Gender reassignment surgery is a complex set of procedures, generally, broken into top and bottom surgery.
A vaginoplasty is one of the gender-affirming procedures that make up bottom surgery. It is a procedure that transgender women have as part of their gender affirmation in Australia.
So, what is a vaginoplasty?
Vaginoplasty: What is it?
During a vaginoplasty, your surgeon reshapes the scrotum, penis and testicles into a vulva and vaginal canal. They may also use different parts of the body and lower intestine if needed.
There is also a technique called a vulvoplasty. This is a version of a vaginoplasty where your specialist plastic surgeon creates only shallow vaginal canal and a feminine outer genital area.
Before a vaginoplasty you will need to ensure permanent hair removal around the genitals and decrease your hormone intake in the lead up and after surgery.
Different Types of Vaginoplasty
There are two main gender-affirming procedures for this type of surgery—vaginoplasty with a canal and a vulvoplasty.
Vaginoplasty with a Canal
A vaginoplasty with a canal is often referred to as a full depth vaginoplasty. This is a gender affirming procedure where the surgeon creates a vulva and a full length vaginal canal so you can have receptive intercourse once you recover.
During recovery, you will need to dilate the vaginal canal so your vagina fully functions and is receptive to penetrative sex.
There are two methods for a full a full depth vaginoplasty—penile inversion vaginoplasty and robotic-assisted peritoneal flap vaginoplasty.
Penile Inversion Vaginoplasty
During a penile inversion vaginoplasty, your surgeon creates the vaginal cavity. Then uses the testes, penis, and sometimes the lower intestine or skin from other sites, to shape and line the vaginal canal. Your surgeon also uses the tissue to form the vulva which includes the outer and inner labia. Using what was once the head of the penis, your surgeon create the clitoris. They use the head so you still have sensations in the area during intercourse. Your surgeon then shortens the urethra and repositions it to the correct position in the vulva.
The operation will take between four and six hours and you will spend up to five days in hospital.
Robotic-Assisted Peritoneal Flap Vaginoplasty
The robotic-assisted peritoneal flap vaginoplasty is a new type of surgical gender affirmation technique. It is sometimes called a robotic peritoneal gender affirming vaginoplasty or robotic Davydov peritoneal vaginoplasty. During this procedure, the surgeon creates the vaginal canal with the assistance of a single port robotic surgical system.
This technique uses a small incision next to the belly button so the surgeon can better see your pelvis area to create the vaginal canal.
The advantage of this type of surgery is that it can lower the surgical risks because it is more precise and takes less time. Using this technique, your surgeon can complete a full depth canal no matter how much tissue you have in the area.
What is a Vulvoplasty?
A vulvoplasty is a type of vaginoplasty but without a vaginal canal. Other names it has includes zero depth vaginoplasty and shallow depth vaginoplasty. During this procedure, your surgeon creates a vulva that has a very short canal. This includes a vaginal opening, clitoris and the labia.
The main disadvantage of this technique is you cannot have vaginal intercourse because of the short vaginal canal.
There are also advantages to these gender confirmation procedures. This includes less complications because the operation takes less time than a vaginoplasty so there is less time in hospital and recovery is quicker. You also do not need to ensure permanent hair removal in the area or dilation after the operation.
Permanent Hair Removal
It is essential to permanently remove the hair from the genital area using either laser, electrolysis or both, before a vaginoplasty. The reason for this is that the skin will be used as the vaginal canal. Permanent hair removal stops hair growing in the canal after the operation and it avoids complications such as hairballs, infection and pain during intercourse.
Dilation after Vaginoplasty
During recovery you will need to dilate the vaginal canal. This involves putting a medical grade dilator into the vaginal canal to keep it open while you are healing.
You will receive dilators of different sizes to use and your doctor will show you what to do. This may not be easy in the beginning but your medical team will help you to increase the comfort level as you continue to heal. You will start with the smallest dilator and continue using it until cleared by your doctor to progress to the next size.
You must dilate for 20 minutes, three times a day during the first few weeks of your recovery. This is a vital part of healing because it helps to keep the length and width of your newly formed vaginal canal open.
Please note that Dr Steve Merten only performs top surgery for trans people. If you want to learn more about these procedures, he is extremely experienced in this area. Make an appointment today to talk with Dr Merten about what you want to achieve.
