Reviewed By: Pramod Kerkar, MD, FFARCSI

A vaginoplasty is a surgical procedure where surgeons construct a vaginal cavity between the urethra and the rectum. Vaginoplasty surgery is ideal for nonbinary people or transgenders who are interested in gender confirmation surgery. The purpose of a vaginoplasty is to create a vagina that has both depth and also the appearance of a biologically developed vagina. The vagina is created out of the penile tissue. The surgery is becoming more common these days and there are very few complications and risks associated with a vaginoplasty.

What is Vaginoplasty?

A posterior colporrhaphy, commonly known as vaginoplasty, is a surgical procedure that is used for tightening of the vagina as well as for constructing a vaginal cavity out of the penile tissue. The vaginal cavity is created between the urethra and rectum and it carries the appearance of a biologically developed vagina, also having natural depth. There are many techniques that are used in performing vaginoplasty. Let us take a look at its cost, some of the commonly-used vaginoplasty procedures, complications and recovery.

Is Vaginoplasty An Expensive Surgery?

Vaginoplasty is not a cheap surgery. The average cost for a penile inversion technique comes to around US Dollars 20,000, if you don't have insurance. If you have a second surgery, a labiaplasty, then the cost will go up. The cost of the vaginoplasty surgery also depends on your insurance coverage, the area where you live, and where you get your surgery done.

What are the Different Vaginoplasty Techniques?

Vaginoplasty-Penile Inversion Technique

A penile inversion technique is the most commonly-used vaginoplasty technique. The penile skin is used in this procedure for constructing the lining of the vagina. Surgeons create the labia majora using scrotal skin and the clitoris is built from the skin at the tip of the penis, which is known for being particularly sensitive. The surgeons leave the prostate in place to serve as an erogenous spot. In cases where sufficient skin is not available to achieve the required vaginal depth, a skin graft from the upper hip, inner thigh, or even the lower abdomen is taken to leave minimal scarring.

One of the controversies surrounding the penile inversion technique is related to the use of skin grafting for building the vulva. Some plastic surgeons believe that extra skin will allow for better cosmetic appearance, while others are of the opinion that functionality is more important and cannot be sacrificed. This controversy is because of the fact that skin is taken from the donation site never has the same sensitivity as compared to the skin from the genitalia region.

This technique of vaginoplasty is considered to be the gold standard in genital reconstruction amongst plastic surgeons and is also recommended by many organizations associated with transgender healthy.

Vaginoplasty-Colon Technique

This technique of vaginoplasty makes use of the lining of the colon rather than using the penile skin. There is limited research available on the outcome of this surgery. Many surgeons believe that this vaginoplasty procedure is preferred because the colon tissue is self-lubricating, while vaginas that are created from penile tissue need artificial lubrication. However, the biggest drawback to this vaginoplasty technique is that due to the associated risks in this technique, colon tissue is only used in the case of a failed penile inversion procedure.

Using the colon technique, many people who have had a vaginoplasty often end up requiring a second surgery for improving the appearance of the labia. This surgery is known as labiaplasty, and it allows surgeons to work with the now-healed tissue so that the positioning of the vaginal lips and the urethra can be corrected.

How Does a Vaginoplasty Work?

During the penile inversion vaginoplasty technique, you need to be under general anesthesia and have your legs in the stirrups as you lie down. The vaginoplasty procedure is somewhat complex as it involves delicate tissues, nerve fibers, and vasculature. Let us broadly look at what the vaginoplasty process entails:

  • To begin with, the testicles are removed and discarded.
  • Surgeons carve out the new vaginal cavity between the rectum and the urethra.
  • A penile prosthesis, commonly known as a surgical dildo, is then inserted into the newly constructed vaginal cavity to maintain the shape.
  • Skin is removed from the penis and then made to form a pouch, which is then sutured and inverted, thus the name penile inversion technique.
  • A triangular piece of the glans penis is removed to shape and build the clitoris.
  • The urethra is removed, then shortened and prepared for repositioning.
  • The remaining parts of the penis are amputated and discarded.

After these procedures, everything is sutured together and bandaged up. The entire vaginoplasty surgery takes two to five hours, depending on how much work is required. The bandages and a catheter remain in place for almost a week, during which time post-operate care has to be followed diligently.

What are the Complications and Risks Associated with Vaginoplasty?

Complications with vaginoplasty are rare and if any infection arises, it can easily get cleared up by using antibiotics. Some of the post-surgical risks associated with vaginoplasty include:

  • Infection.
  • Bleeding.
  • Necrosis of the skin or clitoris.
  • Rupturing of the sutures.
  • Vaginal prolapse.
  • Fistulas.
  • Urinary retention.

Recovery and Post-Surgical Care in Vaginoplasty

It is important that you follow all postoperative instructions properly in order to ensure the success of your vaginoplasty. Once your bandages are removed, your doctor will give you a vaginal dilator that you will have to use daily for nearly a year to make ensure that the desired vaginal depth and girth is maintained after the surgery. Usually, the dilation schedule involves inserting the dilator for 10-15 minutes and using it up to three times a day for the first three months following surgery. It is then reduced to being used once a day for the next three months. After this period, you will need to use the dilator two to three times a week for up to a year.

Some of the required vaginoplasty after care you need to follow include:

  • Do not indulge in strenuous activities for up to six weeks post vaginoplasty.
  • Don't take a bath or allow water to enter the vagina for up to eight weeks after vaginoplasty.
  • Avoid sexual contact for three to four months post vaginoplasty.
  • Apply ice for 20 minutes every hour during the first week of the vaginoplasty surgery.
  • Avoid using tobacco products for up to a month after the vaginoplasty surgery.
  • Expect some vaginal discharge and bleeding for six to eight weeks after vaginoplasty.

Keep consulting your doctor to make sure that you are taking the proper precautions and aftercare post vaginoplasty.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: July 20, 2018

This article does not provide medical advice. See disclaimer

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