Vagina refers to the elastic, muscular part of the female genitalia extending from the vulva to the cervix. Among other purposes its most important function is sexual function. The penis penetrates into the vagina for sexual act. Hence, it is a characteristic feature of women and many Trans women prefer to have a vagina as it symbolises feminism which in turn helps reducing their identity crisis and it also helps them in healthy sexual functioning. Having a vagina may also decrease social and physical dysphoria.

Vagina is created in Trans women through the process of vaginoplasty. It consists of several different procedures.

The objectives of the surgeon during vaginoplasty are:

• To retain the ability of the person to have orgasms
• To create a clitoris, labia and an opening to the vagina that looks realistic. They should also retain good touch sensation.
• To create a vagina wide and deep enough for sexual penetration may it be by fingers or dildo or penis. It should hold its shape and not crumble in pressure.
• The finishing should be done such that it has moist elastic and hairless lining.
• To change the structure of the urinary tract so as to change the direction of urinal flow in a way the person can urinate in a downward direction and in a steady stream.

Pre surgery Events:

• You will most likely be admitted to hospital the day before your surgery.

• Blood tests will be conducted to check your overall health, and you will likely have ECG to measure your heart function; if there are any concerns about your lungs you may have a chest X-ray.

• You will also have a “bowel prep” to flush out excretory fluid and substances clean out your intestines. This both helps prevent problems during surgery and also give you a couple days of rest so you don’t have to strain to go to the bathroom after surgery regularly.

• You will be told not to eat or drink any solids and fluids after midnight the night before you have surgery. The region that will be operated on will be shaved.

• After your surgery, you will be observed for progress by hospital staff as you come out of the anaesthetic.

• You will then have to stay in hospital until you are recovered enough to be sent home – this usually takes 6–8 days but every person has a different recovery period.

• In the early stages of recovery you will be restricted to bed rest. The nurses will help you in excretory functions from the bed.

• You will likely be hooked up to a PCA machine that lets you take pain medication whenever necessary.

• You will also be given antibiotics and medication to prevent blood clots and infections.

• A rod-shaped prosthesis will be put in your vaginal opening and will be left there at a certain depth for five days to help the newly formed vaginal wall.

• A sterile tube will be placed in your new urethra to drain your bladder of urine. Five days after surgery, both the tube and prosthesis will be removed for the surgeon to check on your healing, and you will get instructions on your vaginal health, along with information for you to follow when you go home.

POST SURGERY EVENTS:

• You will see the surgeon at least once in the week after surgery and after recovery you may consult at regular intervals.

• The surgeon will conduct a physical health check-up and will also check your new vagina for healing and sensation.

• You will be asked questions about your bowel movement and bladder function, and the regions of surgical incisions will be inspected for infection and scarring. The surgeon may put a finger inside your vagina to check healing.

• For the first 8 weeks after vaginoplasty you will continue to wear prosthesis inside your vagina most of the time. At first, you can only take it out once a day, when you do routine cleaning.

• The duration the prosthesis is left out will gradually increase with the supervision of the surgeon. You will have to continue to dilate your vagina every day, either by penetrative sex by dildo or penis or fingers, or using the dilator, to keep your vagina open. If you do not dilate the vagina for an adequate amount of time every day, your vagina may become narrow and short.

• Adhesive strips will be used to bring the edges of the incision together and promote healing. Nurse or surgeon will monitor this incision and change your dressings on a regular basis.

• After you go home, schedule an appointment with your regular GP or nurse to check the recovery progress of the graft site and make sure it is free from any kind of infection. It is normal for the incisions to redden, but the redness shouldn’t be at a distance of more than 1–2 cm from the incision. If this happens it can be suspected as infection and should be notified to the surgeon immediately.

• You can go back to your usual routine when you feel well enough to do so or when it isn’t painful anymore. This is typically 4–6 weeks but can take longer in some cases. You should avoid any strenuous activity until you have fully recovered as it may have an adverse effect on your heart.

RISKS AND COMPLICATIONS RELATED TO THE SURGERY:

• Serious infection
• rupture of stitches so that the wound keeps opening more and more
• bleeding with pus more than a few weeks after surgery (minor bleeding after dilation can be considered normal and can be controlled by applying little pressure on the vagina)
• Vaginal discharge containing pus in it
• Gas or faeces leak from vagina: this indicates a tear between your vagina and rectum
• Any signs of tissue death. This can be suspected if you see any mottled skin that progressively becomes darker.
• Vaginal penetration is unbearably or unusually painful or difficult
• Difficulty in urinating, painful urination, decreased amount of urine, or need more time and effort to urinate
• Vagina protrudes outside partially from the body.
• Severe scarring