GENDER AFFIRMATION SURGERY
Penile Inversion Vaginoplasty
Penile inversion vaginoplasty is one of the most common genital surgical techniques, with the aim of achieving an anatomical, aesthetic and functional vagina, with a depth that allows full sexual intercourse.
What is penile inversion Vaginoplasty?
It is a surgical technique of trans vaginoplasty that allows to achieve a vagina with a variable depth according to the patient based on three characteristics: the size of the penis, the skin’s elasticity and the patient’s height. In addition, the IM GENDER team uses the scrotum graft to increase the vaginal depth, so the amount and type of scrotum will also be important in determining the depth of the vagina.
Knowing the before and after of penile inversion vaginoplasty that the IM GENDER team performs can help you gain a clearer picture of the results you may attain. It helps you to see cases similar to yours and gain an idea of the final result.
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PENILE INVERSION VAGINOPLASTY SURGERY
The operation usually lasts from three to five hours. To this time, we add pre-anaesthesia, preparation of the patient and recovery immediately after surgery.
This surgery is always performed under general anesthesia, with the exception of some exceptional cases where it is performed under spinal anesthesia.
The operation begins by opening the penis with a midline cut, leaving the corpora cavernosa and vasculo nervous pedicle visible. Part of the glans will be used to form the clitoris, while most of the penile skin is repositioned to form the vaginal walls. The remaining penile elements comprising the corpora cavernosa (whose function is erection) and part of the penile urethra are removed.
The urethra (or urinary tract) is shortened and redirected to emerge in its normal position; that is, just above the new vaginal opening or introitus. Excess erectile tissue around the urethra is removed in part to prevent it from increasing in size during sexual arousal and preventing the vagina from opening properly. Where possible, the IM GENDER team uses much of the urethra to line the labia minora and inner walls of the vaginal vulva, giving it a pinkish mucosal appearance more similar to the female vulva at birth.
The spermatic cords are severed and the testicles are removed, although the surrounding scrotal skin and skin from the surrounding areas will be used to form the labia majora and labia minora. In some cases, the remaining scrotum is used to form a tube of skin that is added to the end portion of the penis to increase the vaginal depth by a few centimeters.
The anatomical space where the vagina will be placed is between the urinary bladder and the rectum (end of the large intestine). This is the most technically complex part.
Once the space where the vagina will be located has been formed, the penile skin is placed inverted to form the vaginal walls. The vaginal depth will depend on each patient and the elements that determine it are the amount of penile skin available (which will depend on the initial size of the penis and the amount of scrotal skin to graft) and the anatomical disposition of the internal organs. However, the IM GENDER team will always aim for a depth of no less than 15 centimeters. Once the vagina is fixed, a special dressing is placed to keep the skin inverted inside the vaginal cavity until it heals.
The next stage of the surgery is to reconstruct the clitoris. This is done with the portion of the glans that has been preserved, along with its nerves and blood vessels, in order to maintain sensitivity and the capacity for full sexual satisfaction. The clitoris will be attached above the urethral meatus and a hood will be made to cover it. This part of the surgery can be performed during the operation or afterwards. The surgeon will decide according to the existing inflammation and other intra-surgical factors assessed.
The penile inversion vaginoplasty surgery is complete after reconstruction of the labia: part of the skin of the scrotum becomes the labia majora and, if there is excess skin, two additional folds can be formed to simulate the labia minora and a clitoral hood. In most cases, the entire surgery can be performed in a single operation, but in some special cases, vaginal aesthetic surgery can be postponed until a second operation.
Compressive bandages are then applied, and the patient will use a bladder catheter for approximately two weeks.
FAQS BEFORE PENILE INVERSION SURGERY
Who can undergo penile inversion vaginoplasty?
Not all trans people seeking vaginoplasty are suitable for penile inversion. To be able to perform a penile inversion surgery, you must have a penis with minimum dimensions (it must measure more than 12 centimeters stretching the skin of the penis and counting from the peno-pubic angle to the tip of the foreskin) and a good quality of the penile skin. In any case, it will always be the surgeon who will assess all the circumstances, as well as the person’s medical history and the suitability of the technique to be used in their case.
Will I be able to continue with the hormonal treatment?
Many people who undergo surgery such as penile inversion surgery are treated with oestrogens and anti-testosterone drugs. Taking estrogen carries a risk of deep vein thrombosis during surgery. For this reason, oestrogens are withdrawn about one month before the operation. As for anti-testosterone drugs such as Androcur or Decapeptyl, experience has shown that withdrawal is not necessary. They can be maintained until the operation. Their total withdrawal will be one or two weeks after the vaginoplasty. IT IS ESSENTIAL THAT YOU MAKE AN APPOINTMENT WITH YOUR ENDOCRINOLOGIST before and after surgery and that you follow their instructions.
Is admission necessary for the penile inversion vaginoplasty?
Yes, you will be admitted to IM CLINIC one day before the operation. Throughout that day, you will undergo the relevant monitoring and a bowel cleansing, through the intake of laxatives and antibiotics. This cleansing is essential due to the proximity of the intestine in the creation of the neovagina.
FAQS ABOUT POSTOPERATIVE PERIOD OF PENILE INVERSION VAGINOPLASTY
How long will I have to be admitted?
Admission is usually seven days. During post-operative visits, the IM GENDER team will follow a supervision protocol, monitoring vital signs, gradually increasing the patient’s diet, managing pain with a rotation of analgesia, early ambulation and oral antibiotics.
On the last day of admission, the first dilation of the vagina will be performed under a standardized protocol by your doctor, who will explain the care and steps to follow, so that you can perform the recommended dilations at home. The IM GENDER nursing staff will give you a Care Guide and a kit with everything you need so that you can continue with the dilations at home. You will be given a follow-up email as well as subsequent appointments with your surgeon.
The medical team will advise you on the correct post-operative follow-up.
When will I be able to go home after the penile inversion postoperative period?
The bladder catheter is maintained until the tenth day or until periurethral inflammation is minimal, so you will be discharged with this catheter. You will undertake the indicated dilations at home and the treatment prescribed by the analgesia and antibiotic therapy physician.
Once at home, you should contact the endocrinologist supervising your hormone treatment to restart it (after about four weeks) and readjust the dose. You will no longer need to take Androcur or Decapeptyl. It is important that under no circumstances should you readjust your hormone doses yourself as this could cause problems for your health.
What are the postoperative risks of inversion vaginoplasty?
A member of the medical team will tell you how to avoid possible complications and what to do if they should arise. If you have any doubts or anomalies after the operation, you should consult your doctor so that he or she can diagnose and provide a solution. For this purpose, you will have a telephone number available 24 hours a day, as well as a follow-up email address.
Will I be able to have sexual intercourse after penile inversion vaginoplasty?
After vaginoplasty and recovery you will have a functional, anatomical vagina, aesthetically similar to that of any other woman. This vagina will be suitable for full sexual activity, free of painful scars, with sufficient sensitivity to receive satisfactory erogenous stimulation during sexual intercourse. It is important that you follow all the recommendations given to you by the medical team, such as dilations and post-operative visits.
Will I have to go to different medical visits during the penile inversion postoperative period?
It is very important not to skip any of the post-operative visits with a member of the IM Gender team. Only they will be able to assess the progress of your vaginoplasty recovery. As a general rule, once the patient has been discharged from hospital, she will be scheduled for the next visit, which will take place approximately three weeks after discharge from hospital (one month after the operation). The next medical check-ups will be approximately three months, six months and one year after the operation.
At all times, the patient will have a post-operative support telephone number available to answer any questions that may arise, as well as a specialized physiotherapy service if desired.
TIPS PENILE INVERSION VAGINOPLASTY
You will eat a soft diet for the first 7 days after vaginoplasty..
You should wear it for approximately 14 days. Follow the advice of the medical team to avoid any discomfor
We offer you a postoperative guide that will include information for your complete recovery. Also about dilations.
WE SOLVE YOUR DOUBTS
We are happy to help you and answer any questions. After the surgery, you should go home without doubts about the dilations and the postoperative process.
You should avoid doing physical exercises during the first month. Afterwards, your surgeon will tell you how and when to start doing sports.
It is very important that you do not miss any of the visits after your surgery.
Frequently Asked Questions about Vaginoplasty
IM GENDER Team
IM GENDER’s medical and human team has been dedicated to the specialized care of trans people for more than 20 years. Two decades adding experience, professionalism, research and training.
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