Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina.Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.
Congenital disorders such as adrenal hyperplasia can affect the structure and function of the vagina and sometimes the vagina is absent; these can be reconstructed or formed, using a vaginoplasty. Other candidates for the surgery include babies born with a microphallus, people with Müllerian agenesis resulting in vaginal hypoplasia, transgender or transsexual women, and women who have had a vaginectomy after malignancy or trauma.Vaginoplasty can reduce the size of the entrance of the vagina or alter the appearance of the vulva.
The most common vaginoplasty technique is a penile inversion procedure. In this technique, penile skin is used to construct the vaginal lining. The labia majora are created using scrotal skin, and the clitoris is built from the sensitive skin at the tip of the penis. The prostate is left in place, where it can serve as an erogenous zone similar to the G-spot.
In some cases, there is not enough skin to achieve the necessary vaginal depth, so surgeons will take a skin graft from the upper hip, lower abdomen, or inner thigh. Scarring from the donation site is typically hidden or minimal.
The use of skin grafting to build the vulva is a topic of controversy among plastic surgeons. Some believe that the extra skin allows for a better cosmetic appearance. Others believe that functionality should not be sacrificed. Skin from donation sites is never as sensitive as skin from the genitals.
The penile inversion vaginoplasty is considered the gold standard genital reconstruction technique among plastic surgeons, and it is recommended by the Center of Excellence for Transgender Health.
The long-term success of your vaginoplasty will depend largely on how well you follow the postoperative instructions. Your surgeon will give you a vaginal dilatator to begin using as soon as your bandages are removed. This dilation device must be used daily for at least one year to maintain the desired vaginal depth and girth.
Your surgeon will provide you with a dilation schedule. Typically, it involves inserting the dilator for 10 minutes, three times per day for the first three months and once per day for the next three months. Then, you’ll do it two to three times per week for at least one year. The diameter of the dilator will also increase as the months go by.
Reconstructive vaginoplasty in children and adolescents carries the risk of "superinfection".
In adults, rates and types of complications varied with sex reassignment vaginoplasty. Necrosis of the clitoral region was 1-3%. Necrosis of the surgically created vagina was 3.7-4.2%. Vaginal shrinkage occurred was documented in 2-10% of those treated. Stricture, or narrowing of the vaginal orifice was reported in 12-15% of the cases. Of those reporting stricture, 41% underwent a second operation to correct the condition. Necrosis of two scrotal flaps has been described. Posterior vaginal wall is rare complication. Genital pain was reported in 4-9%. Rectovaginal fistula is also rare with only 1% documented. Vaginal prolapse was seen in 1-2% of people assigned male at birth undergoing this procedure.
The ability of emptying the bladder was affected after this procedure with 13% reporting improvement, 68% said that there was no change and 19% reported that voiding got worse. Those reporting a negative outcome experienced in which loss of bladder control and urinary incontinence were 19%. Urinary tract infections occurred in 32% of those treated.
More recently, vaginoplasty has grown into a group of cosmetic surgeries marketed as "vaginal rejuvenation" and "designer vagina" procedures. Plastic surgeons and gynecologists are marketing their own array of designer vaginoplasty surgeries, claiming the same benefits to women as with other cosmetic surgeries, such as beauty, self-esteem, and confidence.
Here are some examples of "vaginal rejuvenation" and "designer vagina" procedures:
"Revirgination." The hymen, the thin tissue at the entrance to the vagina, normally "breaks" the first time a woman has intercourse. A surgery called a hymenoplasty repairs the hymen to mimic its original, virginal state, before a woman was sexually active. Because of the strong religious convictions surrounding the importance of virginity in some cultures, this is among the most controversial of cosmetic vaginal surgeries.
Clitoral unhooding. Some surgeons are marketing a procedure called clitoral unhooding, which removes the tissue that normally covers the clitoris.
G-spot amplification. The front wall of the vagina, some experts believe, holds the highly erotic G-spot, an especially sensitive stimulation site for female arousal and orgasm. The G-spot amplification procedure involves injecting collagen into the front wall of the vagina, theoretically to increase pleasure.