Vaginoplasty

Vaginoplasty

Vaginoplasty is surgery done to reconstruct, make or repair the vaginal canal and other structures thereof. It could be done for:  

• Part of gender-affirmation surgery in male-to-female transsexual patients
• Birth defects (such as vaginal agenesis, MRKH syndrome) 
• Reconstruction following trauma or cancer surgery. 
• Trauma, vaginal laxity (functional or cosmetic, after childbirth, or from) sexual activity.  

Vaginoplasty surgery  

Vaginoplasty is a surgical procedure to construct or reconstruct the vagina.  It may be needed for:

• Sex reassignment surgery in male-to-female transsexuals. 
• Birth defects (such as vaginal agenesis, MRKH syndrome) 
• Post-traumatic reconstruction, oncologic surgery and childbirth injury. 
• Vaginal structural functional or cosmetic enhancement.

Vaginoplasty procedure types

Gender-Affirming Vaginoplasty (MTF) / Male to Female

Penis inversion vaginoplasty 

• The procedure most commonly used.
• The vaginal canal is developed by inverting penile skin.
• The glans is modified and becomes clitoral.
• Labia minora and majora are formed on the scrotal skin.
• Produces a natural functional, aesthetically natural vagina.

Peritoneal (Non-Penile Skin) Vaginoplasty

• The implants are placed beneath the inner lining of the abdomen (the peritoneum). 
• Appropriate when patients have a limited penile/scrotal skin.
• Gives lubrication and natural tissue quality.

Intestinal (Sigmoid Colon) Vaginoplasty

• The vaginal lining is created from a small section of the colon. 
• Offers self-lubrication.
• Chosen in revision cases or in case of inadequate skin.

Reconstructive Vaginoplasty

For Congenital Infections (e.g., MRKH)

Methods are:

• McIndoe Vaginoplasty: Incised vaginal cylinder in with full thickness skin graft. 
• Vecchietti Procedure: Minimal invasive procedure of traction to form a neovagina.
• Davydov Procedure: This procedure utilizes the peritoneal lining as a vagina.

Post Trauma or Post Cancer reconstruction

• Resorts to local flap, skin grafting, or bowel patches.
• Rejuvenates vaginal function and looks.

Advantages of Vaginoplasty

• Expands the vaginal passage.
• Improves sexual function
• Improves the body image and gender dysphoria.
• Reconstructs the vagina following trauma or natural loss.
• Allows uterine menstrual discharge in MRKH cases (in the presence of a uterus)

Vaginoplasty procedure

Precise procedures will depend on the form of vaginoplasty; however, the outline presented below represents the typical penile inversion vaginoplasty; the most commonly used type. Other approaches also have supplementary measures.

Preparation for the operation 

Medical Assessment 

• Blood tests, hormonal tests
• Anaesthesia assessment
• Checking skin availability by genital examination.

Counselling & Planning

• Discussion of expectations
• Instructions for electrolysis/laser hair removal.
• Stop smoking a minimum of 4-6 weeks prior to surgery.

Pre-Op Instructions

• 8-hour pre-operative fasting.
• Bowel preparation (in certain procedures)

Anaesthesia

• General anaesthesia is given.
• The whole surgery takes place when you are asleep and in pain.

Creation of Vaginal Space

Incision

• A line is excised in between the anus and scrotum.

Dissection

• A delicate area between the rectum and urethra is cut.
• This canal is transformed into the neovaginal canal.
• Depth normally aimed at: 12-15 cm, though varies with anatomy.

Vaginal Lining Preparation

Penile Inversion Technique

• The inner lining is created by preserving and inverting penile skin.
• The skin is depilitated.
• It may also be made deeper by adding scrotal skin.

Vaginoplasty (peritoneal) (when preferred)

• Laparoscopic or robotic.
• Abdominal peritoneal tissue is used as lining.
• Offers soft and damp skin.

Intestinal (Sigmoid Colon) Vaginoplasty

• A short section of the sigmoid colon is employed.
• Self-lubricating
• Typically to do a revision or poor skin.

Development of External Female Genitalia

Clitoris Formation

• The end of the glans penis that contains nerves is formed into a clitoris.
• This enables sexual sensation to be preserved.

Labia Minora

• Inner lip formation is done with the help of penile skin flaps.

Labia Majora

• The skin of the scrotum is moulded to outer lips.

Vaginal Opening

• Created at the natural anatomical position.

Positioning and Urethral Shortening

• The urethra is diminutive and re-oriented downwards just like a natural female urethra.
• Normal urination, no spraying.

Final Assembly

• Vaginal lining is introduced in the canal.
• The shaping of labia/clitoris is cosmetic.
• To stay in shape, a vaginal stent (mold) is inserted.
• To avoid the accumulation of fluid, drains can be put.

Closure

• Every incision was closed by using absorbable sutures.
• Protective dressing on the region.

Acute Post-Surgical Management

Hospital Stay

• 5–7 days

Initial Care Includes:

• Catheter for urine drainage
• Packing of vagina taken out 3-5 days later.
• Pain management
• Antibiotics
• Mobilization after 24–48 hours

Dilation Phase (Very Important)

• Beginning: Day 5-7 (after removal has been packed)

Schedule:

• Weeks 1–6: 3–4 times per day
• Months 2–6: 1–2 times per day
• Months 6–12: 1–3 times per week
• Lifetime: As required in order to sustain depth.
• The vaginal constriction (stenosis) is avoided because of dilation.

Long-Term Recovery

• Return to light work: 2–3 weeks
• Strenuous activity: 6 weeks
• Sexual intercourse: 8–12 weeks
• Full healing: 3–6 months
• The duration of sensation is up to 1 year.

Factors Affecting Vaginoplasty cost

The following are the determinants of the vaginoplasty cost in a nutshell:

Type of Vaginoplasty

• Penile inversion
• Peritoneal vaginoplasty
• Raised intestinal (sigmoid) vaginoplasty.
• The more complex methods are more expensive.

Surgeon’s Experience

• Surgeons with high level of skill or expertise are very costly.

Hospital Category

• Premium hospitals cost more
• Multi-specialty versus single-specialty centers.

Tests and consultations before surgery

• Blood tests, x-rays, hormone testing, counselling.

Anaesthesia & Operating Time 

• Prolonged surgery and expert anaesthesia raise the expense.

Grafts or Bowel Surgery

• Skin grafts, peritoneal tissue or intestinal segments are an added cost.

Hospital Stay Duration

• Increased inpatient stay leads to higher costs.

Post-operative Services and Supplies

• Dilation kits
• Dressings
• Follow-up visits

Need for Revision Surgery

• Any further alterations increase overall cost.

City/Location

• The cost of living in big cities is higher than that in small cities. 

Best hospital for vaginoplasty India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Vaginoplasty is a very specialized surgery used to make, make, or recreate the vagina in people who are having gender affirmation, people with congenital syndromes such as MRKH syndrome or need vaginoplasty due to trauma or disease. Surgeons are able to produce an appearance that is natural, depth of functional vaginoplasty as well as the preservation of sensation using the advanced techniques of penile inversion, peritoneal, and intestinal vaginoplasty. This can only be successful when there is good preoperative planning, selection of a qualified surgical staff and adherence to stringent postoperative care, particularly regular dilation.

Vaginoplasty surgery India GetWellGo

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• Language Support
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• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
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FAQ

1. Is vaginoplasty permanent?

• Yes. After healing, the neovagina is permanent, but regular dilation is necessary to maintain depth and to avoid stenosis.

2. How long does the surgery take?

• Vaginoplasty requires 3–6 h, depending on the technique.

3. Is dilation necessary after vaginoplasty?

• Yes. Dilation is important to keep the vagina open and deep, particularly during the first year.

4. Will I have sensation after vaginoplasty?

• Yes. The majority of patients (70-90%) regain sexual sensation, particularly if the clitoris (GLB) is preserved with nerve supply.

5. Does the neovagina self-lubricate?

• Penile inversion: No (needs external lubrication).When it comes to genitals, post-surgical neovagina does not have the natural lubrication of cisgenital women.
• Peritoneal/intestinal vaginoplasty: Yes, offers natural lubrication.

6. Can I menstruate or get pregnant after vaginoplasty?

• Transgender women: No menstruation, no pregnancy.
• MRKH patients: They do menstruate if a uterus is present; pregnancy may be achieved via surrogacy in certain cases.

7. Will the vagina look natural after surgery?

• Yes. Using up-to-date techniques best results are achieved for both external and internal genital anatomy and natural look and feel.a