Vaginoplasty

Vaginoplasty is a gender affirming, lower body surgery that creates a vagina and vulva and removes and inverts the erectile tissue (penis), gonads (testes) and external genital (scrotal sac).

The goal is to have genitals with sexual sensation, a urethra that enables urination while sitting and a vagina capable of penetrative sex. You may be able to stop or reduce testosterone blockers or reduce estrogen dose after vaginoplasty. 

Referral & consult

Referral & consultation process

1Complete surgical readiness assessment

To get started, you will need to complete two surgical readiness assessments by qualified assessors, and meet the eligibility and criteria required for this surgery. After you have completed your assessments, your primary care provider will direct your referral to the available surgeon. Additional assessments may be required at the discretion of your surgeon.

2Review referral options

Your primary care provider will direct your referral to the surgeon office at GRS Clinic in Montreal. Visit the surgery referral page for steps required in the referral options for vaginoplasty. 

3Speak to your surgeon

You may want to speak to your surgeon about:

  • The gender-affirming surgery goal you have, specifically, around sexual penetration after surgery
  • The hair removal requirement prior to surgery - some surgeons do not recommend removing hair from the genitals before this surgery; others require it. Follow the advice of your surgeon. 
  • The need to stop taking hormones - the surgeons at the GRS clinic Montreal typically ask patients to stop taking hormone therapy medication three weeks before vaginoplasty
  • The different surgical techniques available
  • The advantages and disadvantages of each technique
  • What your options are if you are not satisfied with the appearance of your vulva, labia or clitoris
  • What your options are if you are having difficulty with sexual function
  • The limitations of a procedure to achieve "ideal" results
  • Whether they have before-and-after photographs of their own patients, including those of both successful and unsuccessful outcomes
  • The risks and possible complications of the various techniques
  • The surgeon's own complication rates for each procedure
Surgery

The procedure

The basic steps in a vaginoplasty are:

  1. The external genital (scrotum) and gonads (testes) are removed.
  2. The external genital (glans) is made into a clitoris.
  3. Space for the vagina is dissected between the bladder and the rectum.
  4. Skin from the shaft of the erectile tissue (penis) is inverted to create the inner walls of your vagina.
  5. Extra skin may be taken from the external genital (scrotum) to line your vagina. The hair roots on the skin graft will be cauterized.
  6. The urethra is shortened.
  7. Vulva (including a mons, labia, clitoris and urethral opening) are created using scrotal and urethral tissue.
  8. A temporary urinary catheter is inserted into the bladder.
  9. A temporary prosthesis or stent is inserted in the vagina.

Preparing for surgery

Be sure to review the pre-operative surgical package provided by surgeon's office before surgery. For more information about preparing for this surgery and about your post-operative care, contact GRS Montreal clinic directly.

While you wait for your referral to be processed, you should keep your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule consultation and surgery appointments.

You may also want to visit the Preparing for Surgery page to help you create a plan for success after surgery.

Complications

All surgical procedures involve some risks, including negative reactions to anesthesia, blood loss, blood clots and infection. These complications can, in extreme cases, result in death. It's important to discuss these risks in detail with your surgeon. 

Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise, and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Below are a list of some possible complications of this surgery. Please note - this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

An abscess is a collection of pus, caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon

 

when blood collects in the surgical site, causing pain, swelling and redness. Smaller hematomas can be drained, but larger ones require removal through surgery

 

Can lead to numbness or a change of sensation in the skin of the legs. In very rare cases, it can lead to difficulty moving the leg, which needs correction through surgery

 

You may have small areas of numbness. Your ability to achieve orgasm could decrease. Loss of clitoris is a remote possibility

when clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon

 

When an abnormal path between the rectum and vagina is created. Surgery would be needed to correct this

 

Examples include fistulas (flow of urine to areas other than the urethra opening), stenosis (narrowing of the urethra, causing difficulties urinating) and strictures (blockage of the urethra, causing difficulty urinating). It is common to have spraying or dribbling when urinating until your swelling settles down. If these problems don't resolve on their own, they may require additional surgery

 

Outcomes that are quite different from what was expected may require surgical revision

 




After surgery

Post-operative care

You will be admitted to the recovery residence in Montreal two days before your surgery. After your surgery, you will stay in hospital for three nights. Then you will return to the recovery residence for seven days. 

You will likely receive painkillers and antibiotics to prevent infection. Your surgeon will provide you with a list of medications to avoid for the first month. Do not resume taking hormones until your surgeon has advised you to do so.

During the healing process, you can expect:

  • bleeding during the first 48 hours following surgery
  • itchiness and small shooting electrical sensations as nerve endings heal
  • bruising, which can spread from your belly to your thighs and which takes 3 to 4 weeks to settle down
  • a bit of spraying when you urinate, which usually improves over time
  • swelling of your labia, which can take up to 6 weeks to resolve
  • brown or yellow vaginal discharge for the first 6-8 weeks
  • your vulva to approach its final appearance at 4 months
  • numbness, which will improve over the first few months, and can take up to 18 months to resolve
  • red, dark pink or purple scars, which take up to one year to fade

After surgery

A urinary catheter will be in place for the first five days after surgery to allow you to pass urine while your urethra heals. Sometimes people still aren't able to urinate when the catheter comes out, due to swelling around the urethra. This situation can easily be resolved with a second catheter that will remain in place for a week and be removed by your physician when you go home. You'll be encouraged to drink lots of fluids to prevent urinary tract infections.

A prosthesis or stent will be placed in your vagina during surgery and will remain there for 5 days to make sure the skin grafts stay in place. When it's removed, you will begin dilating and douching.

A vaginal douche is a process of rinsing the vagina by forcing water or another solution into the vagina to flush away vaginal discharge or other contents. The nurses in Montreal will show you how to douche.

You will be given a set of vaginal dilators of different sizes. You'll use them to maintain vaginal depth and width and promote healing. The nurses will teach you how to use your dilators and give you a schedule to follow. Initially, you'll dilate several times a day and over the first year the amount of time spent dilating will be gradually reduced. After you have completely healed, you will only need to dilate about once a week. The frequency depends on how much penetrative sex you have.

For the first two months after surgery, you will take sitz baths. A sitz bath is a way to soak your surgical site to keep it clean. Your nurses will provide you with the equipment and show you how to use it.

You'll want to wear thin maxi pads for about one month to manage post-operative bleeding and discharge.

Check-ups

The number of check-ups needed varies from person to person. If possible, see your primary care provider about a week after you return from Montreal and then every 2-4 weeks for the first few months. When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about dilating, bleeding, vaginal discharge, fever, pain and how you are feeling emotionally and physically.

Recovery time

Recovery time varies from person to person, so always follow the advice of your surgeon. Many people begin to feel more comfortable during the second week after their surgery. 

You'll need plenty of rest in the first two weeks. It's common to be back to your usual activities, including work, in six to eight weeks. Some activities, such as driving, heavy lifting, exercise, sex, and soaking in hot tubs, may be restricted in the post-operative period.

Your surgeon will give you advice about when it is okay to resume these activities. Complete recovery can take up to one year.

Surgical revision

A surgical revision of a vaginoplasty, if needed, would typically takes place 6 to 8 months after your surgery is complete. With a letter of recommendation from your surgeon, the cost of your revision will be covered by MSP.

Common reasons for a surgical revision include:

  • To adjust the size, shape, location or hooding of the clitoris
  • To adjust the size or shape of the labia minora or majora
  • To deepen the vagina
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