Vaginoplasty

Vaginoplasty is a surgery that aligns your body with your gender identity by creating a vagina with aesthetically accurate vulva, or the labia majora, labia minora, and clitoris.

The vagina is functional for penetrative sex, ensures the ability to urinate, holds its shape, and is sensitive to the touch. Every effort is made to preserve the ability to orgasm, please discuss more with your surgeon.

Vaginoplasty is a major surgery that can be completed using different techniques such as:

Penile Inversion

• The most common vaginoplasty technique is a penile inversion, where existing genital tissue is used to create a vaginal canal.

Peritoneal Vaginoplasty

• This is often used as a secondary salvage procedure and recommended as secondary stage procedure in cases of poor outcomes
• Peritoneal vaginoplasty uses a combination of genital tissue and lining of the abdominal cavity, the peritoneum, to create a vaginal canal. The vulva or external parts are formed from a combination of different genital tissues. 

Non full depth vaginoplasty options

Some patients may desire partial vaginoplasty—zero or shallow depth, nullification/flat front, and penial preservation are options as well.

Your navigator, primary care provider (PCP), and surgeon can help direct you to resources and information to make a decision that is best for you.

Genital hair reduction aka surgical site treatment

• Genital hair reduction is a highly recommended (required by most surgeons) and should be completed by laser hair removal and/or electrolysis over the course of 9 to 12 months before surgery.
• In some patients, surgical site treatment can take up to 18 months.

FERTILITY

• Sterilizing procedure, meaning biological children will not be possible after completion. Having a family planning and fertility discussion with your care team is an important step in your surgery process

HORMONE PRODUCTION

Undergoing vaginoplasty permanently removes your body’s ability to produce hormone (testosterone).

It is important for your health to take hormones for life to help prevent osteoporosis (weakening of the bones) and to help regulate your mood.

Plan with your PCP to stop spironolactone after surgery and adjust your hormone therapy as needed.

SEXUAL HEALTH

Change in sex drive and sexual functioning

RISK

• Does not remove prostate, recommended cancer screenings are still necessary.
• Vaginoplasty is a major surgery which carries standard risks and complications.

DILATION

Dilation is a lifelong commitment to maintain canal depth, patients may benefit from pelvic floor physical therapy before & after surgery

Patients who understand the surgical procedures for vaginoplasty often have a more successful consultation experience.

Your navigator will provide surgical education and help you prepare for consult. Talking through your expectations, desired outcome, and concerns can be helpful practice prior to seeing a surgeon.

It is essential that you and your surgeon agree on a surgical plan that will be gender affirming to you. 

It is important to note that desired outcomes may not be surgically possible due to anatomy and surgical limitations, please discuss possible limitations with surgeon for best understanding.

Bring a list of questions to ask your surgeon at the consultation to help you plan for your surgery and set expectations. If you don’t understand something, it’s okay to ask your surgeon to repeat or explain it in a different way.

Expectations

• Do you have pictures of your surgery results? 
• Will I be able to have an orgasm and what sexual functioning changes occur? 
• Will I need more than one surgery?
• What are the possible complications of this surgery?
• What can I expect healing to look like?
• How important is dilation and how can I maintain vaginal depth?
• What is the typical depth someone can maintain after vaginoplasty?

Planning

• What choices do I have in surgery procedures and what is best for me? 
• What should I be doing to get the best surgical results? 
• Where will my surgery take place and how long will it take?
• How long will I need to take off work/school?
• When can I resume physical activity or go back to work? 
• What medications, supplements, and hormones do I need to alter or stop before surgery?

Your PCP, surgeon, and Gender Health Navigator can help you achieve optimal surgical outcomes by actively preparing for your surgery and making sure expectations are surgically possible.

PHYSICAL HEALTH

• Maintain a healthy body weight, high body weight can increase complications and interfere with wound healing.
• Although there is not a strict Body Mass Index (BMI) requirement, your surgeon may discuss specific anesthesia risks or considerations, depending on your BMI. It is beneficial to reach your own personal sustainable goal weight prior to surgery

MENTAL HEALTH/WELLNESS

• Having surgery takes both physical and mental preparation.  Surgery is stressful, some people feel an increase in depression or anxiety after surgery. 
• If you notice any changes in your mood or sleep, especially with anesthesia, please discuss with your care team.
• If you struggle with mental health, reach out to your mental health provider or navigator for support.

SMOKING

• Nicotine intake by smoking, patches, chewing gum, or vaping may interfere with wound healing. If you use nicotine, you should discuss a quit date with your PCP and surgeon. Surgeons require patients to stop nicotine prior to surgery and may test for confirmation.
• If you inhale cannabis, it’s important to find another way to use it, for example, topical, edibles, and tinctures, or to stop altogether.

SUPPORT

Build your network of support with providers, family, and community to help you plan and organize your recovery prior to and after surgery

• Transportation to and from appointments 
• Meal planning and preparation
• Providing a calm and supportive healing space

Everyone heals differently.  Patients will experience:

• different levels of pain,
• bruising, swelling, and
• fluid drainage at incision sites.

Each aftercare recovery plan is catered to a patient’s unique medical needs. You will receive post-op care instructions from your surgeon, make sure to review these instructions with your surgeon, PCP, and navigator as needed.

For optimal results and to help avoid complications, it is essential to follow post-op directions and engage in follow-up care appointments as scheduled. Your surgeon will cover post-surgery topics, such as:

• Dilation procedure and frequency
• Sexual health and penetrative sex
• Hormone changes and effect on hormone therapy
• Exercise and physical activity
• Healing process and final appearance
• Complications

• Medicare A&B
• Full Scope Medi-cal
• San Francisco Health Plan (Medi-cal, Healthy Workers and Healthy Families)
• Anthem (Medi-cal)
• Healthy San Francisco (Health Access Program)