When we talk about vaginoplasty, we might mistakenly think it is a single universal technique applied to all surgeries related to the vagina. However, this is not the case. To begin with, we should distinguish between vaginoplasty in cisgender women and transgender vaginoplasty, which is performed on transgender women.
Vaginoplasty in cisgender women
A few years ago, when people spoke about vaginoplasty, it was generally understood to refer to gender-affirming surgery for transgender women. However, today, this term is primarily associated with vaginal rejuvenation or reconstruction surgeries performed mainly on cisgender women.
In this context, vaginoplasty encompasses female genital surgery techniques in cisgender women, also known as intimate surgery. Generally, this type of vaginoplasty aims to correct functional or aesthetic issues in the external genital region. This may include reducing the labia majora or minora, correcting clitoral hypertrophy, improving vaginal tissue laxity, restoring muscle tone and contraction capacity, etc.
What is transgender vaginoplasty?
Transgender vaginoplasty is the common term for a set of surgical techniques that some transgender women request to complete their transition. However, this surgery is not a mandatory procedure for female transgender identity.
This surgery allows transgender women to have a functionally effective, aesthetically natural vagina with adequate depth to enable a fulfilling sexual life, including penetration.
There are several techniques for performing transgender vaginoplasty, but three are primarily used. The choice of technique depends mainly on certain individual characteristics, particularly the size of the penis and the quality of the skin.
Penile inversion vaginoplasty
This technique is performed on transgender women whose penis has a suitable size, thickness, length, and skin quality to allow the creation of a vaginal canal with sufficient width and dimensions for penetrative intercourse.
Colovaginoplasty or vaginoplasty with a pedicled rectosigmoid flap
This technique is used for transgender women whose penis is very small, has undergone significant circumcision, or has experienced underdevelopment. This underdevelopment is often caused by the use of puberty blockers during childhood or prepuberty, preventing normal genital growth. In such cases, penile inversion is not viable because the vaginal depth would not exceed 2 or 3 centimeters.
Penile inversion vaginoplasty with graft
In some cases, the penis is not large enough to achieve optimal vaginal depth. Even if it reaches 12 to 14 centimeters, it may not allow for fully satisfying penetrative intercourse. However, using the colovaginoplasty technique might be excessive if only a slight increase in vaginal depth is needed. In these cases, vaginoplasty with an additional graft is recommended.
This technique is very similar to penile inversion vaginoplasty but includes a small graft of 3 to 7 centimeters at the end of the penile skin to increase vaginal depth. This graft is taken from the excess scrotal skin after creating the labia majora. Since the scrotal skin has hair, it is crucial to prepare it with electrocautery to remove hair follicles.
“Adding more vaginal depth with a small graft is possible and makes the vagina viable, but the graft cannot be too large, as grafted skin tends to be more vulnerable,” explains Dr. Ivan Mañero, director of IM GENDER, with over 20 years of experience in gender-affirming surgery.
It is important to note that vaginoplasty with a graft is less predictable, as the graft may fully integrate, partially integrate, or fail to integrate altogether. Additionally, post-surgical dilation must be performed more carefully in these cases, and it may need to start later than usual.
Differences between transgender and cisgender vaginoplasty
Cisgender vaginoplasty aims to improve the appearance and functionality of the vagina in cisgender women, especially in cases of vaginal laxity and aging of the genital area due to poor postpartum recovery, medication, natural aging, etc. The goal is to restore a normalized vaginal diameter and achieve a rejuvenated aesthetic appearance, allowing cisgender women to enjoy satisfying sexual relations.
Transgender vaginoplasty, on the other hand, seeks to create an aesthetically natural, fully functional vagina with adequate vaginal canal depth for satisfying penetrative intercourse. The results are highly natural.
If you have any questions about transgender vaginoplasty, do not hesitate to contact the IM GENDER team for answers.