Vaginoplasty for transgender women, often referred to as male-to-female (MTF) gender confirmation surgery or gender-affirming genital surgery, is a surgical procedure that constructs a neovagina. The primary goal of this procedure is to create a vagina and external genitalia (vulva) that are functionally and cosmetically similar to cisgender female genitalia. Here’s a broad overview:

  1. Types of Vaginoplasty:
    • Penile Inversion: This is the most common technique where the skin of the penis and, sometimes, a portion of the scrotum is used to construct the vaginal lining. The erectile tissue is removed, and the glans (head) of the penis is reshaped to form a clitoris.
    • Intestinal Vaginoplasty: In cases where there isn’t enough penile or scrotal skin, a segment of the intestine (usually the sigmoid colon) can be used to form the vaginal lining. This technique provides adequate vaginal depth and is self-lubricating, but it may come with different complications or require more upkeep.
    • Non-penile Inversion Techniques: These methods use other tissues, such as scrotal grafts or peritoneal lining, to create the vaginal canal.
  2. Surgical Results:
    • A sensate clitoris and vulva are typically created.
    • A neovagina is constructed with an adequate depth and width for sexual intercourse.
    • Urethral repositioning allows for urination in a sitting position.
  3. Risks and Complications:
    • As with any surgery, potential complications can include infection, bleeding, scarring, and adverse reactions to anesthesia.
    • There’s a risk of fistula formation, where an unintended connection develops between the vagina and another structure, like the rectum or urethra.
    • Stenosis, or narrowing of the vaginal opening, can occur, requiring dilation or additional procedures.
    • The neovagina may not self-lubricate, necessitating lubrication during sexual intercourse.
    • Loss of or reduced sensitivity is a potential risk, though most procedures aim to preserve as much sensation as possible.
  4. Recovery:
    • Hospitalization typically lasts a few days post-surgery.
    • Complete rest and limited movement are usually advised for several weeks.
    • Regular dilation of the neovagina, using medical dilators, is crucial to maintain its depth and width. This regimen might be intensive initially and gradually decrease in frequency.
    • Most people can return to non-strenuous work after 6-8 weeks.
  5. Emotional Considerations:
    • The surgery can have profound emotional and psychological implications. For many, it brings relief from gender dysphoria and an alignment of physical and gender identity.
    • However, like any significant life event, post-operative periods might come with a range of emotions. Mental health support is beneficial.
  6. Cost:
    • Vaginoplasty can be expensive. Some insurance companies in certain countries or regions cover the procedure, but many people face out-of-pocket expenses.
  7. Alternative Procedures:
    • Some transgender women opt for a less invasive procedure called an orchiectomy (removal of the testicles) without vaginoplasty.
    • There’s also a procedure called vulvoplasty, which creates external female genitalia without a vaginal canal.

Choosing to undergo vaginoplasty is a deeply personal decision. As with any surgery, it’s essential to consult with experienced surgeons, gather comprehensive information, and consider the potential risks, benefits, and implications.