Vaginoplasty

What is vaginoplasty?

Vaginoplasty is a procedure to repair your vagina due to damage from medical conditions, injury or other factors. It can also be a type of gender-affirming surgery because it can create a vagina and vulva and remove a penis, scrotum and testicles.

Many people refer to all the reproductive parts associated with being assigned female at birth (AFAB) as a “vagina.” But, to understand vaginoplasty it’s important to distinguish that a vagina is the muscular, hollow canal that you can’t see. A vulva is the visible part of a person AFAB’s genitalia.

What does vaginoplasty treat?

You can have vaginoplasty for both functional and cosmetic reasons. Functional reasons are things like sexual intercourse or urinary incontinence. Cosmetic means how something looks or makes you feel. There are many reasons why a person may decide to pursue vaginoplasty. Some of those reasons are:

• Vaginal childbirth: A vaginal delivery stretches and loosens your vaginal muscles. Aging can also cause your vagina to lose its tightness. This can cause uncomfortable symptoms and affect sexual function.
• Medical conditions: People may need vaginal reconstruction after undergoing radiation to treat cancer. A vaginoplasty can also help reshape your vagina if your provider removes it during cancer treatment.
• Congenital conditions: Certain congenital abnormalities (conditions present at birth) can affect how your vagina looks and functions. This could include being born without a vagina or being unable to menstruate due to an underdeveloped vagina.
• Gender affirmation: People may have vaginoplasty as part of feminizing bottom surgery.

Is vaginoplasty the same as vaginal rejuvenation?

No. Vaginoplasty is a type of vaginal rejuvenation. Vaginal rejuvenation is any procedure to improve your vagina’s appearance or function. There are several different types of vaginal rejuvenation. Other common procedures are:

• Labiaplasty, which evens out or decreases the size of your labia — the fleshy lips of your vagina.
• Vulvoplasty, which reshapes the visible (or outer) part of your vagina.
• Clitoral hood reduction, which removes extra tissue covering your clitoris.
• Perineoplasty, which strengthens the perineum (space between your vagina and anus, or butthole).

What happens before vaginoplasty?

If you have vaginoplasty, you’ll undergo assessments and testing to prepare for surgery. These tests may include:

• A physical exam to assess if you’re healthy for surgery and learn more about your medical history.
• Education about risks, benefits and postsurgical care requirements.
• Recommendations that lower your risk of complications, including quitting smoking.
• For people assigned male at birth (AMAB) undergoing vaginoplasty for gender affirmation, there are specific preoperative requirements (such as genital hair removal) that your healthcare provider reviews with you.

Your provider will give you specific instructions based on your situation to help you prepare for the procedure.

What happens during vaginoplasty?

The procedure will vary based on why you’re undergoing vaginoplasty.

When you have vaginoplasty to improve looseness or to repair an injury, the procedure involves:

• Removing extra or sagging skin/tissue.
• Using stitches to secure loose tissue into your vaginal canal.
• Reducing the opening size of your vagina by pulling back or removing excess tissue.

Vaginoplasty to repair congenital abnormalities may include:

• Creating a functional vagina.
• Removing excess tissue or abnormal structures you were born with.
• Preventing blood from pooling during menstruation.

What happens during vaginoplasty as part of gender affirmation surgery?

During a vaginoplasty as part of gender affirmation surgery, your surgeon removes and reconfigures most of your penile tissue (penectomy). Your surgeon will use the skin of the penis and scrotum to create a vaginal canal and labia. They’ll then reshape and invert (turn “inside out”) the outer penis skin and insert it into the space they created to form a vagina.

How long does vaginoplasty take?

It depends on the extent of the surgery. Some vaginoplasties can take up to 10 hours while others last only a few hours.

What happens after vaginoplasty?

Your surgeon will go over what you can expect after vaginoplasty, including what symptoms are signs of potential problems. Some people recover in the hospital for up to five days, while others go home sooner. Your healthcare provider will prescribe antibiotics to prevent infection and pain medication to help with discomfort after surgery.

Some of the things you can expect are:

• Light bleeding for up to 48 hours after surgery.
• Swelling or bruising in your genital area. Swelling can take several weeks to go away. For people who have vaginoplasty for gender affirmation, the swelling may cause you to spray or dribble pee.
• Itchiness or numbness as your nerve endings heal.
• Scarring (which will lighten or change color over time).
• Using a catheter to help you pee. This can last for up to a week or until your urethra heals.

Does insurance cover vaginoplasty?

This varies and you should check with your insurance provider.

What are the risks of vaginoplasty?

The risks vary slightly based on the extent of the surgery and why you have it. Some of the risks after vaginoplasty to treat injuries or congenital conditions can include:

• Dyspareunia (painful intercourse).
• Numbness or loss of sensation.
• Infection.
• Bleeding.

What are the benefits of vaginoplasty?

The benefits after surgery are improved sexual satisfaction and self-esteem. People who have the surgery often report a better quality of life after recovery.

What are the risks and benefits of vaginoplasty for gender affirmation?

One of the main benefits is relief from gender dysphoria. After surgery, people have genitals that align with the gender they identify with. This has enormous benefits on people’s mental health and improves their quality of life.

Risks of vaginoplasty for gender affirmation can include:

• Infection or excess bleeding.
• Vaginal stenosis (your vagina is too narrow and short).
• Vesicovaginal fistula (an abnormal connection between your vagina and urinary tract).
• Rectovaginal fistula (an abnormal connection between your vagina and rectum).
• Nerve injury.
• Being unhappy with the result.

What is recovery like after vaginoplasty?

Recovery may last anywhere from a few weeks to a few months, depending on the extent of surgery. Postsurgical care after vaginoplasty depends on the type of vaginoplasty you have. Your healthcare provider will go over recovery details so you know what to expect after surgery. For example, your healthcare provider may tell you to avoid things like sexual intercourse or inserting a tampon for several weeks. They’ll also go over how to best care for your incision and stitches.

Will I need to use a vaginal dilator?

Your healthcare provider may recommend the use of a dilator. This device gently stretches the inside of your vagina to maintain the depth and width of your vaginal canal.

When should I contact my healthcare provider after vaginoplasty?

Your care should include follow-up appointments to track your recovery. Contact your healthcare provider immediately if you experience complications.

These may include:

• Blood-soaked dressings, which can be a sign of excessive bleeding.
• Infections, which can cause a fever or yellowish discharge from the incision.
• Pain that doesn’t respond to pain medications.
• Signs of blood clots, such as abnormal swelling in your groin or lower leg.
• Vomiting and not being able to keep fluids down.

A note from Cleveland Clinic

You can have vaginoplasty for many reasons. Most of the time, it’s to improve confidence and sexual function. Some common reasons include to repair an injury, to fix a congenital anomaly or as part of gender affirmation surgery. There are several methods or techniques a surgeon may use to perform vaginoplasty. The risks and recovery process depend on the method your surgeon uses. Be sure to discuss your concerns about the surgery with your healthcare provider.