Vaginoplasty
Vaginoplasty is a surgical procedure that entails the construction of the interior of the vagina. Vaginoplasty is often described within the wide range of medical and surgical options offered to both trans women and natal females with either congenital variations of the reproductive system or genital trauma or cancer. Typically, vaginoplasty may be appropriate for individuals who have been involuntarily assigned male at birth because of differences in sexual development and for individuals who were labeled male or female at birth and have chosen or are considering hormone therapy as part of an intended gender transition. In any elective surgery, whether for the reduction of functionally disruptive gender dysphoria or for purposes of gender-based empowerment, a thorough understanding of the potential risks and benefits is required before making an informed decision.
People seek vaginoplasty for a variety of reasons, some of which may be emotional and some of which may be practical. In some people, the vagina is normally shaped, but its reduced function is a source of distress. The goal of vaginoplasty is to reshape the vulva to enable comfortable sex, wear a tight-fitting bathing suit, and allow for the discharge of menstrual blood. Vaginoplasty may be appealing to individuals who want to experience comfortable, spontaneous sex in a receptive position, and who want private places such as gyms and saunas, locker rooms, and restrooms where they can safely disrobe.
Suitability for Vaginoplasty
Vaginoplasty is not a one-size-fits-all or indeed one-path-fits-all solution. Each person’s situation is individual, and so too is the suitability of the optimum path forward. As a result of this, it is not uncommon to find yourself in a position in which you may not yet be deemed suitable to undertake vaginoplasty. For you to be considered for the surgery, it would likely be expected that:
- You are mentally ready for surgery and have received endorsement from a qualified mental health professional. Reaching a point of absolute certainty in your decision to move forward is paramount, as it means you are less likely to experience regrets following surgery.
- You have optimally managed any external life stressors you may be experiencing or are within the capability to manage these in parallel with your surgery.
- You have been able to cease self-medication with hormones that can impact your surgery but have been able to effectively manage your gender dysphoria without gender-affirming hormone care.
- In terms of physical health, it would be expected that:
- You do not meet any identified contraindications to surgery, which will be completed by a health professional; and
- You are in otherwise good health and well-being generally. The question of risk is always posed, particularly when it comes to major surgery.
Guidelines and best practices ensure that no person who presents with a serious and/or life-threatening contraindication to undergoing vaginoplasty surgery proceeds with this surgery. All individuals seeking surgery must undergo a thorough assessment to ensure this is indeed the case. Subsequently, there are very few people, relatively speaking, who are deemed not to be suitable or ready for surgery. The onus of determining the suitability of vaginoplasty lies with your healthcare provider and surgical team, who can determine whether you meet the medical guidelines and standards that ensure surgery does not involve unnecessary complications. Instead, it aims to provide you with the best possible outcomes while ensuring your emotional, psychological, and physical well-being. This assessment is conducted in order to support you through decision-making processes that regard your body, values, and experiences.
Consequential conversations and reflections on your candidacy require intimate details of your health, family, social, personal, vocational, and gendered experiences. It is important to facilitate these discussions with a suitable healthcare provider in order to ensure the best likelihood of positive outcomes. Anyone moving towards surgery, in relationship with their healthcare provider, should have the ability to ask questions, clarify anything of which they are uncertain, and explore different aspects or concerns regarding their health, sexuality, and reproduction.
Recovery Process and Timeline
Starting at day two to three after your discharge from the hospital, the tucking technique is unnecessary unless there is retraction of the tissues between the vagina and perineum, which would present as the vagina tipping forward and the perineum tipping rearward. As the swelling in the area decreases, the vagina will develop a more normal position on the body. Also, patients should lay on their back with their hips and head both lifted with pillows for the first week to avoid putting pressure on the area. Expect at least 3 months to 1 year of ongoing reduction of swelling and a year to two years for full sensory recovery. Gradually, patients will need to increase walking over 3 weeks to six months in order to develop limberness, flexibility, strength, and a stride wide and comfortable enough to naturally fit a penis-shaped hard dilator. Dilating will involve the insertion of a lubricated, extending soft silicone dilator into your vulva to keep the canal open and flexible, and will begin at 6 to 8 weeks after surgery. A water-based lubricant is available off the shelf and can be applied to the dilator. Dilating should be performed 3 times daily at six to eight, 10 to 12 weeks, and at an additional time each day, with insertion time gradually working up to 45 minutes. Hormonal care will continue before, during, and/or after surgery as part of our comprehensive genital healthcare plan. A wound-check appointment post-procedure provides an opportunity to review dilation needs prior to discharge. It is important to follow up with your prescriber 4 to 6 weeks post-op and continue with your 3-month follow-up post-operative genital HRT services. Dilation should continue once a day for at least 20 minutes during the first year. If the vaginal graft stays too tight, dilation is critical and should be performed more frequently.
Aftercare and Postoperative Instructions
Women who have undergone vaginoplasty are advised to maintain good personal hygiene in the postoperative period. The use of a menstrual pad is suggested initially. Menstrual pads should be changed multiple times in the initial postoperative phase and subsequently as per requirement. Regular showers are encouraged based on patient comfort and surgical site care. Patients will receive specific instructions regarding hygiene during individual follow-up visits by the operating surgeon. Adherence to prescribed medications is crucial for optimal recovery. Resuming normal activity in the postoperative period must be a gradual and slow process based on individual recovery. Activity restrictions recommended for the recovery period will depend on the technique used, surgical complexities, and individual progress. Careful instructions will be provided by the operating surgeon initially and gradually modified based on recovery. Sharp, scratchy, or hot food particles can cause injury to the operative site. Consumption of rough foods must be avoided while the incision is healing. Instructions on the use of topical or any other medications will be given depending on the need.
Patients may be asked to apply topical ointments to the incision. Do not apply any other types of skin ointments or cleansers to the incision or skin. Washing hair can be done as needed. It is important to avoid contamination and infection of the operative area. The surgical dressing should remain intact and dry postoperatively unless otherwise instructed. To avoid infection at the wound site, monitor the operative area and dressing for unusual symptoms. In case of any signs of infection, unusual discharge, an unpleasant smell, excessive bleeding, or a long-term elevated temperature, surgical consultation should be obtained. Emotional adjustment can be a gradual process. It is important to have proper rest and recuperation. During recovery, some emotional aspects in adjustment to the surgical outcome may require assistance; psychological consultation may be undertaken. It is important for women to discuss their feelings with spouses, friends, and support groups during the postoperative recovery stages. The postoperative recovery period and possible complications should be regularly discussed at individual follow-up visits. A cooperative doctor-patient relationship is the key to an optimal outcome of surgery.
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