What effects does it have?
- Lower body
Creates a vagina
What is it?
Surgical creation of a vagina.
How long does it last?
The effects are permanent and cannot be reversed.
After vaginoplasty, you must regularly use dilators for the rest of your life to maintain the shape of the vagina. Failure to regularly dilate can result in prolapse, serious health complications and/or permanent loss of the vagina.
Vaginoplasty involves surgically constructing a neovagina (artificially created vagina), normally out of tissue taken from the penis and/or scrotum. The penis is completely destroyed in the process.
Vaginoplasty only creates the vaginal canal (the internal tube). The vulva (external part of the genitalia) is created by labiaplasty and clitoroplasty. These operations are usually carried out together with vaginoplasty, but some people opt to avoid vaginoplasty because they do not want a vagina or to reduce the risk of complications, reduce recovery time, or avoid the need to dilate 1.
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.
After vaginoplasty, you will be required to dilate by inserting cylinders called dilators into the vagina for the rest of your life. The recommendations for how often to dilate 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.
Vaginoplasty does not give the ability to menstruate (have periods) or to become pregnant or give birth.
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.
A very common but much less serious side effect is granulation tissue forming inside the neovagina, which is treated by treatment with silver nitrate. This can often be carried out by a GP or practice nurse.
UK surgeons will normally expect that your BMI is below 30 before carrying out vaginoplasty.
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.
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 3. However, as with other major life changes, you may find that counselling before and after surgery may be helpful.
Cost and funding
A operation in the UK to perform vaginoplasty along with labiaplasty and clitoroplasty costs around £11-12000.
If you have a formal diagnosis, the NHS will usually provide funding for vaginoplasty and penectomy, orchidectomy, clitoroplasty and/or labiaplasty. 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 4.
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. Not all patients require hair removal, and your surgeon should tell you whether you need to do this or not.
- 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.
- 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.
- 3 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.
- 4 Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” [online] Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr181.pdf
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Page last updated: September 2017