Vaginoplasty - Gender Construction Kit

What is vaginoplasty?

Surgical creation of a vagina.

What does vaginoplasty do?

Lower body
Creates a vagina

Who can have vaginoplasty?

You must have had 12 continuous months living as your gender identity
You must have had 12 continuous months of HRT, unless you’re unable to
You must have capacity to consent for this treatment
If you have significant medical conditions, these need to be “reasonably well-controlled”
Under 18s cannot have this but can be referred at 17
You typically need a BMI of less than 30

How long does vaginoplasty last?

The effects are permanent and cannot be reversed.

How do I stay safe?

After vaginoplasty, you will be required to dilate by inserting cylinders called dilators into the vagina for the rest of your life to maintain the shape of the vagina. How often you will be asked to dilate can vary between surgeons. An example schedule would be to start at 2-3 times a day and gradually reduce in frequency to twice a week. Dilation can be time consuming and painful, but is essential to maintain the length and breadth of the vagina 1, p.272.

Failure to regularly dilate can result in prolapse, serious health complications and/or permanent loss of the vagina.

What should I be aware of?

The penis and scrotum are completely destroyed in the process of vaginoplasty, as the neovagina (artificially created vagina) is normally surgically constructed out of tissue that has been taken from the penis and/or scrotum.

Vaginoplasty is a major surgery, with serious risks including deep vein thrombosis, prolapse of the neovagina, weakness of the rectal wall, and urethral stenosis (blockage of the urethra resulting in inability to pass urine) 2, p.215.

Vaginoplasty does not give the ability to menstruate (have periods) or to become pregnant or give birth.

Why might I not want vaginoplasty?

It is possible to create the vulva (external part of the genitalia) without creating the vaginal canal (the internal tube) - that is, labiaplasty and clitoroplasty without a vaginoplasty. You might choose this option instead of a vaginoplasty if you don’t wish to have a vagina, or if you wish to reduce the risk of complications, reduce recovery time, or to avoid the need to dilate 1, p.268.

How do I get vaginoplasty?

To be eligible for vaginoplasty, you will normally need to meet the following conditions:

persistent and well-documented gender dysphoria
capacity to make fully informed decisions and to consent to treatment
if significant medical or mental health concerns are present, they must be reasonably well controlled
two medical opinions, usually at least one from a gender clinic, that surgery is appropriate
12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless the patient has medical contraindications or is otherwise unable to take hormones)
at least 12 months’ living continuously in a gender role that is congruent with the gender identity 3.

UK surgeons will normally expect that your BMI is below 30 before carrying out vaginoplasty.

NGICNS maintains a list of NHS surgery providers providing various gender-related surgeries. At the moment, all of these surgeons are based in England, so you will have to travel if you live in another part of the UK. If you have decided to pay for your own surgery, rather than using NHS funding, there are additional options available to you. For more information about these private surgery options read our private surgery page.

Vaginoplasty is a major surgery and has a significant recovery time. You should expect to spend around 10 weeks time recovering before you are ready to resume work or study. When you are discharged from hospital, your surgeon should provide you with a sick note to give to your employer.

If tissue from the scrotum is to be used in the construction of the vagina, or if there is hair on the penile skin, hair removal using electrolysis will be required before you can have surgery. This may take up to a year to complete 1, p.269.

A very common complication of vaginoplasty is granulation tissue forming inside the neovagina, which can be treated with silver nitrate. This can often be carried out by a GP or practice nurse.

For some people, vaginoplasty can provide a significant improvement in mental health. There is overall agreement in medical studies that after gender confirming medical interventions, rates of psychiatric disorders and psychiatric symptoms reduce considerably 4, p.181. However, as with other major life changes, you may find that counselling before and after surgery may be helpful.

What kinds are there?

Types of vaginoplasty that surgeons carry out include:

Penile inversion vaginoplasty

In the penile inversion technique, the vagina is created using material from the penis turned inside out (“inverted”).
Penoscrotal flap vaginoplasty

In the penoscrotal flap technique, the vagina is created using material from both the penis and scrotum, and is often used if there is not enough donor material in the penis alone.
Cosmetic vaginoplasty

This is one way used to describe labiaplasty and clitoroplasty without the creation of a neovagina; other terms for this procedure include “vulvoplasty”.
Sigmoid vaginoplasty

Also known as colovaginoplasty, sigmoid colon vaginoplasty, or laparoscopic sigmoid vaginoplasty, this procedure involves creating a vagina using tissue from the sigmoid colon (part of the lower intestine). This approach might be used if there is insufficient penile and scrotal tissue, for example after the use of puberty blockers, or if a repair is needed after complications of an existing vaginoplasty 5.
Peritoneal vaginoplasty

Also known as peritoneal pull-through vaginoplasty, this is a newer technique that is not commonly available in the UK. While the technique has been used for decades for medical conditions that cause underdevelopment of the vagina, and appears to have advantages over sigmoid vaginoplasty, the use of this technique in trans and nonbinary patients is relatively new and untested compared to other techniques 6.

Where can I learn more?

You can read more about vaginoplasty surgeries in these booklets from the NHS Gender Dysphoria National Referral Support Service:

You can also read more about vaginoplasty in these booklets from Parkside Hospital who are a UK provider of vaginoplasty surgeries:

How do I get ready for surgery?

Doing some preparation in advance can help make sure everything goes smoothly during your hospital stay and recovery. To help you avoid forgetting to do or buy something we have created a Getting ready for gender surgeries page.

Where can I ask questions about surgery?

When you and your clinical team agree that you are ready for surgery on the NHS, the NHS Gender Dysphoria National Referral Support Services (GDNRSS) will process your referral to your chosen surgical provider. They have a Single Point of Access support line that you can call for information about your referral, the status of your chosen provider and practical information such as travel and parking, who can accompany you, what to take with you and where to report when you get there.

You can also book a virtual consultation with one of the GDNRSS Clinical Nurse Advisors who can provide information on:

Surgical techniques used by various providers and surgeon teams
Typical recovery times following surgery
Potential post-surgical complications
Surgical eligibility criteria, where providers have these in place
Waiting times for surgical providers
Supporting patients to change provider

You can contact the service by calling 01522 85 77 99 or by email. The service is open Monday to Friday from 9am until 5pm. You can find out more about the service in this booklet.

How much will it cost?

The cost of a vaginoplasty performed in the UK along with labiaplasty and clitoroplasty is currently around £15000 (last updated April 2021).

If you have a formal diagnosis, the NHS will usually provide funding for vaginoplasty and penectomy, orchidectomy, clitoroplasty and/or labiaplasty.

If you're receiving certain benefits, or are on a low income, you may be able to get help with the cost of travel for NHS treatment. Further information about help with travel costs can be found:

The NHS will normally also fund hair removal from the genitals before vaginoplasty, either by laser hair reduction or electrolysis. This is to ensure that hair does not grow in the vagina. The process of hair removal may take many months 2, p.217. Not all patients require hair removal, and your surgeon should tell you whether you need to do this or not.

References

1.
Selvaggi, Gennaro and Andreasson, My (2017) “Genital Reconstructive Surgery for Transgender Women,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 265–275. Link
2.
Bellringer, James (2007) “Genital surgery,” in Barrett, J. (ed.), Transsexual and other disorders of gender identity: A practical guide to management, Radcliffe Publishing, pp. 209–219. Link
3.
Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link
4.
Arcelus, Jon and De Cuypere, Griet (2017) “Mental Health Problems in the Transgender Population: What Is The Evidence?,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 173–188. Link
5.
Bouman, Mark-Bram, Sluis, Wouter B. van der, Buncamper, Marlon E., Özer, Müjde, et al. (2016) “Primary Total Laparoscopic Sigmoid Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia: A Prospective Cohort Study of Surgical Outcomes and Follow-Up of 42 Patients.” Plastic and Reconstructive Surgery, 138(4), pp. 614e–623e. Link
6.
Slater, Michael W, Vinaja, Xochitl, Aly, Islam, Loukas, Marios, et al. (2018) “Neovaginal construction with pelvic peritoneum: reviewing an old approach for a new application.” Clinical Anatomy, 31(2), pp. 175–180. Link

Acknowledgements

This page is illustrated using a photograph by Павел Сорокин available at Pexels.

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