Feminizing genitoplasty, also known as trans vaginoplasty, is a form of gender affirmation surgery that has not only an aesthetic but also a functional focus. In addition to genital appearance, it is important to consider the function of the newly created vagina in terms of urination, sexual penetration and sensitivity. In this article, we will explore the functional perspective of feminizing genitoplasty.
What is feminizing genitoplasty?
Gender affirmation surgery, also known as sex reassignment surgery, is an important step for many, but not all, transgender people in their transition process. One of the most common forms of gender affirmation surgery is feminizing genitoplasty or trans vaginoplasty, which is mainly requested by trans women.
But what is trans vaginoplasty? It is a surgical procedure that transforms male birth genitalia into female genitalia. Also known simply as vaginoplasty, it is a surgical procedure performed to create a functional female vagina and external genitalia in transgender people who were assigned male at birth, but who identify as female and wish to have genitalia recognised as female.
The main goal of this surgery is to help transgender people feel more comfortable and satisfied with their bodies, and to have a genital appearance that matches their gender identity.
Techniques used in feminizing genitoplasty
There are several surgical techniques used in feminizing genitoplasty, and the choice of technique will depend on the patient’s needs and preferences, as well as the surgeon’s experience and skills. Some of the most common techniques include:
Vaginoplasty or penile inversion technique:
In this procedure, skin from the penis and scrotum is used to create the vagina and labia majora and labia minora. The penis is inverted and used to form the side walls of the vagina, while the skin of the scrotum is used to create the labia majora. The glans is remodelled to resemble the clitoris and the urethra is shortened.
Colovaginoplasty or sigmoid colon vaginoplasty:
In this technique, a portion of the sigmoid colon (part of the large intestine) is used to create the vagina. The colon portion is used to form the inside of the vagina and give it greater depth, with the advantage that it is a more naturally lubricated tissue than penile tissue. The skin of the penis and scrotum is also used as in the previous technique to make the labia majora, labia minora and clitoris. This technique is more complex and has a somewhat longer recovery time.
Vaginoplasty using skin grafts:
This is the penile inversion technique to which a scrotal skin graft is added, once the hair has been removed, to achieve a few more centimetres of vaginal depth.
Feminizing genitoplasty using the peritoneal technique:
This technique uses the lining of the abdomen, known as the peritoneum, to create the vagina. The peritoneum is separated from the abdominal muscle and is used to form the walls of the vagina. This technique is less common and is used in special cases where other techniques cannot be used. In fact, IM GENDER considers that it is not a sufficiently proven technique to be standardised or carried out routinely, as there are safer alternatives with fewer serious complications.
After feminizing genitoplasty, patients may urinate in a similar way to cisgender women, bearing in mind that no transgender or cisgender woman urinates in the same way. The new vagina created during surgery includes a female urethra. This allows urine to pass through the new urethral opening at the front of the vagina, similar to the natural female urethra.
However, it is important to bear in mind that the urinary function may vary from patient to patient and the patient may require time and practice to adapt to anatomical changes and learn to urinate efficiently. Some patients may experience temporary difficulties in completely emptying the bladder or controlling urination. This is normal during the recovery process. It is important to follow the recommendations of the medical team. If recommended, pelvic floor strengthening exercises should also be performed so as to improve urinary function after surgery.
Another important consideration in the functional perspective of feminizing genitoplasty is the ability to have penetrative sexual intercourse. After surgery, women will need to undergo a dilation procedure that will begin during their hospital stay and continue for several weeks afterwards. At IM GENDER, a dilatation kit is provided so that the patient has both the dilators and all the necessary material at her disposal. You can watch this video presented by Dr. Labanca in which she explains what the kit consists of.
Once the dilation period is over, a woman can have vaginal intercourse with a partner or using sex toys. The new vagina created during surgery is deep enough to allow penetration and a satisfying sexual experience.
It is important to note that vaginal sensitivity and ability to lubricate the vagina may vary from woman to woman after surgery. Some may experience a temporary decrease in sensation due to the recovery process after feminizing genitoplasty, but which improves over time. The medical team may recommend the use of lubricants and other options to improve comfort during sexual intercourse.
Sensitivity is another important aspect with regard to the functional perspective of feminizing genitoplasty. During surgery, the glans of the penis is reshaped to resemble the clitoris. This provides good sensitivity in this area. Almost all women report orgasm during penetrative and non-penetrative intercourse, as well as satisfactory sexual intercourse after surgery. However, it is important to note that sensitivity may vary in individual women and it may take some time to adapt to anatomical changes.
It is important to follow the medical team’s recommendations for postoperative care and sexual activities to ensure proper recovery and optimal function after feminizing genitoplasty.