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| Vaginoplasty |
For a patient who needs a vaginoplasty, there are several different types that may be offered. The type of vaginoplasty that is most appropriate depends on a number of factors. In particular, the type of vaginoplasty may be limited by the the patient's age and the indication for the vaginoplasty. The surgery appropriate for an adult transgender woman or individual would not be the same one indicated for a young cisgender girl. The main types of vaginoplasty are intestinal, peritoneal, McIndoe, buccal mucosa, and penile-inversion.
Vaginoplasty
What happens during vaginoplasty?
The details of the procedure depend on your goals or medical needs and include reconstruction or recreation of the vagina using various surgical techniques.
Who needs vaginoplasty?
- Individuals seeking repair of childbirth defects or trauma to improve sexual function.
- Women who need vaginal reconstruction after undergoing radiation or excision of the vagina to treat cancer or other conditions.
- Transgender individuals undergoing gender affirmation surgery.
- Women born with congenital abnormalities (issues present from birth) affecting the development of the vagina.
Sometimes when a vagina is created through vaginoplasty it is referred to as a neovagina. This literally means "new vagina."
Types of Vaginoplasty
Intestinal or Sigmoid Vaginoplasty
Intestinal vaginoplasty uses a section of the sigmoid colon to create the neovagina. This is usually done as laparoscopic surgery. Laparoscopic surgery is also often referred to as minimally invasive or keyhole surgery because there is only a small incision through the skin. For this surgery, a small piece of colon is detached and then rotated down to become the lining of the vagina. Then the surrounding colon is stitched together to restore its function.
There have been some criticisms that intestinal vaginoplasty can lead to excess mucus in the vagina and mucus with an unpleasant smell. However, these side effects have not been consistently reported.
Some people see the mucus production by the intestinal tissue as an advantage. The healthy vaginal lining is also mucus-producing and self-lubricating. The colon segment is also stretchy in a way that is more similar to the regular vaginal lining than other tissue options used to line the neovagina.
Peritoneal Vaginoplasty
Peritoneal vaginoplasty is also referred to as the Luohu operation. It uses the lining of the abdominal cavity, the peritoneum, to create the vagina. Like intestinal vaginoplasty, peritoneal vaginoplasty is usually a laparoscopic procedure.
Patients who have this procedure do not necessarily need to use dilation to maintain their vaginal opening. That is particularly true if they are having regular sexual intercourse.
There is a risk of rectovaginal fistula with peritoneal vaginoplasty and with other types of vaginoplasty. A rectovaginal fistula is when the rectum and vagina have a hole between them. Fistulas are usually treatable with surgery.
McIndoe Vaginoplasty
The McIndoe technique, McIndoe procedure, or McIndoe vaginoplasty are quite different from the peritoneal and intestinal vaginoplasty procedures. Unlike with peritoneal and intestinal vaginoplasties, the McIndoe technique does not require abdominal surgery to create the lining.
Instead, McIndoe vaginoplasty lines the vagina with a skin graft. That skin graft is placed on a vaginal mold and then placed into the space that has been opened to become the vagina. In peritoneal and intestinal vaginoplasty, no such mold is used. The mold is used consistently for the first several months after surgery (removing it for regular cleaning) in order to promote healing of the vagina into an open cavity suitable for intercourse.
Unlike the peritoneum and the intestine, the skin is not a mucosal tissue. Therefore, it does not self lubricate. This also increases the risk that the vaginal opening will close. Because of that, those who have a McIndoe procedure, and do not have regular sexual intercourse, will need to commit to dilating their vaginas for the rest of their lives.
Buccal Mucosa Vaginoplasty
Buccal mucosa is the tissue lining the mouth. It is quite similar to the lining of the vagina. Both tissues are hairless and create mucus. Therefore, in some ways, it is an ideal lining for a neovagina created during vaginoplasty.
However, buccal vaginoplasties are not as common as other vaginoplasty procedures for several reasons. Only a relatively small area of tissue is available. People may be concerned about side effects in the mouth and cheek. In addition, the inside of the mouth is not an area most gynecologists are used to working on. Therefore, they may have to collaborate with facial surgeons in order to harvest tissue appropriately.
Penile Inversion Vaginoplasty
Penile inversion vaginoplasty is only used in transgender women. In this procedure, the skin from the outside of the penis is removed and inverted to create the lining of the vagina. The head of the penis is also reshaped to create a clitoris. Finally, scrotal skin is used to create the labia majora and minora.
The disadvantages of this procedure are similar to those when the skin is used for a McIndoe vaginoplasty. Hair must be fully removed to make certain there is no hair growing on the inside of the vagina. The vagina requires a lifetime of dilation for maintenance. It is also not self-lubricating.
Although only transgender women or individuals can get a penile inversion vaginoplasty, that is not the only type of vaginoplasty they can get. These patients may also be offered an intestinal vaginoplasty either as a primary surgery or if they need a surgical revision. At least one transgender woman or individual has also had a peritoneal vaginoplasty, but they are not widely available for this population.
Dilation After Vaginoplasty
Depending on the technique used, patients may or may not need to dilate their neovagina for the rest of their lives.
Dilation involves inserting a silicone dilator—a rod with a curved end—into the vagina and leaving it in place for a short period of time (usually around 10-15 minutes).
Dilation can be used to increase the depth and width of the vagina through gentle stretching. This can help those who have difficulty with intercourse after vaginoplasty. Dilation is also necessary to maintain the vaginal opening when the skin is used to line the neovagina, such as in penile inversion or McIndoe vaginoplasty. The frequency of dilation needed depends on the type of procedure and how long it has been since the surgery was completed.
Is vaginoplasty the same as vaginal rejuvenation?
Vaginoplasty is one type of procedure to improve the vagina’s appearance or function.
Other vaginal rejuvenation procedures include:
- Labiaplasty, which evens out or decreases the size of the labia — the fleshy lobes of the vagina.
- Vulvoplasty, which reshapes the outer part of the vagina.
What happens before vaginoplasty?
You undergo assessments and testing to prepare for surgery. These tests may include:
- Physical exam to assess your health and learn more about your medical history.
- Patient education about risks, benefits and postsurgical care requirements.
- Recommendations that lower your risk of complications, including quitting smoking.
- For transgender women undergoing vaginoplasty for gender affirmation, specific pre-operative requirements exist including genital hair removal and the need to meet the requirements set by the World Professional Association for Transgender Health.
What happens during vaginoplasty performed for women with childbirth injuries?
When vaginoplasty is done to repair injuries after childbirth, the procedure involves:
- Removing extra skin.
- Using stitches to secure loose tissue in part or the full depth of your vagina.
- Reducing the opening size of the vagina.
Vaginoplasty to repair congenital defects (an issue you’re born with) may include:
- Creating a functional vagina.
- Removing excess tissue or abnormal structures.
- Preventing blood from pooling during menstruation.
What happens during vaginoplasty as part of gender affirmation surgery?
During a vaginoplasty as part of gender affirmation surgery, the male external genitalia are partially removed and reconfigured. The skin of the penis and scrotum are used to create a vaginal canal and labia.
What are the risks and benefits of vaginoplasty for vaginal reconstruction after childbirth?
Risks after vaginoplasty for childbirth injuries can include:
- Dyspareunia (painful intercourse).
- Numbness or loss of sensation.
Benefits after surgery can include:
- Improved sexual satisfaction and self-esteem.
What are the risks and benefits of vaginoplasty for gender affirmation?
One of the main benefits is relief from gender dysphoria. After surgery, individuals achieve better consistency with the gender they identify with. This has enormous benefits on people’s mental health and improves their quality of life.
Risks of vaginoplasty for gender affirmation can include:
- Vaginal stenosis.
- Inadequate depth of the vagina.
- Vesicovaginal fistula (an abnormal connection between the vagina and the urinary tract ) or rectovaginal fistula (an abnormal connection between the vagina and rectum).
- Nerve injury.
- Poor cosmetic result.
What is recovery like after vaginoplasty?
Recovery may last anywhere from a few weeks to a few months, depending on the extent of surgery. Postsurgical care after vaginoplasty depends on the type of vaginoplasty performed.
Will I need to use a vaginal dilator?
Your healthcare provider may recommend the use of a dilator. This device gently stretches the inside of your vagina in order to maintain the depth and caliber of your vagina. You may or may not need to use a dilator following vaginoplasty.
When should I contact my healthcare provider after vaginoplasty?
Your care should include follow-up appointments to track your recovery. Contact your healthcare provider immediately if you experience complications.
These may include:
- Blood-soaked dressings, which can be a sign of excessive bleeding.
- Infections, which can cause a fever or yellowish discharge from the incision.
- Pain that does not respond to medications.
- Signs of blood clots, such as abnormal swelling in your groin or lower leg.
- Vomiting and not being able to keep fluids down.
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