Vaginoplasty

Who is this treatment suitable for?

Transgender patients transitioning from male to female and non-binary.

Before any surgery can be carried out patients will have to have followed a care pathway through their local GIC (Gender Identity Clinic) involving hormone treatment and psychological assessment. Some patients will also go through the private sector which shortens their journey. Rather than going through an NHS GIC they will use a private specialist in gender therapy, of which there are several and your surgeon can discuss with you further.

What does the treatment involve?

During the operation, your Consultant will:

• remove the testicles and the majority of the erectile tissue
• create the vagina and labia minora and majora from the penis and scrotal sack
• create a clitoris from the glans of penis, still connected to nerve and blood supply
• shorten and reposition the urethra in the normal position so that you can urinate.

The external skin of the penis becomes the internal lining of the vagina. In some instances where there is not enough penile skin, some of the scrotal tissue will also need to be used. The vagina is inserted into the space between the bladder and rectum and cuts are made to expose the clitoris and urethra.

How should I prepare for the surgery?

• You will need to have a BMI of 28 or lower.
• You should be as fit as you can.
• Stop smoking 8 weeks prior, including vaping and recreational drugs.
• You will need to stop taking hormones 6 weeks before the date of you operation.
• Some patients may need to undergo hair removal treatment prior to surgery. Your surgeon will assess you at your initial appointment and advise if you need hair removal and what treatment is best for you.

How long is the recovery process?

During your initial consultation a specialist nurse will fully explain to you what to expect on your return from recovery. Patients will be provided with a comprehensive list of how to prepare for surgery, what to bring into hospital and advice on how to prepare for your discharge. Patients will follow a care pathway and you will be provided with a plan that you can follow each day. Patients must ensure they have robust plans for their travel home.

You can expect to be in hospital for 7 days after having a vaginoplasty. Your Consultant will give you a compression that reduces inflammation (swelling) after your surgery.

All patients are on strict bed rest for the first 3 days. The pack will come out on day 5 and patients can begin walking around.

After the dressing is removed you will be taught how to dilate and douche your neo-vagina. This is to keep the size and shape of the vagina and also to prevent narrowing or closing. You will have 2 further days in hospital to become confident with dilation. You will need to continue this for the rest of your life however it will decrease in frequency. A full detailed plan of how you will be decreasing your dilating will be given on discharge.

You will be provided with a sick certificate for 12 weeks from your operation date. All patients are seen at around 8-10 weeks for a follow up consultation with the surgeon.

Specific risks and complications of this treatment

As with all surgeries there are risks involved with being under general anaesthetic. All patients are fully assessed for their safety prior to surgery. It is the patient’s responsibility to disclose all medical and surgical history to the consultant or specialist nurses. Any non-disclosure could result in your surgery being cancelled. Specific risks and complications will be discussed in detail at your consultation.