In male-to-female (MtF) gender confirmation surgery, also known as vaginoplasty, a neovagina (new vagina) is constructed. The goal of this procedure is to create a vagina that is functionally and aesthetically similar to a cisgender female’s vagina.

Here’s a basic outline of what happens in a typical penile inversion vaginoplasty, one of the most common techniques used:

1. Construction of the Vagina: The skin from the penis and, in some cases, a section of the scrotal skin, is inverted and used to create the vaginal canal. Sometimes, additional skin grafts may be needed to provide sufficient depth.
2. Creation of the Vulva: The labia majora and minora are crafted from scrotal and penile skin, and the clitoris is formed from a portion of the glans penis, with the aim of preserving sexual sensation.
3. Urethral Shortening: The urethra is shortened and repositioned to approximate the typical female anatomical position.

After healing, the appearance of the neovagina and vulva can be very similar to those of cisgender women, but individual results can vary depending on factors like the surgeon’s technique, the individual’s healing process, and whether additional procedures like labiaplasty are performed.

One key difference is that neovaginas do not self-lubricate to the same extent as cisgender female vaginas, due to the different nature of the tissues used. Therefore, sexual activity and the use of dilators for maintaining vaginal depth often require the use of a lubricant.

Another important point is that the neovagina does not connect to a uterus or ovaries, as in cisgender females, so menstruation and pregnancy are not possible.

Like any major surgery, vaginoplasty comes with potential risks, including infection, bleeding, and complications from anesthesia. It’s also possible for complications like vaginal prolapse or stenosis (narrowing of the vagina) to occur. A period of recovery and vaginal dilation to maintain depth and prevent closure is necessary after the procedure.

Remember that this information is accurate as of my last training data up until September 2021, and the procedures might have been updated or changed since then. Always consult with healthcare professionals to get the most recent and relevant information.