Vaginoplasty is a plastic surgery procedure performed to create and construct a vagina from the existing genital tissues. It is also performed for reconstruction in patients who complain of loose or slack vaginal tissue due to childbirth or aging, termed as posterior colporrhaphy. It involves the manipulation of the existing genital structures, even a penis or scrotum, in a way that results in the creation of a vagina and vulva constituting the labia minora, labia majora, and clitoris.

Other candidates for vaginoplasty include children born with congenital defects of the vagina, vulva, urethra, or rectum or patients who require reconstruction of vulval structure to normal anatomy after surgical removal of abnormal growths or abscesses.

The widened muscular space is reduced, the extra mucosal tissue is removed from the back of the vagina and moreover, the extra skin can also be removed which results in a tightened vaginal canal.

Indications of vaginoplasty

This plastic surgery procedure is performed for both reconstructive and cosmetic reasons. The indications include:

Intersex conditions like congenital adrenal hyperplasia, and gonadal dysgenesis
Vaginal atresia as in imperforate hymen or vaginal agenesis as in Rokitansky Syndrome
Vaginal prolapse or increased vaginal laxity due to multiple childbirth, aging, or trauma
Extensive surgeries of pelvic tumors or abscesses that involve removal of vaginal tissue

Penile inversion procedure

The penile inversion procedure is one of the most common constructive cases where vaginoplasty is employed to create a vulva and vagina out of the existing penile and scrotal tissue. The technique is the final stage of the gender-confirming process for many transgender women. This surgery is carried out in a way that the vaginal area has the depth as well as the appearance of a biologically developed vagina. This technique is considered as the gold standard for genital reconstruction among plastic surgeons. Ideally, this procedure provides a vaginal vault of sufficient size, adequate opening for introitus, and external appearance of a normally developed vulva. Moreover, the outcome is aimed at providing brilliant long-term function as well as minimal morbidity.

Before of vaginoplasty

Before the procedure, all patients undergo an extensive process of history taking and physical examination. The laboratory workup includes an ultrasonographic assessment of the abdomen and the pelvis, karyotyping, endocrinological assessment.

After of vaginoplasty

The penile inversion surgery is performed under general anesthesia. In this technique of vaginoplasty, the skin of the penis is used to construct the lining of the vagina. The vaginal canal is carved out in the space between the rectum and the urethra. If there is not enough skin to create the vaginal lining, skin grafts may be taken from different sites such as the inner thigh, lower abdomen, or the upper part of the buttock.

The skin of the penis is removed, inverted, and sutured into the cavity. The sensitive triangular skin at the tip of the penis is used to construct the clitoris and the scrotal skin is used to create the labia majora. The prostate gland is left intact where it acts as an erogenous zone like the G-spot in non-transgender females. This also prevents the complications of urinary incontinence or urethral strictures. The testicles are entirely removed and discarded in a process called orchidectomy.

Another way of constructing the vaginal wall is the use of the lining of the colon instead of the penile skin. In this procedure, a section of the sigmoid colon is mobilized and resected from the large intestine. The edges of the vaginal opening are sutured to the distal end of the sigmoid colon. Although the knowledge of this procedure and the outcome is limited, the advantage of this approach is the natural lubrication which in the case of penile skin has to be provided artificially. This technique of vaginoplasty also eliminates the necessity of long term use of vaginal dilators.

After this surgery, additional surgery is planned to further operate on the healed skin and manipulate and correct the positioning of the labia, the urethra, and vaginal canal, also known as secondary labiaplasty. The urethra is also shortened and repositioned to provide the smaller urethra found in females in front of the vagina.

The risks and complications of this procedure infection, bleeding, necrosis of the penile tissue used to create clitoris, rupture of the sutures causing vaginal prolapse, and fistulas due to damage to peripheral structures such as urethra or rectum. The postoperative complications are generally common but are minor and can be managed easily.

Vaginoplasty procedure ends up with a lifetime of commitment where post-operatively, the patient has to regularly dilate their vagina to keep it open. Initially, the vagina needs to be dilated multiple times during the day which then becomes less frequent as the healing process continues. Furthermore, the hospital stay significantly depends on the extent of manipulation done during the surgery. It usually is for almost a week. The patient is encouraged to urinate from a catheter for almost two weeks, return for regular follow-ups, and not perform strenuous exercises for almost six weeks after the surgery. For these reasons, the patient is also counseled on how to identify signs of urinary tract infection or surgical site infection and report immediately.


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