Vaginoplasty is one of the most requested gender-affirming surgeries by both trans women and some non-binary people assigned male at birth. It’s important to recognize that the relationship with one’s birth genitalia is deeply personal and varies from person to person. Some trans women and non-binary people feel comfortable with their existing genitalia, while others need gender-affirming surgery to live in harmony with their gender identity.
This post is designed for the latter—those who are considering a vaginoplasty technique and want clear, up-to-date information about the different types of vaginoplasty and the factors that may influence the choice.
Different Types of Vaginoplasty
Trans vaginoplasty is a gender-affirming surgical procedure aimed at creating a functional and aesthetically natural vagina that aligns with the person’s gender identity. Today, several vaginoplasty techniques are available. Choosing the most appropriate one depends on various factors such as available genital tissue, anatomical characteristics, hormone history, lifestyle, and expectations.
Penile Inversion Vaginoplasty
Penile inversion vaginoplasty is the most traditionally used technique. It involves inverting the penile skin to form the vaginal canal. Scrotal skin may also be used if additional depth is required. The glans is reshaped to form the clitoris, and the labia majora and minora are constructed using penile and scrotal skin.
This technique is feasible when there’s enough genital tissue—typically when the penis is over 12 cm in length at rest—to achieve adequate vaginal depth for penetrative intercourse. The amount of usable skin varies due to genetic and hormonal factors. This method can be more challenging in individuals who began hormone treatment at an early age. It also requires good skin elasticity and favorable anatomy.
Colovaginoplasty
In colovaginoplasty, a segment of the sigmoid colon is used to construct the vaginal canal. It is recommended when there isn’t enough genital tissue, for example in individuals who began puberty blockers and estrogen in adolescence, limiting the development of the penis and scrotum.
At IM GENDER, colovaginoplasty is currently one of the most used techniques, especially due to the early medical care provided to young trans individuals who may lack sufficient tissue for classic penile inversion. Intestinal mucosa offers excellent depth and satisfactory functional results. However, it’s a more complex surgery and has a slightly longer recovery period.
Vaginoplasty with Scrotal Skin Graft
This technique is generally considered when penile skin alone does not provide sufficient depth, but a colovaginoplasty is not necessary. Scrotal skin grafts are used to extend the vaginal canal. The tissue must be carefully prepared and grafted into the canal.
While this is a valid option, it comes with some risks, such as partial graft loss. Therefore, it’s used selectively and evaluated on a case-by-case basis.
Peritoneal Vaginoplasty
Peritoneal vaginoplasty uses the inner abdominal wall layer—the peritoneum—to extend vaginal depth. It’s a good alternative when genital tissue is insufficient and the patient wants to avoid the use of intestinal tissue. In this technique, the vaginal entrance is lined with penile skin, while the deeper part is made with peritoneal tissue.
One of the main advantages of this method is natural lubrication, as the peritoneum has self-lubricating properties.
Zero-Depth Vaginoplasty (Vulvoplasty)
Some trans women and non-binary individuals opt for genital construction without a vaginal canal. In such cases, a vulvoplasty is performed to create a natural-looking, functional vulva without internal depth. This may be ideal for people who do not want penetrative intercourse and prioritize quicker recovery and fewer complications.
Vulvoplasty yields good results in terms of sensitivity and appearance and eliminates the need for postoperative dilation—one of the more demanding parts of recovery in vaginoplasties with depth.
What Should I Know Before Undergoing Vaginoplasty?
Before any gender-affirming surgery, it’s essential to be fully informed about what to expect during the procedure, recovery, and long-term care. In Spain, mental health reports are no longer required to access trans vaginoplasty. At IM GENDER, autonomy and informed consent are the foundation of the process.
However, we strongly recommend:
- Receiving proper medical guidance regarding hormone therapy, if applicable.
- Having realistic expectations about aesthetic, functional, and sensory outcomes.
- Understanding the postoperative process, especially dilation (if a depth technique is chosen).
- Having emotional support before, during, and after surgery to ensure overall well-being.
Who Decides Which Vaginoplasty Technique Is Best?
Choosing the most appropriate vaginoplasty technique should never be a one-sided decision. At IM GENDER, we take a holistic view of each case, considering the person’s desires, anatomy, general health, and needs. Our experienced medical team provides clear information, active listening, and expert advice to arrive at the best joint decision.
Results Based on Vaginoplasty Technique
All vaginoplasty techniques aim to align genital anatomy with the person’s gender identity when desired. However, outcomes vary:
- Penile inversion offers good aesthetic and functional results if there is enough tissue. It requires regular dilation to maintain vaginal depth.
- Colovaginoplasty allows for greater depth and is not dependent on genital tissue. It offers a stable cavity but requires a longer recovery and advanced surgical expertise.
- Scrotal graft techniques are used when penile skin is insufficient. While effective, they have a higher risk of local complications such as graft loss.
- Peritoneal vaginoplasty is an innovative option offering good functional and aesthetic outcomes.
- Vulvoplasty (zero-depth) enables faster recovery with fewer complications and no need for dilation, though it does not allow for vaginal penetration.