Transgender vaginoplasty: Everything you should know

This is the most common technique used for trans women. It involves using penile skin, inverted inward, to form the walls of the neovagina. Part of the glans is preserved and reshaped into a clitoris to maintain erotic sensitivity.

• Suitable candidates: Patients with sufficient penile length (at least 12 cm when stretched) and good skin quality.
• Procedure: Lasting 3–5 hours under general anesthesia, it involves removing the erectile tissue while using the penile skin to construct the vaginal canal. The glans is transformed into a clitoris, and the scrotal skin is used for labial reconstruction.

La Penile inversion vaginoplasty provides aesthetically pleasing and functional results, including the ability to have satisfying sexual intercourse. However, patients with smaller or circumcised penises may experience limited vaginal depth.

Colovaginoplasty is a technique that uses a segment of the sigmoid colon (part of the large intestine) to form the neovagina. This technique is used when penile inversion is not viable or cannot provide sufficient vaginal depth.

• Suitable Candidates: Patients with insufficient penile skin, small or underdeveloped penises (less than 12 cm), or those with prior extensive circumcision. It is also ideal for patients who’s prior vaginoplasty did not achieve desired depth.
• Procedure: A more complex surgery lasting 5–6 hours under general anesthesia. It involves creating a vaginal canal between the bladder and rectum, where the colon segment is placed.

Currently, thanks to early care for trans youth, colovaginoplasty is becoming more common than penile inversion vaginoplasty to achieve more satisfactory results.

Colovaginoplasty is a more complex surgery than penile inversion vaginoplasty and has a longer duration, and it is always performed under general anesthesia.

La Colovaginoplasty provides adequate vaginal depth and a naturally moist texture similar to cisgender vaginas. However, it is more invasive and requires a longer recovery.

La Vaginoplasty with skin grafts is a variation of penile inversion vaginoplasty that incorporates a skin graft to increase the depth of the neovagina. It is used when penile skin alone is insufficient to achieve the desired depth, but the patient is not a candidate for colovaginoplasty.

• Suitable candidates: Patients who don’t qualify for colovaginoplasty but require more vaginal depth than penile inversion can provide. The graft usually comes from scrotal skin.

The outcome of this surgery is less durable compared to other techniques, as grafted grafted skin may be less resistant to friction, which could lead to scarring or partial closure of the vaginal tunnel over time. Additionally, graft survival is not always guaranteed, which may require additional surgeries.

Vaginoplasty is a complex surgery performed under general anesthesia, lasting 4–8 hours depending on the technique and patient-specific factors.

The procedure varies depending on the technique used but generally, key steps include:

• Preparation: The genital area is cleaned, disinfected and anesthetized.
  Creating the vaginal cavity: The surgeon makes an incision to form the space for the neovagina.
• Penile inversion vaginoplasty: The penis is opened along its midline, the erectile tissues are removed, and the penile skin is inverted to form the neovagina. A clitoris is created from the glans, preserving sensitivity. The labia majora and minora are reconstructed using scrotal skin.
• Colovaginoplasty: Involves creating a vaginal tunnel between the bladder and rectum, where a segment of the colon is placed. This procedure is more complex and requires two surgical phases: one vaginal and one abdominal.
• Vaginoplasty with grafts: Similar to penile inversion but includes a skin graft from the scrotum to increase the depth of the neovagina.
• Labial and clitorial reconstruction: Part of the glans is reshaped to form a sensitive clitoris. The labia majora and minora are created from scrotal skin or additional grafts, such as excess urethral skin.
• Closure: The neovagina is secured, external incisions are closed, and a urinary catheter is inserted.

Recovery from trans vaginoplasty requires time and careful adherence to the surgeon’s instructions. Important aspects of post-surgical care include:

• Hospitalization: After surgery, the hospital stays is between 5 and 14 days with monitor recovery. During the stay, the patient transitions gradually from a liquid to a solid diet. Additionally, the IM GENDER team will perform the first vaginal dilation before discharge.
• Urinary catheter: The patient will use a urinary catheter for the first 10–14 days.
• Vaginal dilation: One of the most important aspects of care is vaginal dilation, a process involving the use of dilators to maintain the depth and width of the neovagina. This is crucial in the first weeks and months to prevent the vaginal cavity from closing. IM GENDER provides a dilation kit, a guide on how to perform them, and specialized physiotherapist advice.
• Wound care: Keeping the surgical wound clean and dry is essential to avoid infections. Antibiotics and pain relievers are prescribed to aid healing.
• Physical restrictions: Physical exercise and heavy activities should be avoided during the first month. Your surgeon will advise when and how to resume physical activity.
• Follow-up appointments: Regular checkups at 3 weeks, 3 months, 6 months, and a year post-surgery. Attending all postoperative visits is essential to monitor recovery progress.

It is important to have realistic expectations and understand that results may vary depending on the technique used and individual anatomy— there’s no identical vaginas.