Vaginoplasty (Penile Inversion Method) is the creation of a vaginal canal, clitoris, labia majora, and/or labia minora with sensation using your existing genital tissue. The typical result is a vaginal canal with 4.0–5.5 inches of depth. This procedure allows people to urinate while sitting, feel sexual sensation, and have receptive sex with a vagina.
About the Surgery
- At Temple, we use the penile inversion technique
- The vaginal canal is created in the space between the rectum and urethra
- The vaginal canal is lined with skin from the penis and scrotum
- Outer labia are created using scrotal skin
- Inner labia are created using skin from the penis and urethra
- The clitoris is created using the glans, or head of the penis
- If there is not enough penile or scrotal skin, or if you’ve already had an orchiectomy, skin from the lower abdomen, groin, or thigh can be used
Vaginoplasty Considerations
- Vaginoplasty is a complex procedure that takes six to eight hours
- Vaginoplasty will require a six- to seven-day hospital stay following the procedure
- Recovery typically takes six to eight weeks and requires intensive post-operative care, including pelvic floor physical therapy before and after surgery, and daily dilation exercises after surgery
- Vaginoplasty is permanent and irreversible, and it ends the ability to be a biological parent without prior fertility preservation. If you would like fertility planning resources, please reach out to our social worker at [email protected]
- In preparation for vaginoplasty, you will be asked to stop estrogen for two weeks leading up to surgery. This can decrease the risks associated with blood clots
- There are potential risks with vaginoplasty, including infection and healing problems, urethral or rectal injury, blood clots, varied aesthetic results, lack of sensation, rejection of tissue, and more. Your surgeons will review risks and benefits in detail during your consult
Temple Surgical Candidacy Requirements
- 18+ years old
- Adequate support before and after surgery, which includes:
- Safe, stable housing. Having a clean and private place to recover is essential to your healing
- Minimum of one reliable caregiver/support person to help manage post-surgical care for a minimum of 4–6 weeks, including:
- Transportation: accompaniment and access to transportation
- Daily supports: may include food preparation, obtaining and administering medication, and other post-operative care as directed by your surgeon
*It is recommended that you have more than one person—ideally a network of people—to help manage your post-operative care
- Emotional preparedness for the realities of surgery (including realistic expectations of outcomes and potential complications)
- Commitment to learning and performing vaginal dilation with the expectation of the lifelong need for vaginal dilations
- Testing:
- Preadmission testing with our anesthesia team (to determine that you are in good condition to undergo this major surgery)
- Drug screen and nicotine test before scheduling and 1–2 months before surgery
- Other health criteria include:
- BMI – our program does not have a defined cutoff, this will be discussed at your consult with your gender-affirming surgeon
- You must be nicotine free for a minimum of 2–3 months prior to surgery and 2–3 months after surgery
- Diabetes should be well controlled to minimize the risk of infection and wound healing complications
- Active substance use needs to be accurately assessed and managed, with at least six months free of use (does not include marijuana/cannabis)
- For patients living with HIV, we require that your HIV is well controlled, because this can affect your ability to heal after surgery
- For patients living with hepatitis C, we require blood work and an ultrasound exam prior to scheduling surgery to confirm that your hepatitis C is controlled with no evidence of active liver cirrhosis
- Hair removal may be required to move forward with surgery—this is patient-specific and determined by your surgeon
- Pelvic floor physical therapy is required before and after surgery. More information will be provided during your consult
WPATH SoC 8 Requirements
- Gender incongruence is marked and sustained
- You have the capacity to offer consent
- You understand the risks and benefits of surgery
- SoC 8 only requires 1 letter written by a credentialed gender-affirming care provider (health care or mental health care)
- Please check in with your insurance provider to confirm that they have updated to the SoC 8
- Pelvic floor physical therapy is recommended before and after surgery, but it is not required
Note on support person: This is a challenging surgery to recover from physically, mentally, and emotionally. Having a support person or network is for your safety and helps you achieve the best outcomes after your surgery. This is most important for the first 4–6 weeks after surgery, when you will need the most help. This may mean your support person(s) may have to take time off work, which may require planning financially. We can assist with any paperwork (FMLA, etc.). We will provide your support person(s) with education on the expectations so that they are adequately prepared. We will also obtain consent from your support person(s) and verify that they are willing and able to assist in your recovery.
Note on gender-affirming hormones: Consult your surgeon and hormone prescriber prior to surgery, as your hormone regimen will be altered prior to and post-surgery.
Note on fertility: Vaginoplasty is a permanent, irreversible procedure that results in the loss of fertility. Fertility preservation and family planning decisions must be completed prior to surgery.
Note on nicotine use: It has been well-documented that nicotine increases the risk of wound complications, which can have a significant impact on your surgical outcomes. You must quit ALL NICOTINE PRODUCTS (smoking, vaping, hookah, chewing tobacco, nicotine patches/gum, blunts, etc.) for at least 2–3 months (with a documented negative nicotine screening test) before scheduling surgery. You should remain nicotine free for at least 2–3 months after surgery.
Note on marijuana use: We recommend no smoking or inhaling at least four weeks before surgery to decrease the risk of breathing issues during surgery.
Note on hair removal: Depending on your hair follicle density and hair thickness, hair removal may be required to optimize your outcomes. All patients will be examined by their surgeon, and final recommendations for hair removal will be made at that time. Hair removal can take months to complete, so be sure to plan accordingly. All treatments should be completed at least 2–3 weeks before surgery. Hair removal from the penile shaft and scrotum prior to your surgery is highly recommended, as hair within the vaginal canal can cause problems with odor, discharge, and discomfort with dilation and intercourse, and concretions/calcifications can form within the vagina. Hair removal must be completed prior to surgery, as there is no way to remove the hair from inside the vagina. Electrolysis is more effective than laser hair removal.
Note on pelvic floor therapy: There is emerging evidence demonstrating the benefits of pelvic floor therapy for vaginoplasty patients. You may have underlying pelvic floor dysfunction and not even know it, or it may develop after surgery. Typical symptoms include urinary symptoms, bowel symptoms, and pelvic pain.
Insurance coverage: Typically, vaginoplasty is covered by insurance. It is important that you check with your insurance company regarding your specific coverage. We will also provide you with a letter of medical necessity that you can send to your insurance company to request coverage for your hair removal. They may still refuse to cover these costs despite having this letter. Please reach out to our patient navigator with any questions or for additional resources at [email protected].
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