Often known as “the surgery” by the media, genital surgery for trans women has come a long way since 1930.
Suggestive flower is suggestive
What exactly is vaginoplasty? Labiaplasty? Why different terms?
Vaginoplasty specifically refers to the creation or modification of a vagina. Labiaplasty is the creation or modification of the labia. I used both terms in the title because they can be different surgeries. It’s also important to note that the terms are sometimes used for surgeries for cis women – often to reduce the size of the inner labia to “smooth out” the appearance. For simplicity’s sake, for the rest of this FAQ I’ll use the term “vaginoplasty” to refer to the whole of genital surgery for trans women.
What kinds of vaginoplasty are available?
There are two basic kinds: penile inversion and colon graft. Penile inversion involves taking skin from the penis and using it to create the vagina. The skin of the scrotum is used to create outer labia. The nerves and part of the head of the penis are preserved and used to form a clitoris. Some variations on these basic principles include:
- Using tissue from the urethra to create the lining on the inside of the labia. This may help to produce a pinkish color to the area and additional lubrication.
- Performing a second surgery to refine the labia. This may improve the appearance of the labia.
- Scrotal tissue may be used to line the vagina. Naturally, this tissue would need to have all hair removed by electrolysis or laser therapy beforehand.
- Using tissue from the inside of the cheek to line some portion of the vagina. This may provide additional lubrication.
Colon graft is not as common, but still practiced today. This uses tissue from the colon to line the vagina. Many of the other techniques involved are the same. Colon tissue provides its own lubrication, but may also present issues of odor or unusual color.
Why would I want vaginoplasty?
Everyone is different, but these are factors I have heard…
- Reduction of dysphoria, whether you desire simply not to have a penis or desire to have a vagina.
- No more need to “tuck”, which can be uncomfortable and encourage yeast infections. No more bulge to hide!
- Safety. No more fear of being accidentally “outed” by a straying hand or eye and assaulted because of it.
- Better access to women-only spaces, such as changing rooms and bathrooms. Also, no staring in clothing-optional spaces such as hot springs!
- Being better able to sit down to pee
- Having vaginal penetration during sex
Can you tell me more about the surgery? Does it require full anesthesia? How long would I be in the hospital? What kind of recovery time am I looking at?
Vaginoplasty is major surgery. It absolutely requires full anesthesia (besides, would you really want to be conscious?!). Surgery length depends on the type of surgery and your surgeon. Expect to be in the hospital for several days, and staying in the area for at least a week.
Full recovery will take months. You may be able to return to a desk job in two weeks, and able to return to more strenuous activity in eight. This depends on your surgeon of course. As I said, this is major surgery.
Your surgeon and their staff will instruct and assist you in specific aftercare: Drains, antibiotic ointments, cotton packing/padding, hygiene, and so on. Dilation I’m covering in a separation question.
Naturally you’ll need to abstain from sex for a period of time. Your surgeon will give you thorough instructions. If s/he omits an activity you’re interested in, please ask before trying!
A set of dilators from Soul Source
Tell me about dilation!
The “neo”-vagina needs to heal. The body’s natural response to “wounds” is to close them up. Your body responds to your new vagina as if it’s a wound and tries to close it up. A dilator is a plastic rod that is inserted into the vagina to hold it open and stretch out the tissue, keeping it open. Some dilators even come in pretty colors! You can think of it like a new piercing – a new piercing will close up without something in it to keep it open. Unlike a piercing, a dilator is not used constantly.
Dilation needs to be done multiple times a day at first. Your surgeon will instruct you in their use and make sure you’re using them correctly. Over time you will be able to go down to once a day or even less often.
If by any chance you lose depth, dilation may be a possible way to regain it. It’s been used to increase depth in cis women who are born with short vaginas. But it takes time, and please do consult your physician.
Penetrative sex can help keep the vagina open, but not as well as a dilator. Don’t replace dilation with penetrative sex unless your physician(s) tell you it’s okay!
What are the possible risks?
As with any major surgery, vaginoplasty carries risks that could affect your long-term health. In addition to the risks of anesthesia, vaginoplasty carries the following health risks:
- Urinary problems, including urinary stricture (narrowing of the opening of the urethra)
- Fistula, or a hole between the vagina and rectum. This requires follow-up procedures and may require the complete closure of the vagina to allow for healing.
- Blood clots. The risk of blood clots is reduced by stopping hormones before surgery, but the risk is still there. A blood clot can, rarely, be fatal.
- Infection and death of tissue
- Blood loss leading to a transfusion – if you are religious this may be an issue for you
Among the more “minor” problems are…
- Loss of sensation or a change in sensation. This is a major surgery in which nerves are cut, simply because that’s the nature of surgery. Nerves can and do regrow, but they don’t always regrow “right”. You may lose sensation, though surgeons do their best to prevent it.
- Scarring. Scars are usually minor in the end and/or hidden by hair, but scars do occasionally retain color or stay raised.
Be prepared to face these risks. They are generally rare, but they do happen.
How deep will my vagina be? How sensitive with the clitoris be? Will I be able to orgasm? Will I be able to have penetrative sex?
Vaginas made via vaginoplasty are generally about as deep as a cis vagina: anywhere from 5-6 inches. Some surgeons offer a revision surgery which can be used to deepen a vagina if you’re not happy. Modern vaginoplasty techniques are designed to keep sensitivity, so your clitoris will likely be sensitive if all goes well.
Orgasm and penetrative sex are usually achievable. Post-op women generally report that their sexual experiences feel different, but I can’t comment on “how”. Keep in mind that not all cis women can orgasm, so it makes sense that not all trans women can orgasm. Enjoy your experiences, whether they involve orgasm or penetration or not!
Will the fact that I’m circumcised/uncircumcised matter?
Generally speaking, no. Don’t stress about it.
Can I have vaginoplasty if I never went through natal puberty?
Yes! And surgeons are reporting satisfactory depth for people using the penile inversion technique. A skin graft from elsewhere in the body might be necessary for depth, but surgeons are reporting success without it.
It’s the wrong lube, Gromit!
How is a trans vagina different from a cis vagina? What about lubrication?
Again, it does depend on the surgeon and the technique. For women who had a penile inversion, in general the vagina is less stretchy and more liable to tearing for a trans woman than a cis woman. But I’ve heard reports of OB/GYNs unable to tell the difference. So relax!
I highly recommend you check out resources like the Wall of Vagina if you’re concerned about final appearance looking “normal”. Cis women vary enormously. Chances are, you’ll fit right in.
Believe it or not, the vagina of a post-op women does lubricate. The fluid itself is thought to be a result of glands like the prostate which remain. Not all women find that it’s sufficient by itself for vigorous penetrative sex, though. Don’t be afraid to use lube – and do remember to have fun! If your lubrication is still too little for comfort, speak with your physician. An estrogen cream may be helpful.
Will vaginoplasty affect my long-term health? Pap smears?
Aside from the risks of surgery, the biggest effect to long-term health is the removal of the testes. For those risks, check out the FAQ on orchiectomy.
Trans women after vaginoplasty do NOT need a pap smear. A pap smear is a specific test that looks at the cell shapes and types of cervical cells. A vaginoplasty will not give you a cervix, so you are at no risk for cervical cancer and do not need to be screened. However, a “neo” vagina can get torn or for some other reason need to be medically examined. This is part of why it’s important to have a primary care physician you’re comfortable with!
Since you would now have a vagina, there is some TLC that vaginas tend to need. Vaginas are dynamic systems. Your smell, taste and sense of touch will change depending on a myriad of variables. You are still susceptible to sexually transmitted infections. Get to know your vagina so that you can alert a physician if something changes.
Be aware that the vagina is made of skin. Like other vaginas, it can develop cancers. Another good reason to get to know your body!
Your vagina will grow its own set of flora (yes – all vaginas have their own micro-organisms living in them!). While after surgery your surgeon will tell you to douche, after that period douching is typically considered bad. It destroys the delicate balance of flora in the vagina and can lead to yeast infections.
Remember: If you have it, get it checked!
Will the prostate be removed?
No. Depending on what your physician says, you may still need prostate screenings. Some women report that it’s easier to feel the prostate through the vagina than through the rectum. So if you enjoy prostate stimulation, try it that way!
You will need to learn to pee all over again. Such fun. The shower is a great place to practice, but expect to have some… interesting urinary experiences. Also note that your urethra will be shorter after vaginoplasty, so you may be more prone to urinary tract infections. So hydrate well, and seek medical care if you develop burning during urination that doesn’t go away.
Are there any health conditions that mean I can’t get it?
I do not know of any absolute contraindicators. Even if you do not have a penis, tissue from other areas can be used to create a vagina.
However, some surgeons may have their own requirements like being a certain BMI. There are conditions, like diabetes, heart disease, or infection that need to be controlled before surgery can be attempted.
Anything else I should know?
Your mileage will vary, depending on your body, how you take care of yourself pre and post-op, and your surgeon. Remember to do your own research – this is just a starting point! Your surgeon should have results photos s/he can share with you. Talk with other women about their experiences as you make your decision.
Resources I should check out?