Vaginoplasty with graft

Penile inversion vaginoplasty with a graft is a genital gender affirmation technique that is performed when the trans woman’s circumstances or anatomy do not allow penile inversion vaginoplasty. It is suitable if she cannot undergo the surgical technique of a pedicled rectosigmoid flap, otherwise known as a colovaginoplasty.

What is vaginoplasty with graft?

When the penile inversion vaginoplasty technique is not sufficient for the trans woman to obtain a vagina of sufficient size and depth enabling a fully penetrative sex life, a graft can be used to enlarge the cavity.

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    Vaginoplasty results

    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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    This skin is usually taken from the scrotal area. The scrotal skin is usually removed after forming the labia majora, which are narrower and finer than the scrotum itself. The excess skin, instead of being discarded, is prepared for use as a graft. Grafting depths of three to six centimeters are used, as more would be unfeasible.

    Since the skin of the scrotal area is usually hairy, it is very important during the graft generation process to remove the hair follicles using electrocautery so that they do not grow back. However, sometimes not all of these hair follicles may be removed, with some follicles remaining.

    The rest of the surgery process is exactly the same as penile inversion, except for the last stage of surgery. Here, the skin graft is inserted inside the cavity we have formed to create the vaginal tunnel. Once inserted, it is sutured at the end of the cavity.


    Who can undergo graft vaginoplasty?

    You should bear in mind that grafting is a technique used by surgeons to cover wounds so that they do not close. However, it is difficult to predict how much of the graft will take.
    Lengthening or deepening your vagina is possible so long as the graft is not large. This is because grafted skin tends to be more vulnerable. In this vaginoplasty technique, the graft is added to the end of your penile skin to increase your vagina’s depth.
    However, the skin that can be used for such a graft tolerates rubbing very poorly. During sexual intercourse, over time and if adequate lubrication is used, chronic wounds can appear that will create fibrosis and closure of the end of your vagina.

    Should I stop my hormonal treatment before vaginoplasty with graft?

    Many people who undergo surgery such as vaginoplasty are following treatment with estrogen and anti-testosterone drugs. Taking oestrogens carries a risk of deep vein thrombosis during surgery. This is why we withdrew this treatment about a month before surgery. As for anti-testosterone drugs such as Androcur or Decapeptyl, experience has shown that you do not need to withdraw from them. So you can keep taking them until your operation. Complete withdrawal will be until one to two weeks after vaginoplasty. IT IS ESSENTIAL THAT YOU SEE YOUR ENDOCRINOLOGIST before and after surgery and that you follow their instructions.


    When should dilations be performed in the postoperative period of vaginoplasty with graft?

    When penile inversion vaginoplasty with a graft has been performed, the dilation processes must be undertaken much more carefully. If in a penile inversion vaginoplasty without a graft, or colovaginoplasty, it is usual to start dilations seven or eight days after surgery, with a penile inversion vaginoplasty with a graft it is necessary to wait a few days longer to avoid losing the graft. Alternatively, you can begin early dilations just at the beginning of the vagina, without entering the graft. And always follow the guidance of both your medical team and your specialized physiotherapy team at IM GENDER. If the graft does not take for various reasons, we can consider colovaginoplasty, so as to obtain greater vaginal depth.

    Will I need to attend postoperative visits after vaginoplasty with graft?

    Yes. It is very important not to skip any of your post-operative visits with a member of the IM GENDER team. Only they will be able to assess the progress of your vaginoplasty recovery.



    It is important for you to eat a soft diet for the first 7 days after the vaginoplasty surgery.


    You should wear it for 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.


    Go home without doubts about dilations and postoperative process. We’re happy to help you.


    Avoid it during the first month. Your surgeon will tell you how and when to start.


    It is very important that you do not miss any of the visits after your surgery.

    Frequently Asked Questions about Vaginoplasty

    In this section you will be able to answer the most common doubts about colonovaginoplasty. If you have any other question, do not hesitate to contact us either by mail, telephone or with the contact form.

    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.

    Do you need more information about IM GENDER’s Gender Unit? Do you have questions about gender affirmation surgery?