MTF vaginoplasty

Before undergoing vaginoplasty surgery, the IM GENDER team will determine the appropriateness of the surgery for each person, considering factors such as their overall health, medical background, and exploring all available alternatives.

Preparation before trans vaginoplasty

It is important to have a blood test at least 3 months before the surgical procedure. It is also essential to control your diet and clean your intestines. In addition, it is very important to refrain from any alcohol, tobacco or drug consumption one month prior to the surgery. 

Furthermore, it is important to note that estrogen is not routinely discontinued before surgery. At IM GENDER, we understand the importance of maintaining hormonal medication continuity in trans women. As for anti-androgens such as cyproterone, spironolactone, and triptorelin, experience has shown that their withdrawal is not necessary. Therefore, they can be continued up until the surgery. Their complete discontinuation will take place one or two weeks after the transgender vaginoplasty.

When you visit your doctor, everything will be explained and any doubts that may arise will be clarified.

A member of the medical team will instruct you on how to prevent possible complications and what to do in case they happen. 

These are the most common complications that may arise:

• Dehiscence or opening of the wound.
• Urinary tract infection while the catheter is in place.
• Local infections.

If you have any doubts or abnormalities after the procedure, you should consult your doctor so that they can diagnose the issue and provide a solution. A 24 hour phone line will be available for you to make your inquiries.

What is MTF vaginoplasty surgery?

Vaginoplasty surgery allows to repair a vagina that had been injured due to the childbirth or to solve pelvic floor disease complications. But also, vaginoplasty is a gender-affirming procedure performed on transgender women as part of their transition process. It has 3 main aims:

• • • Sensitivity: We preserve all the nerves that go through the glans and prepuce, and use those structures to create the clitoris and labia minora. After the surgery, erogenous sensitivity and orgasms will be located in those areas.
    • Aesthetics: We create all the feminine structures that a vulva has, including the labia majora, labia minora, and clitoris. We also shorten the urethra and create the vaginal introitus.
    • Functionality: Depending on the patient’s sexual preferences, we adapt the surgical needs. If her willing is to be penetrated, then we will need to cover the deep vaginal canal with either penile skin or a portion of the colon.

This surgery involves the creation of a neovagina, typically by using penile and scrotal skin, to provide the patient with a vagina that has both functionality and appearance similar to a cisgender woman’s vagina. The procedure may also include the creation of a clitoris, labia (MTF labiaplasty) and vaginal opening. 

What are trans vaginoplasty procedures like?

When a trans woman requests genital affirmation surgery or vaginoplasty, the medical team must plan the surgery carefully, considering the needs, medical history, characteristics and personal circumstances of every single woman. Our team will evaluate the case by classifying it into three main techniques described below to remove the penis and achieve a functional and aesthetically complete vagina.

• • Colovaginoplasty: We use this technique when the penis is small or when there has been a major circumcision prior to genital reconstruction. It is also performed when there is a lack of penile development as a result of hormonal inhibitors used during the pre-puberty stage. In that case, the penile inversion technique is not recommended, as the vaginal depth would be too shallow and would not allow the trans woman to have a satisfactory intercourse.
  • Penile inversion vaginoplasty: Penile inversion vaginoplasty is performed when the size, thickness, length and quality of the penis skin allows to make a vaginal canal of sufficient width and size to have regular sexual intercourse.
  • Penile inversion vaginoplasty with graft: When a trans woman does not have the right dimensions penis for a successful penile inversion, but does not require a colovaginoplasty, she can choose to have what is known as vaginoplasty with skin graft. This technique gives a vagina the right depth and dimensions without having to use the rectosigmoid flap technique.

Will I be able to have children?

If you are going to undergo a transgender vaginoplasty, you can consider the option of storing sperm – sperm cryopreservation – before having this surgery, in case you wish to have children.

Is there sensitivity with MTF vaginoplasty?

Yes, there is sensitivity after trans vaginoplasty. Surgeons strive to preserve and create as much sensation as possible in the neovagina and surrounding areas. The clitoris, which is typically constructed using the sensitive glans tissue of the penis, often retains sensation. The overall extent of sensitivity may vary from person to person and it can take time for nerves to heal and sensation to fully develop after surgery.

Wound care and vaginal dilation

Wound care and dilation begin at the clinic between the third and seventh day after the procedure. A member of the medical team will instruct the patient on the dilation and washing technique. For this purpose, two dilators of different sizes and a vaginal washing kit will be provided, which should be used as directed by the doctor, usually on the day of discharge.

Hospital admission

After this transgender genital surgery, you will have to stay in the clinic for at least a week so that the surgeon can follow your evolution and provide you with the necessary care for your complete recovery.