For Trans Women

For transgender women and nonbinary feminine individuals who have undergone vaginoplasty, a neovagina is a life-affirming part of their gender journey.

While a neovagina can bring immense joy and alignment with one’s gender identity, it also requires care and attention to maintain its health.

Since neovaginas are created through surgical techniques, they differ from natal vaginas in structure and function, including a unique neovaginal microbiome, which means unique challenges can arise.

Common issues affecting neovaginas include dilation to maintain depth and width, lubrication concerns due to the absence of natural glandular secretions, and an increased risk of infections or scarring if proper hygiene is not observed.

Additionally, understanding how to manage sensitivity, discomfort, or other physical changes over time is crucial to ensuring a comfortable and fulfilling relationship with your body.

Here you can explore the main health considerations for neovaginas, including tips for care, potential complications, and when to seek medical advice.

Whether you’ve recently had surgery or are years post-op, understanding these issues can empower you to maintain your neovaginal health and enjoy a positive, affirming connection with your body.

A neovagina is a surgically constructed vaginal canal designed to align the anatomy of transgender women with their gender identity. It is created through a procedure called vaginoplasty, which transforms existing genital tissue into a functional and aesthetically feminine vaginal structure.

This life-affirming surgery provides a physical alignment that helps reduce gender dysphoria, enabling many transgender women to live more comfortably in their bodies and engage in various forms of intimacy if desired.

What does a neovagina include?

A neovagina typically includes a vaginal canal, clitoris, labia majora, and labia minora, carefully designed to look and feel like natural female genitalia.

How is a neovagina created?

The most common technique for creating a neovagina is penile inversion vaginoplasty. In this procedure, the skin of the penis is inverted and used to form the walls of the vaginal canal.

The head of the penis (glans) is reshaped into a clitoris, preserving its sensitivity for sexual pleasure. Scrotal tissue is often used to create the labia majora, while other tissues from the genital area contribute to forming the labia minora.

If additional depth is required for the vaginal canal, grafts from other parts of the body, such as the inner thigh or lower abdomen, or segments of the intestine (in bowel vaginoplasty), may be utilised.

The creation of a neovagina is a complex and personalised surgery requiring skillful planning and precise execution by experienced surgeons.

Recovering from vaginoplasty surgery

Recovery of vaginoplasty involves close monitoring, regular follow-ups, and ongoing self-care, including dilation to maintain the canal’s depth and width.

With advancements in surgical techniques and postoperative care, many transgender women experience highly satisfying outcomes, both functionally and aesthetically, with a neovagina that supports their physical and emotional well-being.

A vulvoplasty is a gender-affirming surgical procedure that creates external female genitalia, such as the clitoris, labia majora, and labia minora, without constructing a vaginal canal.

This surgery is an option for transgender women who do not require or desire a vaginal canal for penetrative intercourse, offering a less invasive alternative to vaginoplasty.

By eliminating male genital anatomy and reshaping the external genitals, vulvoplasty helps many transgender women align their physical appearance with their gender identity, reducing gender dysphoria and improving overall comfort and confidence.

How is a vulvoplasty performed?

During a vulvoplasty, the surgeon uses existing genital tissue to sculpt the external vulva. The glans of the penis is preserved and reshaped into a clitoris to maintain sexual sensitivity.

The scrotal tissue is typically repurposed to form the labia majora, while penile and other genital tissues are used to create the labia minora and mons pubis.The urethra is also shortened to allow for seated urination.

While the vulvoplasty does not include a vaginal canal, the external appearance is carefully designed to resemble natural female genitalia, meeting the aesthetic goals of the patient.

Recovering from a vulvoplasty

Because vulvoplasty is less invasive than vaginoplasty, it carries a lower risk of complications and requires less intensive aftercare. Patients do not need to perform lifelong dilation, which is necessary to maintain the depth of a neovagina after vaginoplasty.

Recovery from vulvoplasty is typically quicker, with swelling and healing completing within a few months.

For transgender women who prioritize external aesthetics over functionality or who have health concerns that make vaginoplasty more challenging, vulvoplasty provides a highly effective and satisfying option for gender affirmation.

The neovaginal microbiome presents a unique and complex bacterial environment shaped by the surgical creation of a neovagina, which involves penile inversion, scrotal grafts, or sigmoid colon grafts.

Unlike cis women’s vaginal microbiomes, which are dominated by Lactobacillus species that maintain a protective acidic environment, neovaginal microbiomes display greater bacterial diversity.

This diversity arises from the interplay between penile, scrotal, and, in some cases, intestinal tissue microbiomes, combined with hormonal, mechanical, and environmental changes following surgery.

Neovaginas often feature anaerobic bacteria like Porphyromonas, Prevotella, and Peptostreptococcus, which are associated with bacterial vaginosis (BV) in cis women. Additionally, unique species such as Eikenella and Anaeroglobus, potentially introduced through oral-genital contact or tissue origins, are also observed.

While the diversity is intriguing, it may contribute to inflammation, immune challenges, and a higher susceptibility to infections compared to the typical vaginal environment.

Immune and inflammatory responses in neovaginas reveal significant differences compared to cis women’s vaginas. Protein analysis shows neovaginas have decreased keratinisation and reduced barrier function, likely due to the lack of estrogen-driven maintenance of the tissue.This can lead to compromised structural integrity, increasing the risk of tearing, irritation, and infections.

Furthermore, antimicrobial proteins such as lipocalin-2, which regulate microbial inflammation, are diminished in neovaginas. This deficit may exacerbate microbial-driven inflammation and compromise the immune response.

Unique microbial functions, such as vitamin B6 metabolism by neovaginal bacteria, are associated with inflammation and immune system inefficiencies, potentially worsening the neovagina’s vulnerability to infections and irritation.

The findings suggest that neovaginas are more similar to polymicrobial or BV-like environments in cis women than the Lactobacillus-dominated microbiomes typical of cis vaginal health.

These differences underscore the importance of tailored care for neovaginal health, including potential hormonal supplementation to support barrier function and targeted strategies to mitigate bacterial overgrowth or inflammation.