Vaginoplasty is often talked about, and oftentimes when discussing vaginoplasty, people seem to talk about similar and, yet, quite different surgical procedures. This can be very confusing.

In a nutshell, a vaginoplasty is a surgical procedure which reconstructs the vagina in biological women, and constructs a new vagina (neovagina) in biological men.

When talking about vaginoplasty, it’s important to clarify if we’re talking about vaginoplasty as a vaginal rejuvenation procedure, vaginal reconstruction, or as a gender-reassignment surgery. (Read Your Comprehensive Guide to Perineoplasty: Procedures & Recovery Tips to Vaginal Rejuvenation.)

Vaginoplasty as Vaginal Rejuvenation

Vaginal rejuvenation is a cosmetic treatment designed to tighten the vagina, stop incontinence and eliminate vaginal dryness. Vaginal rejuvenation can be non-surgical (dietary supplements, use of vaginal weights in pelvic exercises, vaginal tightening cream), or surgical.

Vaginoplasty, in this context also referred to as vagina tightening, is a surgical vaginal rejuvenation option.

Who Needs Vaginal Rejuvenation?

Some may experience changes in their vaginas after childbirth or as a natural consequence of aging. These changes may include the stretching of vaginal tissue and loss of sensitivity, which lead both to cosmetic changes in the aesthetics of the vagina as well as a change in the experiencing of sexual pleasure.

Some opt for vaginoplasty in an effort to tighten the vagina and reconstruct its shape. A vaginoplasty in this context is a purely cosmetic procedure.

What to Expect When Undergoing Vaginoplasty

During a vaginoplasty, the surgeon brings together the separated vaginal muscles, making the vaginal tunnel tighter. Extra mucosa skin is removed in the process. During the procedure, the surgeon will mark a pie-shaped wedge inside the vagina to delineate the excess skin that is to be removed. The tissue which is behind the skin is tightened with sutures, and the mucosal skin is sutured closed.

The expected downtime after a vaginoplasty is two weeks. Any type of penetration, including sexual intercourse and usage of tampons, is forbidden for eight weeks after the surgery to give the vaginal canal sufficient healing time.

Additional Procedures Used With Vaginoplasty

A vaginoplasty is most often accompanied by other cosmetic procedures which further reconstruct the vagina. In fact, this is so common that the term “vaginoplasty” is mostly considered to include at least one of the following procedures:

Vaginoplasty as Vaginal Reconstruction

Vaginal reconstruction is a surgical procedure that reconstructs the vagina after suffering trauma in the vaginal area. The trauma can be a consequence of injury, assault, genital mutilation, or illness. While vaginal rejuvenation is a purely cosmetic procedure, vaginal reconstruction is a surgical procedure which brings back the function of the damaged vagina while simultaneously reconstructing it aesthetically.

Vaginal reconstruction includes:

  • The repairing or constructing of the labia minora and labia majora.
  • The repairing or reconstructing of the vaginal canal.
  • The repairing or reconstructing of the urethra and rectum.
  • Clitoroplasty (the surgical creation of a clitoris).

Who Needs Vaginal Reconstruction?

Vaginal reconstruction is a surgical procedure used to treat the following conditions:

  • Pelvic organ prolapse (the collapse of the pelvic floor which results in the dislocation of pelvic organs as a consequence of gynecological cancer, heavy lifting or childbirth).
  • Damage caused by the treatments of malignant growths or abscesses.
  • The protrusion of the urinary bladder or the rectum into the vagina.
  • Congenital adrenal hyperplasia.

Vaginoplasty as Gender Reassignment Surgery

Vaginoplasty, when is performed as part of gender reassignment surgery, is called male-to-female vaginoplasty (MTF vaginoplasty). The goal of MTF vaginoplasty is the construction of the neovagina. The neovagina is a surgically constructed natural looking, fully functional vagina.

There are two types of MTF vaginoplasty: penile inversion vaginoplasty and rectosigmoid vaginoplasty.

MTF Vaginoplasty: The Procedure

MTF vaginoplasty is a highly invasive, complex surgical procedure which entails the following steps:

  1. Orchiectomy: the removal of the testicles.
  2. Penectomy: the removal of the penis.
  3. The harvesting of the penile skin and inverting it to prepare it for lining the vaginal canal (in penile inversion vaginoplasty).
  4. The harvesting of the sigmoid graft (in rectosigmoid vaginoplasty).
  5. The creation of the vaginal canal: an incision is made between the rectum and the prostate which is then lined with the penile skin and dilated to create the vaginal cavity.
  6. Labiaplasty: the creation of the labia minora and labia majora - the folds of skin surrounding the vulva.
  7. Clitoroplasty: the surgical creation of a clitoris.
  8. The closing of the vaginal incision with dissolvable sutures.
  9. The placement of genital dressing, vaginal mold, and a urinary catheter.

Essentially, during a male-to-female vaginoplasty the male sexual organs are removed, and the skin of the penis, scrotum, or a Sigmoid colon section are used to create the lining of what is to become the neovagina.

The vaginal tunnel is created through an incision which spans from the rectum to the prostate, and additional cosmetic surgery is done on the outer parts of the body to construct a clitoris and the labia minora and labia majora.

What to Expect From MTF Vaginoplasty

The end result of a MTF vaginoplasty is the a functional neovagina. The created neovagina is flexible, moist, hairless, with normal voiding function. The neovagina is sensitive to the touch and the patient will be able to feel sexual pleasure. The patient will have also retained control over the bladder.

The average dimensions of the neovagina are 10 cm in depth and 3 - 4 cm in diameter.

MTF vaginoplasty is an invasive procedure with a long healing period. The surgery has an expected recovery period of about a year, with regular dilation being a crucial part of the healing procedure and maintenance.