Vaginoplasty refers to a group of surgical procedures designed to construct, reconstruct, or repair the vagina and its related structures. These surgeries serve a range of purposes, from addressing congenital conditions to repairing trauma or damage caused by cancer treatments, and for some, as part of gender-affirming care.
Vaginoplasty is highly individualised, with techniques tailored to the patient’s specific needs and goals. Whether performed for medical, reconstructive, or affirming purposes, these procedures aim to create or restore a functional and often aesthetically aligned vaginal structure.
What is a vaginoplasty procedure?
The term “vaginoplasty” can encompass a wide variety of procedures. For those born with congenital conditions like congenital adrenal hyperplasia or Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, surgery may be necessary to create or reconstruct a functional vagina.
Individuals with these conditions may experience an absence of a vaginal canal, requiring surgical intervention to enable menstruation, sexual function, or both.
Reconstructive vaginoplasty is also a vital procedure for individuals who have experienced trauma, undergone cancer treatments, or been affected by radiation therapy, which can cause destruction or alteration of vaginal tissues.
In these cases, vaginoplasty restores the vagina’s form and function, allowing for improved quality of life and, in some cases, restored sexual health.
The neovagina – gender-affirming surgery
For transgender women and some nonbinary individuals, vaginoplasty is a cornerstone of gender-affirming care. This procedure involves creating a neovagina that aligns with their gender identity.
The surgery is not merely physical but also deeply affirming, offering a sense of congruence between one’s body and identity.
Techniques used in gender-affirming vaginoplasty are designed to create a functional and sensitive vaginal structure. Surgical outcomes often include the ability to engage in penetrative sexual activity, the formation of a clitoris for sexual sensation, and an external vulva that reflects feminine anatomy.
For many, this surgery provides profound psychological and emotional benefits.
Surgical techniques used in vaginoplasty
The surgical techniques used in vaginoplasty vary widely based on individual circumstances.
Surgical techniques for gender-affirming neovagina surgery
Penile inversion vaginoplasty is a common method for gender-affirming surgeries, where the penile skin is inverted to form the vaginal canal of the neovagina.
Additional tissue, such as scrotal skin or grafts from other parts of the body, may be used to enhance depth and width. This technique often includes the creation of a clitoris from the glans penis, preserving sensitivity and allowing for sexual pleasure.
In cases where there is insufficient tissue, bowel vaginoplasty may be performed, using a segment of the large or small intestine to form the vaginal canal. This approach often results in a naturally lubricated neovagina due to the mucus-producing properties of intestinal tissue.
Vaginoplasty techniques for trauma or congenital conditions
For patients undergoing vaginoplasty due to congenital conditions or trauma, techniques like the McIndoe procedure are commonly employed. This involves surgically creating a vaginal canal between the bladder and rectum, often using a skin graft taken from the thigh, buttocks, or inguinal region.
The graft is shaped and inserted into the newly formed canal, allowing the tissue to heal and integrate. In some cases, alternative materials like amniotic membranes or buccal mucosa are used to line the canal. These methods aim to restore normal anatomy and function while minimising complications.
Post-surgery care and dilation
Postoperative care is a critical aspect of vaginoplasty, regardless of the technique used. Dilation is often required to maintain the depth and width of the vaginal canal, particularly in cases where the body might otherwise heal by closing the space.
This involves using medical dilators to gently stretch the vaginal tissues on a regular schedule, with frequency decreasing over time.
Skipping dilation can lead to narrowing or loss of depth, necessitating additional corrective procedures.
Maintaining good hygiene is equally important, as the neovagina can be prone to infections if not properly cared for. Regular irrigation with recommended solutions helps keep the vaginal canal clean and reduces the risk of bacterial overgrowth.
Risks and complications of vaginoplasty surgery
Potential complications of vaginoplasty vary depending on the type of surgery and individual factors. In gender-affirming surgeries, complications such as necrosis of the clitoral or vaginal tissue, strictures, or vaginal prolapse are rare but possible.
Patients may also experience issues like urinary tract infections or difficulty with bladder control in the weeks following surgery.
In cases involving congenital conditions or trauma repair, complications might include incomplete healing or the need for additional surgeries to refine the results. Close monitoring by a skilled medical team can mitigate these risks and ensure a successful recovery.
Ongoing care is required no matter the reason for a vaginoplasty
For individuals considering vaginoplasty, understanding the long-term implications is essential. The neovagina, whether created for gender affirmation, reconstruction, or congenital conditions, requires ongoing care to maintain its health and function.
Annual check-ups with a knowledgeable healthcare provider are important to monitor for signs of infection, scarring, or other issues.
For those with a neovagina created from bowel tissue, additional monitoring may be required due to the unique microbiome of the intestinal lining.
Vaginoplasty is a deeply personal and transformative procedure that serves many purposes. Whether undertaken to address medical conditions, repair damage, or affirm one’s gender identity, the surgery represents a significant step toward improved health, function, and well-being.
With advancements in surgical techniques and postoperative care, patients can achieve outcomes that align with their goals and enhance their quality of life.
By understanding the options and considerations involved, individuals can make informed decisions about their care and embark on a journey toward greater comfort and confidence in their bodies.
References1–3
- 1.Morrison SD, Claes K, Morris MP, Monstrey S, Hoebeke P, Buncamper M. Principles and outcomes of gender-affirming vaginoplasty. Nat Rev Urol. Published online February 1, 2023:308-322. doi:10.1038/s41585-022-00705-y
- 2.Kloer C, Parker A, Blasdel G, Kaplan S, Zhao L, Bluebond‐Langner R. Sexual health after vaginoplasty: A systematic review. Andrology. Published online May 10, 2021:1744-1764. doi:10.1111/andr.13022
- 3.Davies MC, Creighton SM. Vaginoplasty. Current Opinion in Urology. Published online November 2007:415-418. doi:10.1097/mou.0b013e3282f0d5b3
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