Vaginoplasty is a procedure to construct or repair a vagina. It treats various medical issues, including vaginal injury due to childbirth and pelvic floor disease complications. It’s also for creating a transgender vagina, which helps individuals achieve their preferred gender identity.

Who needs vaginoplasty?

• Individuals seeking repair of childbirth defects or trauma to improve sexual function.
• Women who need vaginal reconstruction after undergoing radiation or excision of the vagina to treat cancer or other conditions.
• Transgender individuals undergoing gender affirmation surgery.
• Women born with congenital abnormalities (issues present from birth) affecting the development of the vagina.
• What happens during vaginoplasty performed for women with childbirth injuries?
• When vaginoplasty is done to repair injuries after childbirth, the procedure involves:
• Removing extra skin.
• Using stitches to secure loose tissue in part or the full depth of your vagina.
• Reducing the opening size of the vagina.
• Vaginoplasty to repair congenital defects (an issue you’re born with) may include:
• Creating a functional vagina.
• Removing excess tissue or abnormal structures.
• Preventing blood from pooling during menstruation.

What happens during vaginoplasty as part of gender affirmation surgery?

During a vaginoplasty as part of gender affirmation surgery, the male external genitalia are partially removed and reconfigured. The skin of the penis and scrotum are used to create a vaginal canal and labia.

PROCEDURE DETAILS

What happens before vaginoplasty?

You undergo assessments and testing to prepare for surgery. These tests may include:

Physical exam to assess your health and learn more about your medical history.

Patient education about risks, benefits and postsurgical care requirements.

Recommendations that lower your risk of complications, including quitting smoking.

For transgender women undergoing vaginoplasty for gender affirmation, specific pre-operative requirements exist including genital hair removal and the need to meet the requirements set by the World

Professional Association for Transgender Health.

RISKS / BENEFITS

What are the risks and benefits of vaginoplasty for vaginal reconstruction after childbirth?

• Risks after vaginoplasty for childbirth injuries can include:
• Dyspareunia (painful intercourse).
• Numbness or loss of sensation.
• Benefits after surgery can include:
• Improved sexual satisfaction and self-esteem.
• What are the risks and benefits of vaginoplasty for gender affirmation?
• One of the main benefits is relief from gender dysphoria. After surgery, individuals achieve better consistency with the gender they identify with. This has enormous benefits on people’s mental health and improves their quality of life.
• Risks of vaginoplasty for gender affirmation can include:
• Vaginal stenosis.
• Inadequate depth of the vagina.
• Vesicovaginal fistula (an abnormal connection between the vagina and the urinary tract ) or rectovaginal fistula (an abnormal connection between the vagina and rectum).
• Nerve injury.
• Poor cosmetic result.

RECOVERY AND OUTLOOK

What is recovery like after vaginoplasty?

Recovery may last anywhere from a few weeks to a few months, depending on the extent of surgery. Postsurgical care after vaginoplasty depends on the type of vaginoplasty performed.

LABIAPLASTY

Overview

Labiaplasty is a surgical procedure to reduce or increase the size of your labia. The surgery is done to improve the appearance of your labia, to reduce physical discomfort or as part of gender-affirming surgery.

Your labia are the folds of skin around your vagina opening. You have two folds of skin. The outer folds are called the labia majora, which means large lips. These folds are the larger fleshy folds that protect your external genital organs and are covered with pubic hair after puberty. The inner folds are called the labia minora, which means small lips. These skin folds protect the opening of your urethra (where your pee leaves your body) and vagina.

During a labiaplasty and depending on why it’s being done, your surgeon either:

• Removes some tissue from the labia to reduce its size.
• Injects a filler material or fat into the labia to enlarge it.
• Reconstructs a labia from other tissue.

What are the reasons for wanting a labiaplasty?

Medical and physical reasons

To reduce the size of labia minora so it doesn’t protrude beyond the edges of the labia majora. Excess labial tissue can twist, turn, or get pinched or tugged, and cause physical discomfort and irritation during exercise, physical activities (such as bike riding or jogging) and intercourse.

To improve hygiene and health since excess tissue can make cleansing more difficult and can harbor bacteria that can lead to the development of urinary tract infections.

Cosmetic and emotional reasons

To restore a more youthful look after childbirth or aging.

To reduce asymmetry (uneven shape) of the labia minora or labia majora when one side is longer or shaped differently than the other.

To increase self-confidence and eliminate the visual lines, bulges or “camel toe” appearance when wearing body-conforming pants or leggings. Tight-fitting clothing can also cause physical discomfort if there’s excess labia tissue.

To improve comfort, confidence and sexual well-being about the appearance of your genitalia during intimate contact.

Gender-affirming surgery

If surgery is part of a gender-affirming process, labia can be created using existing genital tissue. Labiaplasty may be performed before or after other reconstruction surgeries.

What causes a labia to become oversized?

• Age. Menopause or other hormonal changes can thin the tissue of the labia majora, allowing the labia minora to protrude beyond the labia majora.
• Pregnancy and childbirth.
• Changes in your weight.
• Genetics.

What happens before surgery?

First, you and your surgeon will discuss the reasons why you want to undergo labiaplasty. You’ll discuss your expectations and goals as well as the risks of the surgery.

Next, your surgeon will explain the details of your surgery, including where incisions will be made and what to expect regarding changes to the size and shape of your labia.

You may undergo some presurgical tests including blood work, urinalysis and chest X-ray. You’ll be given instructions about what to wear to your procedure, when to stop food and drink, when to adjust or temporarily stop certain medications and other information on how to prepare for your surgery.

What happens on the day of surgery?

After you arrive at our hospital, you will change into a surgical gown. A healthcare provider will take your vitals (temperature, pulse, blood pressure, oxygen level, breathing rate). You may have some blood work and urinalysis done again. They’ll place an intravenous line (IV) in your arm or hand and they may place a urinary catheter in your urethra.

Next, your provider will cleanse your labia and the skin around it and shave your pubic area if needed. Then, they’ll start anesthesia. You may have IV sedation with local anesthesia or general anesthesia depending on the procedure you’re having. Your provider will discuss which type of anesthesia is best for you during the planning stage of your surgery.

Your provider chooses which surgical technique according to how your labia (labia majora and/or labia minora) will be resized or reshaped. They usually perform this surgery with a scalpel, scissors or laser.

Reduction procedures

To reduce your labia (labia minora and/or labia majora), there are two general approaches:

Trim procedure. With this approach, your surgeon removes excess tissue from the outer edge of one or both sides of your labia minora so that it’s even with or receded from the edges of your labia majora.

Wedge procedure. With this approach, your surgeon removes a wedge or pie-shaped piece of tissue from the inner areas of one or both sides of your labia minora. They leave the submucosa intact so that when the labia is stitched (sutured), the wrinkled edge of the labia remains intact. This retains a more natural look for the labia minora. Similarly, an inner portion of each labium of your labia majora can also be removed if you’re having surgery to reduce the labia majora.

Your surgeon may have other preferred approaches depending on their surgical expertise or your desired result. You and your surgeon will work together to choose the surgical approach that will best meet your goals and concerns.

How long do the results of labiaplasty last?

Labiaplasty performed as a reduction surgery is meant to be a one-time, long-lasting procedure. Unless complications develop, you may never need this surgery again. Enhancement labiaplasty with injections of fat or fillers may need additional “touch-ups” over time.

You should know that if you choose to have children after your procedure, your labiaplasty may be affected. Many people choose to wait to have their labiaplasty until after they’ve completed their families.

Enlarging procedure

To enlarge your labia majora, your surgeon takes a small amount of fat from another body area, such as your abdomen or thigh (in a liposuction procedure) and injects it into your labia majora. Injecting hyaluronic acid into your labia majora is an alternative option.

Gender-affirming surgery

Tissue from the penis can be used to create your labia. Labiaplasty is one step in the entire gender-affirming reconstructive surgery process.

All incisions in the procedures described above are closed with absorbable stitches (sutures) that dissolve over time and don’t need to be removed. Your surgical site is covered with surgical dressing.

How long does labiaplasty take?

Labiaplasty is an outpatient procedure. Labiaplasty typically takes less than two hours. Gender-affirming surgery would require more time.

What happens after surgery?

After surgery, your provider removes your urinary catheter (if you have one) and you’ll become more alert as the anesthesia wears off. You’ll be checked for bleeding. Before being discharged, you’ll be given instructions about how to care for your wound while it heals. Your providers will also discuss pain control and give you information about activity restrictions and follow-up appointments.

What are the risks and complications of labia surgery?

Complications are infrequent, but can include:

• Too much tissue or not enough tissue is removed.
• Bleeding.
• Bruising (hematoma).
• Infection.
• Wound breakdown.
• Scarring.
• Ongoing pain, pain with sex or loss of sensitivity.

Is the recovery painful?

You will have some swelling, discomfort and pain, but it’s usually easy to manage with over-the-counter medication, such as acetaminophen (Tylenol®), or a limited prescription medication. If your discomfort is not well controlled with the recommended medications, be sure to contact your surgeon. Home remedies, such as a cold compress or icepack, are helpful too. Apply an ice pack to the operative area (on top of a cloth undergarment) on a 20 minutes on/20 minutes off schedule to reduce pain and swelling. Most people report only mild pain or tenderness for a few days.

You may be given an oral antibiotic prescription or topical antibiotic to apply to your surgical wound to prevent infection.

Wear loose-fitting pants and undergarments during the healing period. Tight-fitting clothes or undergarments can cause friction against the wound and prevent or delay healing.

Will there be much bleeding?

You may have some bleeding for days up to a week or so. You can wear a mini-pad to absorb this minor bleeding.

When will results be at their very best?

The initial swelling, soreness and temporary discoloration decrease over the first couple of weeks after surgery. Most swelling is gone after six weeks. However, it may take up to four to six months of healing time for swelling to completely go away before seeing the final results of your labiaplasty. There’s usually little to no scarring.

How do I wash my labia area?

Use lukewarm water only (no soap) to wash your wound. Gently wipe or dab the area dry after peeing; don’t rub the surgical area.

Your surgeon may have you take medication or recommend a diet to prevent constipation so that you do not strain, which could stretch or break your stitches.

Follow all your provider’s post-op instructions for peeing and pooping, for keeping your surgical area clean and free from bacteria, and allowing the surgical area to heal.

When can I return to work, physical activity and sexual activity?

You should be able to return to work and other light activities after a few days. If your job involves physical activity or lifting, you may need to stay home longer. You should avoid the following for four to six weeks or until cleared by your surgeon:

• Strenuous exercise.
• Physical activities such as cycling, running and swimming.
• Sexual intimacy.
• Returning to these activities too soon can put pressure on the wound, tear stitches and delay healing.

Hymen repair (hymenoplasty) is the cosmetic repair, restoration, or construction of a woman’s hymen, and is often requested by women for physical, psychological, or cultural reasons. Restoration of the hymen is also known as hymenoplasty or revirginization.

Hymen repair is usually a simple outpatient procedure that can be done in our hospital under local anesthesia. Any torn skin around the edges of the hymen is gently and neatly cut away, after which the remaining tissue is stitched together, leaving a small opening. This restores the hymenal ring to a normal size and shape.

If there is not enough skin to restore the hymen, or if a hymen is nonexistent, the surgeon may create one, using either some of the body’s own thin vaginal skin (vaginal mucosa) or a synthetic tissue. A small blood supply may be added, either artificial or the patient’s own taken from a piece of vaginal flap, thus simulating the traditional bleeding upon subsequent penetration.

Tubal ligation — also known as having your tubes tied or tubal sterilization — is a type of permanent birth control. During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy.

Tubal ligation prevents an egg from traveling from the ovaries through the fallopian tubes and blocks sperm from traveling up the fallopian tubes to the egg. The procedure doesn’t affect your menstrual cycle.

Tubal ligation can be done at any time, including after childbirth or in combination with another abdominal surgery, such as a C-section. Most tubal ligation procedures cannot be reversed. If reversal is attempted, it requires major surgery and isn’t always effective.