Vaginoplasty is considered an irreversible and good option for healthy patients who want gender affirming genital surgery.  Minimal or individualized depth vaginoplasty is a variation that is more appropriate for certain patients. Examples include individuals who do not desire vaginal intercourse, do not want to dilate, want to only be able to reach their prostate, or who want to minimize risk and avoid the potential for urinary or rectal complications.

 

PREOP REQUIREMENTS for vaginoplasty include:

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• 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.

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PROCEDURE OVERVIEW:

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General information:

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

• Duration of surgery: 3-4 hours

• Duration at medical facility: outpatient typically

• In town stay: 4 weeks on average

• Usually a 23 hour stay in the surgical facility.

• Support person required for minimum 2 weeks: from leaving hospital to second post op visit.

• Return to work for most patients is 8 weeks.

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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 excised.

• 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.