Vaginoplasty: What to Expect on the Day of Surgery

A vaginoplasty—also called transfeminine bottom surgery—entails creating a new vagina, most commonly from the inverted skin of the penis. A surgeon who specializes in gender-affirming surgery will perform the vaginoplasty under general anesthesia in an operating room within a hospital.

Before the Surgery

On the actual day of your surgery, you will arrive at the hospital and go to a pre-operative room. Here, you can expect the following:

• You will change into a gown and store your clothes and personal items in a plastic bag.
• A nurse will place an intravenous (IV) line for delivering fluids and medications.
• Your vital signs will be recorded and monitored.
• Members of the surgical and anesthesia team will meet with you briefly to review the surgery.

Next, you will be taken into the operating room where you will lie on your back on a padded operating table with your hips and knees flexed at 90 degrees. Your feet will be placed on padded stirrups to keep the hips, knees, and ankles aligned. You will then be given anesthesia medication to put you to sleep.

During the Surgery

Once you are in the operating room and are asleep, the anesthesiologist will insert a breathing tube through your mouth and into your airway. The breathing tube is connected to a ventilator, which helps with breathing during surgery.

The anesthesiologist will remain in the operating room during the entire surgery to monitor your vitals and adjust your medications, accordingly.

There are different surgical techniques for a vaginoplasty:

• Penile inversion vaginoplasty: A vagina is created from the inverted skin of the penis.
• Intestinal vaginoplasty: A vagina is created from a portion of the small intestine or colon.

The penile inversion technique is the most researched and commonly utilized procedure. This technique involves the following steps:

• The skin from the penis is removed and turned inside out to create the lining of the new vaginal cavity.
• A part of the head (glans) of the penis will be reshaped to create the clitoris
• A new opening for the urethra will be made to allow for urination.
• Skin from the scrotum will be used to create the labia majora
• The vagina canal, which has a depth of about 5 inches, will be created from scrotal tissue. If not enough skin is available, a skin graft may be taken from the hip, lower abdomen, or inner thigh.
• The prostate is left in place to avoid problems, like urinary incontinence.
• Once the surgery is completed, which may last seven hours (it's variable), you will be taken to a recovery room.

Orchiectomy

It's important to mention that as part of the surgical transition process, surgeons will remove the person's testicles, either prior to the vaginoplasty (in a separate surgery) or in conjunction with the vaginoplasty. The removal of the testicles is called an orchiectomy.

An orchiectomy takes about 20 minutes and may be performed under general anesthesia in an operating room in a hospital or under local anesthesia in a urologist's clinic.

After the Surgery

After the surgery, you will be taken to a recovery room for a couple of hours where a nurse will monitor your heart rate, blood pressure, and pain level as you wake up. From there, you will be taken to a hospital room where you can expect to remain for approximately five to seven days.

Once in your hospital room, the following care measures will be taken:

• Your diet will be restricted to ice chips right after your surgery, clear liquids the day after surgery, and then eventually, a regular diet, as tolerated.
• Your pain will be initially controlled with IV pain medication and then switched to an oral opioid once you can start eating.
• Since pain medication can make you constipated, you will be given a stool softener once or twice daily.
• Your activity will initially be restricted to bed rest to avoid undue stress on your wound site. After a couple of days, you will be able to begin light walking.

After the surgery, you may notice the following devices on or within your body that were placed during the operation:

• One or more surgical drains located near the wound site (removed two to three days after the surgery)
• Gauze packing or a stenting device within your vagina (removed five days after the surgery)
• A temporary urinary catheter (removed five days after the surgery)

After the vaginal packing is removed, you will begin vaginal dilation in order to maintain the new vagina's width and depth. Your surgical team will provide you with dilators and detailed instructions.

A Word From Verywell

Undergoing a vaginoplasty is no small feat, and the preparatory and recovery process requires time and devotion. The lifelong outcome, though, can be extremely rewarding and satisfying. Throughout the process, try to have a support system to lean on, whether that's a support group, a close friend, or a family member.