Understanding the vulvoplasty procedure

Vulvoplasty is a gender-affirming surgical procedure that creates external female genitalia—known as the vulva—for individuals assigned male at birth (AMAB). The vulvoplasty surgery constructs features such as the mons pubis, clitoris, labia majora, and labia minora using tissue from the penis and scrotum.

Unlike vaginoplasty, vulvoplasty does not involve the creation of a vaginal canal. This makes it a less invasive option for individuals who do not require or desire a neovagina for penetrative sexual activity.

Vulvoplasty is often chosen by transgender women and nonbinary individuals as part of their gender-affirming journey. For some, the primary goal is to eliminate male genital anatomy and achieve a feminine appearance that aligns with their gender identity.

Others may prefer vulvoplasty due to its lower surgical risks, reduced recovery time, and the absence of the lifelong maintenance required with a neovagina, such as dilation and douching.

Why choose vulvoplasty?

The decision to undergo vulvoplasty is deeply personal and influenced by a variety of factors. For many, the procedure offers significant emotional relief by eliminating dysphoria related to male genitalia.

In a recent study, patients ranked “elimination of male genital anatomy” as their top priority when choosing vulvoplasty, followed closely by achieving an appearance comparable to cisgender female vulvae. This focus on external aesthetics highlights the importance of physical congruence with gender identity.

Some individuals opt for vulvoplasty due to specific health or lifestyle considerations. For instance, patients with medical conditions that increase the risks of full-depth vaginoplasty, such as a history of radical prostatectomy or pelvic radiation, may find vulvoplasty to be a safer alternative.

Additionally, older patients or those with higher body mass indices (BMIs) may prefer this less invasive procedure, which typically involves fewer complications and a faster recovery process.

Practical considerations also play a role. Vulvoplasty eliminates the need for post-surgical dilation, a lifelong commitment required to maintain the depth of a neovagina after vaginoplasty.

For those not interested in penetrative sexual activity or unable to commit to this maintenance, vulvoplasty provides a simpler and less burdensome option.

In some cases, timing and access to care also influence the decision; patients facing delays for vaginoplasty due to requirements like pre-surgical hair removal may choose vulvoplasty as a faster alternative.

The vulvoplasty procedure

During a vulvoplasty, surgeons use penile and scrotal tissue to construct a vulva that appears feminine and natural.

The head of the penis is preserved and reshaped to form the clitoris, ensuring erogenous sensation. The scrotal skin is repurposed to create the labia majora, while other genital tissues contribute to forming the labia minora and the mons pubis.

Advanced techniques, such as the use of gathering sutures, can create a recessed introitus (vaginal opening) that mimics the appearance of a cisgender vulva.

The procedure typically lasts two to four hours and is less invasive than vaginoplasty. This results in a shorter hospital stay and a quicker initial recovery period.

While patients can expect some swelling, bruising, and numbness after surgery, most can return to regular activities within eight to twelve weeks, with full healing taking up to a year.

Satisfaction and outcomes with vulvoplasty procedures

Studies on vulvoplasty outcomes demonstrate high levels of satisfaction among patients. In one study, 93% of participants reported being happy with their decision to undergo vulvoplasty and with the appearance of their vulva.

When comparing their vulva to those of cisgender women of similar age and weight, all surveyed patients described their vulva as “similar” or “somewhat similar” in appearance.

Additionally, 92% found their vulva as attractive or more attractive than cisgender vulvae, reflecting the procedure’s success in achieving realistic and aesthetically pleasing results.

The study also highlighted vulvoplasty as a suitable option for individuals not interested in receptive vaginal intercourse.

By focusing on external anatomy, the procedure avoids the risks and extensive aftercare associated with creating a vaginal canal.

However, patients considering valvuloplasty should be counselled about the potential for future regret if their desires change. While secondary surgery to create a vaginal canal is possible, it requires additional tissue grafts or intestinal segments, as the genital skin used during vulvoplasty is typically discarded.

Advantages of vulvoplasty over vaginoplasty

Vulvoplasty offers several benefits, particularly for those seeking a less invasive gender-affirming surgery.

The procedure carries fewer surgical risks compared to vaginoplasty, as it avoids complications such as rectal injury or fistula formation. It also eliminates the need for lifelong dilation and douching, making it a more manageable option for patients who prioritise ease of care.

For many transgender women and nonbinary individuals, the greatest advantage of vulvoplasty is the psychological and emotional relief it provides. By aligning the appearance of the genitals with one’s gender identity, vulvoplasty can significantly reduce gender dysphoria and enhance overall well-being.

The ability to pee while sitting, wear feminine clothing comfortably, and feel confident in one’s body are profound everyday benefits that improve quality of life.

Considerations and risks of the procedure

As with any major surgery, vulvoplasty carries risks. Potential complications include infection, hematoma, seroma, or delayed healing.

Some patients may experience reduced sensation or difficulty achieving orgasm, although this is rare. It is crucial to discuss these risks thoroughly with a qualified surgeon before making a decision.

Because vulvoplasty is irreversible, patients must carefully consider their long-term goals. A supportive care team, including surgeons and behavioural health specialists with expertise in transgender health, is essential. These professionals can help ensure patients are making informed decisions that align with their needs and desires.

Vulvoplasty is a big decision

Choosing vulvoplasty is a deeply personal decision that depends on your individual goals, health, and lifestyle.

For transgender women and nonbinary individuals seeking an external feminine appearance without the need for a vaginal canal, vulvoplasty can be a highly effective and satisfying option.

By eliminating male genital anatomy and creating a realistic vulva, the procedure offers a significant step toward living authentically and comfortably.

If you’re considering vulvoplasty, consult with experienced healthcare providers who can guide you through the process and provide the support you need. With careful planning, realistic expectations, and a trusted care team, vulvoplasty can be a transformative and affirming experience.

References^1–4

1.
Sandhu S, Smith S, Stelmar J, Yuan N, Mallavarapu S, Garcia M. (022) A NOVEL SURGICAL TECHNIQUE TO CREATE A NATURAL-APPEARING RECESSED VAGINAL INTROITUS WITH GENDER-AFFIRMING VULVOPLASTY (“SHALLOW-DEPTH VAGINOPLASTY”) UTILIZING A PEDICLED ADVANCEMENT FLAP. The Journal of Sexual Medicine. Published online June 2024. doi:10.1093/jsxmed/qdae054.022
2.
Aaen EK, Kesmodel US, Pop ML, Højgaard AD. Requests for vulvoplasty as gender-affirming surgery: a cross-sectional study in Denmark. The Journal of Sexual Medicine. Published online February 12, 2024:262-269. doi:10.1093/jsxmed/qdae003
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Claeys W, Wolff DT, Zachou A, Hoebeke P, Lumen N, Spinoit A. Variant genital gender‐affirming surgery: a systematic review. BJU International. Published online August 29, 2024. doi:10.1111/bju.16513
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Aaen EK, Højgaard AD, Pop ML, Kesmodel US. Outcomes and Experience of Gender-Confirming Vulvoplasty: A Systematic Review. Transgender Health. Published online September 30, 2024. doi:10.1089/trgh.2023.0231