Vaginal reconstruction surgery, also known as vaginoplasty, is a surgical procedure to repair or create a vagina. In addition to repairing vaginal injuries, vaginal reconstruction surgery is also performed to treat congenital irregularities of the female reproductive system, incontinence, vaginal dryness, painful sex, and gender affirmation surgery.
Is Vaginal Reconstruction Surgery (Vaginoplasty) the Same as Vaginal Rejuvenation?
According to the American College of Obstetricians and Gynecologists (ACOG), vaginal rejuvenation is marketed as an umbrella term for several types of corrective treatments for the vagina, both surgical and non-surgical.
Vaginoplasty, or vaginal reconstruction surgery falls under the term vaginal rejuvenation.
Medically, vaginal rejuvenation more accurately refers to reducing the width of the vagina or ‘tightening’ it through vaginoplasty or vaginal dilation therapy. These types of vaginal rejuvenation are often performed to alleviate uterine prolapse, birthing injuries, vaginal laxity, and incontinence after vaginal childbirth.
They are also commonly recommended to relieve vaginal dryness (atrophy) and dyspareunia (painful sex) due to natural aging and menopause.
That said, vaginoplasty is also performed to repair vaginal injuries, correct abnormalities, create an absent or underdeveloped vagina since birth, or construct a vagina (and vulva) from male genitalia during gender affirmation surgery.
Other forms of vaginal rejuvenation include labiaplasty, vulvoplasty, and clitoral hood reduction. Each of these is generally performed as an elective surgery to improve the outer appearance of the female genitals cosmetically, but also for medical reasons.
Conditions Treated & Improved by Vaginoplasty
As outlined above, vaginoplasty is performed for cosmetic and functional reasons. Cosmetic reasons, in addition to improving the outer appearance of the vagina, can also include improving how your vagina feels on the inside.
Functional reasons requiring vaginoplasty often include the following:
Vaginal Childbirth
After delivering one or more children vaginally, women's vaginal muscles, perineum, and pelvic floor muscles can loosen and lose their elasticity. In addition to incontinence, uterine or pelvic prolapse, sexual pleasure and function can also be diminished. In these cases, vaginoplasty can help ‘tighten’ the vagina by shortening the muscles at the back of the vagina and removing the excess tissue.
Congenital Conditions
Congenital conditions (conditions present at birth) that affect how the vagina looks and functions can also be treated with vaginoplasty. Women with MRKH syndrome, for instance, who are born with a missing uterus and/or under-developed vagina can experience vast improvements in self-esteem, sexual pleasure, and overall quality of life after vaginoplasty.
Medical Treatments
Medical conditions and subsequent treatments such as radiation treatment for uterine cancer, or the removal of the vagina due to cervical cancer can be helped with vaginoplasty. In these cases, vaginoplasty is sometimes performed to reconstruct the part of the vagina that was removed or damaged.
Gender Affirmation
Vaginoplasty is one part of the feminizing bottom surgery for persons assigned male at birth (AMA) undergoing gender affirmation surgery.
How Long Does the Surgical Procedure for Vaginoplasty Take?
How long it takes to perform vaginoplasty is based on the reason for the surgery. A vaginoplasty carried out to relieve vaginal looseness, incontinence, or dyspareunia could last 3-5 hours, whereas a vaginoplasty to construct a new vagina could take up to 10 hours.
What is the Preparation Procedure for Vaginoplasty?
Before vaginoplasty, each patient will undergo a series of consultations and tests to assess their medical history, determine if the surgery is right for them, and if their body is healthy enough to recover from the surgery. The extent of the tests and consultations will largely depend on why each patient is undergoing vaginoplasty. In some cases, a sex therapist or counselor is recommended to help patients adapt to the results of vaginoplasty.
What Does Vaginoplasty Involve?
What vaginoplasty involves will vary from patient to patient. A woman having vaginoplasty to construct a missing upper vagina due to MRKH syndrome or other congenital abnormalities for example, will undergo a different procedure to women having a vaginoplasty to treat prolapse, vaginal looseness, or incontinence.
Vaginoplasty to ‘tighten’ the vagina, repair an injury, treat incontinence, or relieve dyspareunia often includes:
- The removal of extra muscle, tissue, or sagging skin
- Removing loose skin from the vaginal opening to reduce its size
- Administering dissolvable sutures to stitch loose vaginal tissue into the wall of the vaginal canal
Vaginoplasty to treat, remove, or repair congenital abnormalities often involves the following.
- The removal of abnormalities, extra tissue, or unusual growths
- Making a hole in a partially formed vagina and using tissue grafts from elsewhere in the body to create a functional vagina
- In the absence of a cervix, an outlet is created to allow the flow of menstrual bleeding
What Does Vaginoplasty for Gender Affirmation Surgery Involve?
Vaginoplasty for gender affirmation begins with penectomy and orchiectomy, which is the surgical removal of the penis, penile skin, and penile tissue, as well as the testicles and scrotum.
A vaginal canal is then created by shaping a space between the rectum and the bladder. The penile skin is used to construct the vaginal walls, labia (labioplasty), and clitoris (clitoroplasty). And to maintain the new shape of the vaginal canal, a medical tool called a conformer is placed inside to hold the skin in place.
Recovering After Vaginoplasty
Depending on the extent of your vaginoplasty you might stay in the hospital for a few days or you may go home after 24-48 hours. You will have bandages, sutures, a catheter to help you urinate as you heal, and possibly surgical drains for a few days. You will be prescribed pain medication and antibiotics to prevent infection and both should be taken timely as advised by your surgeon.
Before surgery, surgeons will typically outline the steps you will encounter during recovery, and provide guidelines for optimal healing, such as refraining from sex, strenuous activities, heavy lifting, and getting plenty of rest. They will also explain how to clean and wash the surgical site(s) to prevent infection.
In the first few days and weeks of recovery after vaginoplasty, the following are considered normal:
- Some mild pain and discomfort even after pain medication
- Light bleeding for approximately 48 hours after surgery
- Inflammation and bruising around the genital area for a few weeks
- A catheter for up to a week
- Itching and numbness as the nerve endings heal
- Fatigue and tiredness
- Vaginoplasty for gender affirmation can result in swelling that causes temporary urine dribbles
Recovery Tips for Vaginoplasty
It can take six weeks to heal from the surgery and a little longer for the body to fully recover from vaginoplasty. For the first four weeks, patients are advised to schedule time off work, wear loose clothing, eat and hydrate well, and get as much rest as possible to promote healing.
As the muscles and tissues of the vagina heal, it’s normal to feel some tightness or limited range of motion in the area. To alleviate this, surgeons typically recommend using a set of vaginal dilators to maintain the shape of the new vaginal canal. Sold in sets of gradually increasing sizes and widths, modern vaginal dilators are made with plastic or medical-grade silicone as opposed to traditional dilators made from glass.
Some patients are advised to begin vaginal dilation a week after surgery, while others might be advised to wait a further week or two. Always check with your surgeon as to when you should start vaginal dilation and follow their advice on continuing with smaller dilators even if you feel ready for a larger one.
Vaginal Dilators: How Long Will You Use Them After Vaginoplasty?
When to start using dilators after vaginoplasty can vary for each patient and is generally advised by your surgeon. They are recommended to maintain the size of the new vagina, improve blood flow, and prevent the vaginal walls from sticking together.
Women who have undergone a vaginoplasty to ‘tighten’ the vagina after childbirth, or repair it after injuries, will find dilators helpful to prepare the vagina, and self-confidence, for penetrative sex. Once patients have enjoyed a pain-free sexual experience they may not need to continue vaginal dilation, but many women continue to keep the vagina healthy and elastic well into their elderly years.
After vaginoplasty for gender assignment, or to construct a new vaginal canal due to congenital disorders, dilators are used to gradually increase the size of the vaginal canal, as well as prepare it for penetration. In these cases, patients are often encouraged to continue vaginal dilation for the rest of their lives to maintain the integrity of the new vagina.
What are the Risks & Benefits of Vaginoplasty?
Whether you have vaginoplasty to treat a congenital disorder, relieve vaginal looseness, alleviate incontinence, or for gender affirmation, the benefits include improved self-esteem, better mental health and quality of life, and enhanced sexual pleasure.
There are also some risks involved, such as excessive bleeding, infections, numbness, and pain during sex.
In addition to these, the risks of vaginoplasty for gender affirmation can also include a dislike of their new vagina, an abnormal connection between the vagina and urinary tract, or between the vagina and the rectum, and vaginal stenosis, which is when the vagina feels too tight or too short.
Conclusion
As well as gender assignment surgery, vaginoplasty is performed for several medical reasons associated with female health. These often include injury repairs after vaginal childbirth or to relieve incontinence, atrophy, vaginal looseness, and pain during sex. Vaginoplasty is also used to repair a congenital disorder involving the abnormal appearance or absence of the vagina.
There are risks as well as benefits to vaginoplasty and anyone considering the procedure is advised to discuss all aspects and concerns with their healthcare provider before deciding on such a life-changing surgery.
References
Web MD – Vaginoplasty and Labiaplasty - https://www.webmd.com/women/vaginoplasty-and-labiaplasty-procedures
American College of Obstetricians & Gynecologists - https://www.acog.org/womens-health/faqs/vaginal-rejuvenation-labiaplasty-and-other-female-genital-cosmetic-surgery
National Library of Medicine - Vaginal Reconstruction in Patients with Mayer–Rokitansky–Küster–Hauser Syndrome—One Centre Experience - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404697/
American Society of Plastic Surgery - Aesthetic Genital Plastic Surgery - https://www.plasticsurgery.org/cosmetic-procedures/aesthetic-genital-plastic-surgery/vaginoplasty
American Society of Plastic Surgeons - Gender Confirmation Surgeries - https://www.plasticsurgery.org/reconstructive-procedures/gender-confirmation-surgeries
National Library of Medicine - Management of Reproductive Tract Anomalies - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5425643/
American Society of Plastic Surgeons - Transfeminine Bottom Surgery - https://www.plasticsurgery.org/reconstructive-procedures/transfeminine-bottom-surgery/safety
The London Transgender Clinic – How Does Dilation Work after Gender Confirmation Surgery - https://www.thelondontransgenderclinic.uk/general/how-does-dilation-work-after-gender-confirmation-surgery/