Vagina & vulva construction
Having surgery to create a vagina and vulva is a step that some people choose to help them feel comfortable in their bodies and reach their gender goals.
Surgical options to create a vulva and vagina
A vulva and vagina (if desired) can be created through two different procedures — vulvoplasty and vaginoplasty.
Vulvoplasty
The goal of vulvoplasty is to create a vulva with a mons, labia, clitoris and urethral opening. With vulvoplasty, the vagina will have minimal or no depth. This surgery allows you to:
- Pee sitting down
- Stop or reduce testosterone blockers and reduce estrogen dose
- Have an orgasm (many people retain or develop the ability to orgasm)
You might choose this surgery based on personal preferences or considerations. Reasons you may choose vulvoplasty include:
- You don’t want a vagina.
- You don’t want to, or are unable to, maintain the demanding dilation and aftercare routine associated with vaginoplasty.
- You may have individual circumstances that make vaginoplasty not possible for you or your body.
Surgical techniques vary from surgeon to surgeon, but in general vulvoplasty includes the following steps:
- The external genitals (penis and scrotum) and gonads (testes) are removed
- The sensitive erogenous tissue (glans) is made into a clitoris
- The urethra is shortened
- Vulva (including a mons, labia, clitoris and urethral opening) are created using scrotal and urethral tissue
- A temporary urinary catheter is inserted into the bladder
Vaginoplasty
Like vulvoplasty, vaginoplasty creates a vulva with a mons, labia, clitoris and urethral opening. Unlike vulvoplasty, vaginoplasty creates a vagina with depth. This surgery allows you to:
- Pee sitting down
- Stop or reduce testosterone blockers and reduce estrogen dose
- Have an orgasm (many people retain or develop the ability to orgasm.)
- Have receptive vaginal sex
You might choose this surgery if you want to have a vagina and are willing and able to maintain the demanding dilation and aftercare routine required.
Surgical techniques vary from surgeon to surgeon, but in general vaginoplasty includes the following steps:
- The external genital (scrotum) and gonads (testes) are removed.
- The external genital (glans) is made into a clitoris.
- Space for the vagina is created between the bladder and the rectum.
- Skin from the shaft of the erectile tissue (penis) is inverted to create the inner walls of the vagina.
- Extra skin may be taken from the external genital (scrotum) to line your vagina. The hair roots on the skin graft will be cauterized.
- The urethra is shortened.
- Vulva (including a mons, labia, clitoris and urethral opening) are created using scrotal and urethral tissue.
- A temporary urinary catheter is inserted into the bladder.
- A temporary packing or stent is inserted in the vagina.
Risks & complications
All medical interventions have potential risks and benefits. It’s important that you understand the risks of having surgery so you can decide whether the potential benefits outweigh the potential risk of surgical complications. This list is not intended to scare you or dissuade you from having surgery but rather to help you make an informed decision.
General risks associated with surgery
Anesthesia issues — Some people experience a negative reaction to anesthesia.
Cardiovascular issues — Such as blood loss, blood clots and artery blockages.
Hematoma — This is when blood collects in the surgical site, causing pain, swelling and redness. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.
Seroma — This is when clear fluid accumulates in the surgical site. Your surgeon will manage this complication. The ways in which it might be managed include monitoring, clinical exam, ultrasound or possibly drainage.
Infection — This is when microorganisms such as bacteria get inside the body. Infection can occur at different locations such as the surgical site or bladder and are generally treated with antibiotics.
Abscess formation — This is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.
Wound separation — This is when there is a partial or complete opening of incisions along the sutures.
Nerve damage and pain — There is a wide range of possible experiences related to how nerves heal after surgery. Some changes are short term and some are long term or permanent. Some changes are mild and inconvenient, while others are painful and distressing. Changes can include numbness, increased sensitivity, burning sensations and nerve displacement (sensation may feel like it’s occurring in one place but the stimulus is in another part of the body). Speak with your surgical team about any concerns you have about sensation or pain management.
Scarring — Scarring can be reduced by following your surgeon’s advice, which may include activity restrictions, avoiding sun, seeing a physiotherapist or massage therapist and doing massage exercises (if recommended). Severe scarring may require medical intervention or surgical revision.
Postoperative regret — Regret can happen for several reasons, such as experiencing significant complications or being dissatisfied with the outcome of surgery.
Risks specific to vulva and vagina construction
Injury to the nerves or muscles in the legs — Can lead to numbness or a change of sensation in the skin of the legs. In very rare cases, it can lead to difficulty moving the leg, which needs correction through surgery.
Loss of sensation — You may have small areas of numbness. Your ability to achieve orgasm could decrease. Loss of clitoris is a remote possibility.
Urological complications — Examples include fistulas (flow of urine to areas other than the urethra opening), stenosis (narrowing of the urethra, causing difficulties urinating) and strictures (blockage of the urethra, causing difficulty urinating). It is common to have spraying or dribbling when urinating until your swelling settles down. If these problems don’t resolve on their own, they may require additional surgery.
Unsatisfactory appearance — Outcomes that are quite different from what was expected may require surgical revision.
Rectovaginal fistula — When an abnormal path between the rectum and vagina is created. Surgery would be needed to correct this. Applies to vaginoplasty only.
Change in libido — Your desire may no longer feel as spontaneous, requiring more time to engage in pleasurable stimuli to experience arousal.