What is Vaginoplasty and Why is it Important?
Vaginoplasty aims to restore the integrity of the body by creating or repairing vaginal tissue that has somehow lost its function or has not developed at all. We can sometimes think of it as building the missing room in a house: Even if the other areas of the house are in place, the presence of the missing room negatively affects overall comfort, privacy and daily life. Vaginoplasty allows the completion of this missing or damaged room (vagina) in people who need it.
In addition to providing physical integrity, this surgery also offers significant psychological and social support. For transgender individuals who identify as women, it responds to the need to "feel a part of the body belonging to oneself" rather than the external appearance. In addition to sexual health and reproductive functions, the vagina is an important organ that establishes the link between one's self-identity and gender identity. Therefore, cooperation with health professionals and psychological support before and after the surgery are of great importance.
In which cases is vaginoplasty an option?
Everyone's story is unique, so the need for vaginoplasty cannot be attributed to a single reason. However, certain conditions may make this surgery necessary:
Congenital Vagina Absence or Developmental Anomalies
For example, in a condition known as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, the vagina may be largely underdeveloped. This syndrome can be recognized from a young age with obvious symptoms such as missed periods or problems during sexual intercourse. Vaginoplasty offers these people a comfortable life going forward, both sexually and socially.
Androgen Insensitivity (AIS)
It is a condition in which people with a genetic XY chromosome develop feminine external genitalia as a result of the body tissues being insensitive to testosterone. In people with complete androgen insensitivity, the length or opening of the vagina may be insufficient. Similarly, vaginoplasty may be considered to create a functional vagina.
Reconstruction after Trauma or Cancer
Severe trauma, traffic accidents, sexual assaults or cancer surgery can damage the vaginal tissue. This damage damages both physical function and self-confidence. Vaginoplasty can repair or rebuild these tissues.
Gender Reassignment Surgery for Trans Women
Trans women are not at peace with their sex assigned at birth and aim for a physical body that conforms to their self-defined female identity. Here vaginoplasty is like a "missing piece of the puzzle". After the surgery, the person's body image and the identity they feel are harmonized, which is a big step in terms of mental health and self-confidence.
Pelvic Organ Prolapse or Other Medical Conditions
Especially at an advanced age or after multiple births, the pelvic organs can sag downwards. This can lead to problems such as loosening of the vagina, urinary incontinence or difficulties with sexual intercourse. Sometimes, in this case, restorative procedures such as vaginoplasty may be required to strengthen the support structure of the vagina.
Which Surgical Techniques Are Available for Vaginoplasty?
Imagine you are going on a journey; sometimes you choose a short route, sometimes you choose a long route with a beautiful view. Vaginoplasty techniques also vary depending on the patient's condition and the surgeon's experience. Let's briefly get to know a few prominent techniques here:
Penile Inversion Technique
It is especially popular for trans women. The existing penile skin is inverted (folded inwards) to form a "neovagina". In this method, the glans (penis tip) can be transformed into a clitoris to maintain sensitivity. It can be imagined as a kind of "turning the glove inside out".
The advantage is that the tissue is already blooded and the nerve endings are protected. The disadvantage is that if the penis and scrotum (scrotum) have insufficient tissue, it is difficult to reach the desired depth.
Bowel Segment Vaginoplasty
In this approach, a section of the large intestine (sigmoid colon) is usually removed to create a vagina. Since it has a self-moisturizing feature, it can increase sexual comfort. However, since a larger surgical intervention in the abdominal area is required, the healing process can be a bit more laborious. In addition, the mucus secreted by the intestinal segment requires regular monitoring of hygiene.
Peritoneal (Peritoneal Pull-Through) Vaginoplasty
Here, a vaginal canal is created using the thin membrane (peritoneum) that lines the abdominal cavity. This membrane is also partially self-moisturizing. Since it can be performed laparoscopically (closed), scars may be less. It is a preferred method when there is not enough genital skin tissue, especially in transgender teenagers who have received hormone suppressive therapy in childhood.
McIndoe Vaginoplasty
It is a historically old method. A skin graft from the patient's thigh or buttock is placed into the canal where the vagina will be created. A mold (stent) is then kept in this area so that the tissue takes shape and healing takes place correctly. The disadvantages are that the skin graft does not provide sufficient lubrication and requires regular dilatation.
Vecchietti Method
It is especially used in cases with congenital vagina deficiency. Laparoscopically, a mechanism is used to gradually stretch the area where the vagina will be created. Within days and weeks, the canal is widened. The recovery time is short because it does not involve large incisions, but it still requires patience and regular check-ups.
Each technique has its own pros and cons. The anatomical features, health history, sexual desires, body image expectations and the experience of the surgeon are taken into consideration when making the decision.
How to Prepare for Vaginoplasty Surgery?
Before going on a trip, you need to pack your suitcase, find out the weather conditions of your destination and plan your travel time. Vaginoplasty requires similar preparation. These preparations have a positive effect on the course of the surgery and minimize possible complications.
General Health Assessment
Tests to check your blood values, ECG to examine your heart rhythm, any chronic conditions (diabetes, high blood pressure, etc.) are reviewed. All these data indicate how ready your body is for surgery.
Psychological readiness
Vaginoplasty is not just a cosmetic operation or a tissue augmentation procedure. Especially for trans women, it is a big step in the completion of body and identity harmony. Emotional fluctuations may occur during this process. Emotional strengthening in the lead up to this surgery with the support of a specialist psychologist or psychiatrist is very beneficial.
Hormone and Medication Regulations
For example, trans women often take estrogen and anti-androgen therapy. These hormones may need to be temporarily stopped or their doses adjusted before surgery. In addition, blood thinners or herbal supplements (such as ginkgo or garlic pills) may increase the risk of bleeding and should be stopped for a certain period of time before the operation.
Smoking and Alcohol Use
Smoking negatively affects oxygenation and tissue healing in the body. Especially in major surgical interventions, it is recommended to stop smoking at least 6-8 weeks before surgery. Alcohol can similarly interfere with anesthesia and the healing process.
Hair Removal and Bowel Preparation
Methods such as penile inversion require the removal of hair from the surgical site. This is usually done with hair-removing creams instead of shaving, because using a razor can cause micro-incisions in the skin and increase the risk of infection. If a segment of intestine is to be used, bowel emptying medications or enemas may be given before surgery.
Creating a Support Perimeter
It is possible to have difficulty with daily tasks for up to a few weeks after surgery. It is very helpful to have family members, friends or caregivers to help you when you return home. We are not only talking about physical help; it is also important to be supported in terms of morale and motivation.
What is the Recovery Process After Vaginoplasty?
When you come out of a surgery, your body needs time to recover. Vaginoplasty is no exception to this rule. We can think of this period like a plant taking root. Just as a freshly planted sapling requires regular watering and care, postoperative care requires the same sensitivity.
Hospitalization and First Days
It is usually necessary to stay in hospital for 2-4 days after surgery. During this time, pain control and wound care are performed. A urinary catheter (urinary catheter catheter) is often in place because it is important that the surgical site rests and the sutures heal. Mild pain, edema (swelling) and bruising may be observed during the first few days.
Pain Management and Movement
Painkillers and sometimes antibiotics are prescribed after surgery. In addition, laxatives (bowel softeners) may be recommended to prevent constipation. In the first weeks, recommendations such as avoiding sitting for long periods of time and not spreading the legs too wide while lying down are given. However, taking "light walks" increases blood circulation and speeds up recovery.
Vaginal dilatation
Especially in penile inversion or skin graft (McIndoe) approaches, dilatation is essential for the vaginal canal to maintain its new shape. This can be likened to wearing earrings after an ear piercing to prevent the hole from closing. In the beginning, this is done several times a day and becomes less frequent in the following months. Dilatation materials (dilators) can be hard plastic or silicone. The important thing is to apply it regularly and gently.
Wound Care and Hygiene
Cleanliness of the area is very important to prevent infections that may occur in the suture line. Washing with antiseptic solutions prescribed by the doctor, regular dressing and using creams if necessary support healing. In the early postoperative period, underwear and comfortable clothes that will not irritate the genital area should be preferred.
Return to Sexual Activity
It may take several months for the new tissue to consolidate and sensitivity to return. Generally, surgeons recommend waiting 2-3 months (in some cases longer) for penetrative sex. During this time, tissue healing is more secure. Erogenic sensations usually start to be felt more clearly between 3-9 months, but this can vary from person to person.
Emotional Support and Spiritual Healing
Although the physical aspect of the surgery is complete, it takes time to recover psychologically and get used to the new bodily experience. Especially for trans women, in addition to the feeling of happiness and relief after vaginoplasty, there is sometimes a process of recognizing the integrity of the body in its new form. During this period, the support of both the close environment and mental health specialists is valuable.
What are the risks and benefits of the surgery?
Like any surgical intervention, vaginoplasty has its own advantages and potential complications. We can liken it to making an investment: Your investment can bring you gains, but there are always market uncertainties. So what are these gains and risks?
Main Benefits:
Ensuring Physical Integrity: A functional vagina is created for people who were born without or with a damaged vagina. This is an important step in terms of sexual intercourse and body integrity.
Psychological Relief: For trans women, it is a critical step in terms of body conformity, as well as increasing overall self-confidence and happiness.
Improved Quality of Social and Sexual Life: After vaginoplasty, many people talk about a more satisfying and comfortable sex life. The increased intimacy with the partner promotes subjective well-being.
Potential Risks and Complications:
Infection and Bleeding: As with any surgery, there is a risk of infection, wound dehiscence or bleeding at the operation site.
Tissue Necrosis (Death): If there is not enough blood supply in the newly created tissue, tissue loss may occur. This may require additional surgical intervention.
Vaginal Narrowing (Stenosis) or Fistula Formation: Without proper care and dilatation, the vagina may narrow. In addition, if a segment of intestine is used, unwanted connections (fistulas) may develop between the intestine and vagina, although this is rare.
Urinary Tract Problems: Conditions such as difficulty urinating and urinary tract infections may occur in the early period.
Change in Sexual Sensitivity: While increased sensitivity is a positive development for some people, others may experience problems such as loss of sensitivity or pain (dyspareunia).
Although the list may seem long, many people who undergo this surgery experience a significant increase in their quality of life after surgery. The most important point here is to work with an experienced surgeon and healthcare team and to follow the postoperative instructions meticulously.
What should be considered in the long term after vaginoplasty?
Our body requires constant care and attention even after surgery. Some points should be taken into consideration especially for the health of the newly formed vaginal tissue. Following the surgery, you should go to the controls at the periods recommended by the surgeon. If necessary, a gynecological examination can be performed once a year. Vaginal discharge and mucus secretion may occur if the intestinal segment is used. Regular cleaning and, if necessary, using pH-balanced products reduce the risk of infection. New vaginal tissue is also vulnerable to sexually transmitted diseases. Condoms and other contraceptive methods should not be ignored. Trans women in particular may experience emotional fluctuations as they adjust to their new bodies. Attending regular therapy or support groups can ease the emotional burden. Continued smoking negatively affects tissue integrity and blood circulation in the long term. Paying attention to nutrition and exercising regularly are also beneficial for general health and tissue quality.
