Vaginoplasty: Penile Inversion

Vaginoplasty is considered an irreversible and good option for healthy patients who want gender affirming genital surgery.  

 

PREOP REQUIREMENTS for vaginoplasty include:

  • Three letters (2 from mental health professionals, 1 from a hormone provider or primary care doctor).

  • Overall good health.

  • No smoking, nicotine, or any other inhalational products (including second hand smoke) around 3 months before and after surgery. This can cause about a 5-fold increase in complications. Patients who smoke within this 3 month window before surgery may be rescheduled for a later time when then they have reliably stopped smoking.

  • Hair removal.

  • Perioperative assistance (friends, family, hired help).

  • Surgical technique, anatomy, and genetics dictate most of the individualized aesthetic results.

 

PROCEDURE OVERVIEW:

General information:

  • Team members: Reconstructive Surgeon, associated surgical and perioperative care staff

  • Duration of surgery: 4 - 5 hours

  • Duration at medical facility: 3 nights on average

  • In town stay: 4 weeks on average

Surgery:

  • The testicles are removed and excess scrotal skin is excised; residual scrotal skin will be used to create the labia majora.

  • Penile skin is preserved for construction of the vaginal canal. For a majority of patients, scrotal skin is used as the deeper portion of the vaginal lining. In some instances, additional skin from the groin or abdomen can be recruited.

  • Urethral shortening: the urethral excess is excised. A portion of the urethra is used for the internal lining and the inner labia minora. The new urethral opening is placed in anatomical position above the vaginal opening.

  • Clitoroplasty: the glans of the penis is reduced in size and positioned appropriately, and a clitoral hood is created; the neurovascular bundle is kept intact. 

  • Below are illustrations that represent the procedure. Note that individual results will vary and that each patient may have results that differ from the final cartoon.

1. Surgical markings (labeled).jpg
2. Orchidectomy (labeled).jpg
3. Neovagina (labeled).jpg
4. Penis sections (labeled).jpeg
5. Clitoris formation (labeled).jpeg
6. Skin graft (labeled).jpeg
7. Graft placement (labeled).jpg
8. Final result (labeled).jpg