A vaginoplasty is a surgical procedure that constructs or reconstructs a vagina. The procedure can be performed on biological women who have experienced certain amounts of damage to the vagina due to physical trauma or childbirth. However, vaginoplasty is also performed as part of gender-reassignment surgery.

Understanding Male-to-Female Vaginoplasty

Male-to-Female Vaginoplasty (MTF for short) is the name given to vaginoplasty performed as part of gender-reassignment surgery. The goal of a male-to-female vaginoplasty is the construction of a feminine, natural-looking, functional vagina. The vagina that is the result of a male-to-female vaginoplasty is called the neovagina.

A successful neovagina has the following characteristics:

  • Normal voiding function.
  • Flexibility.
  • Moisture.
  • Sensitivity.
  • Hairlessness.
  • 10 cm in depth (minimum).
  • 3 - 4 cm in diameter (on average).

When considering undergoing MTF vaginoplasty, you have two procedure options. There are two types of MTM vaginoplasty techniques available: penile inversion vaginoplasty and rectosigmoid vaginoplasty.

The Basics of MTF Vaginoplasty

The basic difference between penile inversion vaginoplasty and rectosigmoid vaginoplasty is the way the lining of the vaginal tunnel is created. The two procedures have a lot in common, though, and to fully understand what a vaginoplasty entails it’s important to be aware of the way the entire surgical procedure works.

Any MTF vaginoplasty includes:

  • Orchiectomy (the removal of the testicles).
  • Penectomy (the removal of the penis).
  • The creation of a vaginal tunnel.
  • The harvesting of skin for the vaginal tunnel lining.
  • Labiaplasty (the creation of the labia minora and labia majora - the folds of skin surrounding the vulva).
  • Clitoroplasty (the surgical creation of a clitoris).

Read Labiaplasty: Why Women Care (Plus Pro Tips For Quick Labiaplasty Recovery).

The goals of any type of MTF vaginoplasty are:

  • To create a realistic, natural looking clitoris, labia and vagina.
  • To create a neovagina that is sensitive to the touch and wide and long enough for sexual penetration.
  • The preservation of the ability to experience sexual pleasure.
  • To create moist, hairless, and elastic lining for the vaginal tunnel.
  • To change the structure of the urinary tract so that the patient retains control over the bladder and the ability to urinate.

The aftermath of MTF vaginoplasty:

  • The incisions are closed with dissolvable sutures which take up to three months to completely dissolve.
  • Genital dressing, vaginal mould, and a urinary catheter are present for the first several months after the surgery and initially kept in place by the sutures.
  • Dilation is the crucial part of the recovery treatment which starts as soon as two or three days after the surgery - dilation helps form and maintain the new vaginal opening.
  • The recovery period and the full healing take up to 12 months on average.

While this is true for all MTF vaginoplasty surgery, the two procedures do have certain differences which are important to consider and discuss with your surgery once you have decided to undergo gender-reassignment surgery.

What is Penile Inversion Vaginoplasty?

The penile inversion vaginoplasty entails the creation of a neovagina using penile skin as its lining. During the procedure, the surgeon makes an incision in the area between the rectum and the prostate, creating a tunnel. This tunnel is turned into the new vaginal tunnel. The inside of the tunnel is lined with penile skin.

The penis and the testes are removed, and the penile skin is turned inside out and used to line the newly created vaginal cavity. A clitoris and the labia minora and labia majora are created by the performance of a labiaplasty and a clitoroplasty.

What is Rectosigmoid Vaginoplasty?

The rectosigmoid vaginoplasty starts off exactly like the penile inversion procedure: the penis and the testes are removed, and the vaginal tunnel of the neovagina is created through an incision between the rectum and the prostate.

However, the lining of the neovagina’s vaginal tunnel is created from a colon graft. The skin is taken from the section of the Sigmoid colon and the Sigmoid colon graft is used to line the vaginal tunnel.

The advantage of using the Sigmoid graft is the fact that this makes the neovagina self-lubricating. The drawback is that this means that there is another procedure involved in the surgery, which makes it a more invasive operation with a more intense recovery period. The surgery is completed with the labiaplasty and the clitoroplasty just like during the penile inversion vaginoplasty.

What Are the Benefits of a Penile Inversion Vaginoplasty?

  • Less invasive.
  • Absence of hair on the donor flap.
  • No odor issues.

Drawback: some patients don’t have sufficient penile skin for the creation of the vaginal lining.

What Are the Benefits of a Rectosigmoid Vaginoplasty?

  • Enables the procedure for those with insufficient penile skin.
  • Self-lubricating vaginal tunnel (due to the natural self-lubricating properties of the Sigmoid graft).

Drawback: a possibility for a strong, unpleasant odor persisting for months after the surgery is quite high.

Breaking It All Down

The only difference between the penile inversion vaginoplasty and the rectosigmoid vaginoplasty is the skin used to make the lining of the neovagina. This might sound like a small difference, but it has wider implications that are important to consider.