act of inserting a medical grade dilator into the vagina to keep your vaginal canal open. The hospital provides and bills your insurance company for a set of dilators that will be provided for you.
Who teaches me how to dilate?
On your last day in the hospital, someone from the clinical team will show you how to dilate. This can often be an overwhelming first time experience, but our team will work with you and your level of comfort to ensure that the dilation process goes smoothly.
How often do I have to dilate?
During the first few weeks after surgery, you must dilate twice a day for at least 15 minutes. It is very important that you continue dilating, especially during your immediate post-operative period, or you may potentially lose vaginal depth and width.
What size dilator do I use?
You will begin dilating with the small orange dilator, the smallest within the dilator pack. You will continue to use this dilator until cleared by your care team.
Is dilation painful?
Dilation should not be a painful process. As you begin the process, you may feel discomfort as you learn the best angles and techniques that are unique to your body. If you feel severe pain at any time during dilation, it is important to stop, readjust the dilator, and readjust your body to alleviate your pain. It is also important to use lubricant when you dilate.
What type of hygiene is required after vaginoplasty?
Starting 8 days after surgery, you will begin douching. When douching, you must use a non-scented vaginal douche. You should douche 1-2 times per week, or sometimes more, depending on the amount of vaginal discharge you are experiencing. If you notice you are having a lot of vaginal discharge, you can increase your douching schedule.
It is also very important to keep the external vagina dry. If the area is looking very red and wet, like you were soaking in a tub too long, you need to focus on keeping the area dry. You can place an absorptive pad between the labia to wick away excess moisture.
Can I shower after surgery?
Yes. It is very important to clean the area to prevent infections. You can gently wash the area with soap and water. Never scrub or allow water to be sprayed directly at the surgical site.
Is going to the bathroom different?
It is important to remember for the rest of your life that when wiping with toilet paper or washing the genital area, always wipe front to back. This helps keep your vagina clean and prevents infection from the anal region. Additionally, you may experience “urinary spraying” – this is common. As you recover, you may be referred to our partner in the Physical Therapy department where they will help you work on pelvic floor strengthening, which may help improve this over time.
How long do I need to stay in town after surgery?
After you are discharged from the hospital, we ask that you stay in town for at least 4 weeks. You will have weekly and biweekly appointments to check the status of how you are doing after surgery. It is also important to be nearby so that if a problem arises, you can quickly get in contact with us.
To schedule intake...
To schedule consult...
We need 1 mental health letter and any other information asked for after your intake. You can refer to the communication from our team in MyChart for more information.
To schedule surgery...
We will need:
- 2 mental health letters
- 12 months hormone therapy records
- Hair removal completed
- Any other information that was asked for at the consult. You can refer to the communication from our team in MyChart for more information.
Will be scheduled at the time your surgery date is finalized. If you have any questions, please reach out to our team through MyChart.