Is Vaginoplasty Safe? We Take a Look at the Risks

 Side Effects and Risks

1. Infection: post-operative surgical site infection is very common in patients who undergo surgery. In some cases, the infection continues and the process of necrosis starts.  
2. Permanent changes in sensation due to permanent damage to innervation
3. Consistent pain: recurrent or chronic pain may be experienced by the patient after undergoing vaginoplasty. It may occur from the nerve damage
4. Dyspareunia: painful sexual intercourse. This may be due to adhesions or scarring that are irritated or tucked in during sex. 
5. Scarring, strictures, and adhesions: Some cases of vaginoplasty have also been reported where strictures have formed and narrowing of the vaginal orifices have occurred. This has resulted in another surgery to reduce strictures or painful scarring. Additional surgeries are also performed to treat the tissue adhesions formed as a result of the vaginoplasty procedure.  
6. Fistula formation: a specific risk of vaginoplasty includes rectoneovaginal fistula or urethrovaginal fistula formation due to intraoperative damage to these structures that may usually require corrective surgery. A small rectovaginal fistula usually passes flatus while a larger fistula may even pass stool through the fistula into the vagina. 
7. Prolapse of the uterovaginal or vaginal vault may occur as a result of vaginoplasty where the content of the vagina or uterus protrudes from the opening.
8. Urinary tract infections are also common after vaginoplasty. Moreover, urinary incontinence and loss of bladder control are also some of the complications that are experienced by the patients post-operatively. Patients with recurrent UTIs shall get assessed for urinary strictures. Poor hygiene and hydration also contribute to the development of UTIs in postoperative patients. 
9. There is an increased risk of developing peritonitis in cases where the peritoneal cavity is breached. Other risks involving intestinal vaginoplasty include paralytic ileus and  constipation
10. Vaginal stenosis: A patient after a vaginoplasty is at an increased risk of developing vaginal stenosis especially after inadequate dilatation of the vagina in the early stages of healing and not being adherent to the dilatation regimen set by the surgeon. 
11. Granulation tissue formation: post-operatively the patient is at the risk of developing granulation tissue in the vaginal wall. This may result from delayed healing which is further exacerbated by the postoperative frequent dilation causing repeated trauma to the healing site. 

With all these risks involved in undergoing this surgery, the decision to undergo this procedure is significant. Moreover, in order to reach a decision if one should undergo a vaginoplasty, it is important to consider the difference between reconstructive surgical procedures and cosmetic surgery. For instance, in the case of a nose job, the manipulation in the inner nasal cavities can be done for the sake of appearances – cosmetic reasons, or in order to help the patient who presents with symptoms of difficulty breathing due to the structure of his nose – reconstructive procedure. 

In the case of vaginoplasty, the experts encourage the procedure for patients who present with complaints of urinary incontinence or birth defects, that must be restructured in order to improve the function of the vulva but, undergoing the surgery for cosmetic reasons and only improving the aesthetics is discouraged not only because of the risks involved but also because of the lack of evidence and data on safety and effectiveness of the outcome. 

Although the elective healthcare field is ever-growing with a wide variety of options on vaginal rejuvenation, the limited amount of understanding and efficacy of these procedures lead to risks of these procedures outweighing the mere need for aesthetic refinement. Therefore, patients should be made aware that any procedure requested for altering the sexual appearance or function is not medically indicated because of the substantial risks it carries and the unestablished effectiveness of the procedure. 

References:

1. Davies MC, Creighton SM. Vaginoplasty. Current opinion in urology. 2007 Nov 1;17(6):415-8.
2. Gaither TW, Awad MA, Osterberg EC, Murphy GP, Romero A, Bowers ML, Breyer BN. Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients. The Journal of urology. 2018 Mar;199(3):760-5.
3. Pariser JJ, Kim N. Transgender vaginoplasty: techniques and outcomes. Translational andrology and urology. 2019 Jun;8(3):241.
4. Amies Oelschlager AM, Kirby A, Breech L. Evaluation and management of vaginoplasty complications. Current Opinion in Obstetrics and Gynecology. 2017 Oct 1;29(5):316-21.
5. Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male‐to‐female transsexuals. The journal of sexual medicine. 2015 Jul;12(7):1626-34.