An Expert Guide to Vaginoplasty for Transgender Women

Choosing to have a vaginoplasty can unleash a flood of conflicting emotions, even if it’s something you’ve wanted for a very long time. It's completely normal to feel just as worried or scared as you are excited and hopeful. What’s going to happen? What might happen? How will you feel afterward? Being informed about the procedure and getting expert support are two of the best ways to alleviate some of your fears.

With that in mind, let’s take a look at what you can expect and how pelvic floor physical therapy can help you have a positive experience, both before and after the procedure.

What is gender-affirming vaginoplasty?

Vaginoplasty is a surgical procedure that involves the creation of a vagina (neovagina) for transgender women as part of their gender-affirming surgery. The goal is to create a vagina that looks, feels, and functions as closely as possible to a cisgender woman's vagina. The term is also sometimes used to describe a procedure that cisgender women might have to correct congenital anomalies or repair damage from childbirth.

Types of vaginoplasty procedures

Vaginoplasties are not a one-size-fits-all kind of procedure. There are various types of procedures used to help folks develop a neovagina, each with different recovery and postsurgical care recommendations. Depending on you, your current anatomy, desired end results and goals, you and your doctor will determine the best route for you. Here are three types of vaginoplasty procedures they might suggest.

Penile inversion

Penile inversion vaginoplasty uses the skin of the penis and scrotum to create the neovagina. It is one of the most common methods, and many patients achieve satisfactory results in terms of appearance and function.

Intestinal vaginoplasty

In this procedure, a segment of the intestine is used to create the neovagina. This technique may be recommended for patients who need more depth or have insufficient penile and scrotal skin.

Peritoneal vaginoplasty

This procedure involves using a segment of the peritoneal lining (a thin membrane that lines the abdominal cavity) to create the neovagina. It is a newer technique that offers some advantages, such as the potential for natural lubrication.

Why might someone consider getting a vaginoplasty?

Everyone’s journey with their bodies and gender is different, so there’s no single reason a person might want to get a vaginoplasty as part of their gender-affirming journey. Some common reasons trans women who have chosen to undergo the procedure give, however, include:

• Alleviating gender dysphoria: Vaginoplasty can help reduce feelings of distress related to the mismatch between one's gender identity and assigned sex at birth.
• Achieving a more congruent physical appearance: The surgery can help create a body that better reflects one's gender identity, leading to increased self-esteem and confidence.
• Improving sexual function and satisfaction: Vaginoplasty can enhance sexual experiences and satisfaction by creating a vagina that allows for penetration and sexual pleasure.

Risks and potential complications of vaginoplasty

Vaginoplasty is a major surgery and, like any major surgery, it does come with risks. Your surgeon will go through each one with you so that you’re fully informed about the possibilities before the procedure. While it's natural to be concerned about potential risks and complications, it's important to remember that serious complications are relatively rare, and most patients have successful outcomes.

Some potential risks include:

• Infection: As with any surgery, there is a risk of infection. Following your surgeon's post-operative care instructions can help minimize this risk.
• Scarring: Scarring is a natural part of the healing process, but excessive scarring can sometimes occur. Your surgeon will provide guidance on how to minimize scarring during your recovery.
• Complications related to anesthesia: Anesthesia carries its own set of risks, which your anesthesiologist will discuss with you prior to surgery.

How long does it take to recover from vaginoplasty?

Recovery time varies depending on individual factors and the complexity of the surgery. Generally, most patients can expect to take at least six to eight weeks to recover from vaginoplasty.

There are some things you can do to speed up or smooth out the recovery process. First, make sure you’re in good health before you have the procedure—and do your best to stay in good health while you’re recovering. It’s also important to follow your surgeon's guidance on wound care, activity restrictions, and any other instructions they give you about healing.

How do I prepare for a vaginoplasty?

Like a lot of things in life, a successful vaginoplasty is more likely if you’ve prepared beforehand. And you’ve already started, just by being here! This is a great first step (or second or third) toward ensuring that you’re fully prepared before getting the surgery.

Here are a couple of other things you can do to both soothe any lingering nerves—and prepare:

Consult with a doctor

A thorough consultation with a knowledgeable and experienced surgeon is essential for a successful outcome. During the consultation, discuss your goals and expectations, ask questions, and address any concerns you may have. This will help you feel more informed and confident about your decision to undergo vaginoplasty.

Consult with a pelvic floor physical therapist

Pelvic floor physical therapy can and should be an integral part of your care both before, and after surgery. Your pelvic floor — the bowl-shaped group of muscles at the bottom of your pelvis that supports your bladder, internal genitalia, rectum, and helps to maintain all of its functions — will not only go through a transformation on its own during surgery, but it is also incredibly important for your healing, and long term sexual function.

By seeing a pelvic PT before your vaginoplasty they can help resolve any pre-existing pelvic floor dysfunction, provide guidance on what to expect during recovery, and even help to reduce the incidence of having pelvic floor dysfunction after your surgery.

A pelvic floor physical therapist can also help you to become more familiar with post-surgical care procedures. For example, consistent use of vaginal dilators in the postpartum will support your healing, and help you to maintain the proper depth and circumference of your neovagina, but it’s also a major (and often intimidating) commitment. Your pelvic floor physical therapist will help to make sure you feel comfortable with the dilators, so that you can jump right into healing.

How vaginoplasty can affect bladder, bowel & sexual function

Vaginoplasty is a major abdominal surgery that affects all of the organs in the pelvic floor—not just the penis. That means you’ll likely have issues with bladder, bowel, and sexual function while you’re healing. Luckily, a pelvic floor physical therapist can help you through the process.

Potential effects of vaginoplasty on bladder function

Regardless of the type of vaginoplasty you have, the procedure will shorten your urethra. You’ll also need a catheter immediately following the surgery and, according to Origin’s Dr. Natasha Carl, PT, DPT, there’s always a risk of urethral damage when you’re dealing with a catheter.

“Bladder emptying after the surgery is always an issue,” Dr. Carl says. “There’s lots of tension in the area, making it hard to urinate.”

Some people also experience temporary changes in bladder function, like needing to pee more frequently or more urgently. Others might have issues with incontinence.

“If you’re having any kind of bladder leakage, please come and see us,” Dr. Carl says. “We teach relaxation techniques, different postures to try, and different bladder emptying techniques.”

Potential effects of vaginoplasty on bowel function

You’ll likely be on pain medication after the surgery—and a common side effect of pain medication is constipation.

“Especially very early on, like the first three months, you have a lot of healing that needs to happen,” Dr. Carl says. “Externally you’ll have tiny little scars, but internally there’s a lot of healing that needs to happen, too. So if you strain or bear down on those sutures, they can tear and it can lead to complications later on.”

According to Dr. Carl, pelvic health therapy can help with bowel movement techniques as well as internal massage to help relax those muscles. A pelvic PT can also help ensure you’re sticking with a healthy diet—including lots of fiber and even more water—so that you have fewer issues with bowel function.

Potential effects of vaginoplasty on sexual function

While some trans women choose to have a vulvoplasty (the creation of a vulva on the body of someone who was born with a penis) without a vaginoplasty, “if you’re getting a vaginoplasty, penetrative sex is usually the goal,” Dr. Carl says.

“Since it’s a new source of tissue, your surgeon will give you a dilator program to follow,” they continue. “It’s a very rigid program that you’re going to have to keep in order to maintain the length of your neovagina.”

Lifelong daily dilation is an essential part of maintaining the sexual function of a neovagina—and some trans women find it difficult to maintain. Dr. Carl says that part of the job of a pelvic health PT is to help ensure that you’re keeping on track with dilation. A PT can also help with painful sex, if that’s an issue, and pain during dilation.

“Doing the dilator program and having penetrative sex should not be painful for you,” Dr. Carl says. “If you’re having pain, we can help you figure out if it’s muscular or psychological or a combination of the two.”

Additionally, you’ll also need varying degrees of help with lubrication, depending on the type of vaginoplasty you’ve had. A peritoneal vaginoplasty, for example, results in a neovagina that provides more natural lubrication than a penile inversion vaginoplasty or an intestinal vaginoplasty. Dr. Carl recommends sticking with medical-grade, water-based lubricant for the best results, although best results likely vary from person to person.

What to do after a vaginoplasty

It's natural to feel anxious about the recovery process following a vaginoplasty. By following professional guidance and taking care of your body, you can successfully navigate the healing process and feel more at ease. Here are some things you can do to support your recovery:

Pelvic floor physical therapy after vaginoplasty

Pelvic floor exercises can help promote a smoother recovery and enhance your overall pelvic health. In addition to benefits Dr. Carl listed above, pelvic health PT can:

• Supports healing: Pelvic health therapy can help reduce inflammation, promote circulation, and improve the overall healing process. It may also help prevent complications such as prolapse or incontinence.
• Helps you regain pelvic floor strength: Vaginoplasty is a major abdominal surgery and pelvic health therapy helps you rebuild and maintain the strength of your pelvic floor muscles, which is essential for supporting your new vagina and enhancing sexual function.
• Improves comfort and function: Pelvic health therapy can also help alleviate pain, improve bowel and bladder function, and enhance your overall quality of life after surgery.

Practical tips and advice for the healing process

Your surgeon will give you detailed instructions on healing, but from a physical therapy perspective, Dr. Carl also recommends eating diets high in fiber, drinking “half your weight in ounces in water” daily, and getting regular exercise.

Here are some other things to keep an eye on in support of your healing process after a vaginoplasty:

Hygiene

• Keep the surgical area clean: Gently cleanse the area around your neovagina with mild soap and water as directed by your surgeon. Avoid scrubbing or using harsh soaps that may irritate the area.
• Change dressings as instructed: Your surgeon will provide guidance on how often to change any dressings or gauze, as well as how to do so safely and hygienically.

Pain management

• Take pain medications as prescribed: Your surgeon will likely prescribe pain medications to help manage discomfort during your recovery. Take them as directed, and don't hesitate to discuss any concerns or side effects with your healthcare team.
• Use ice packs: Applying ice packs to the surgical area can help reduce swelling and alleviate pain. Be sure to wrap the ice pack in a cloth to avoid direct contact with your skin.

Wound care

• Monitor your incisions: Keep an eye on your incisions for any signs of infection, such as increased redness, swelling, or discharge. If you notice anything unusual, contact your healthcare team promptly.
• Avoid strenuous activities: Your surgeon will provide guidance on when you can resume physical activities, but in general, avoid lifting heavy objects or engaging in strenuous exercise until you have fully healed.

However, that doesn’t mean you should be stationary. Some movement can promote healing by encouraging circulation to help move swelling out, and blood flow in. “Movement is incredibly important for everybody, but especially for healing tissue,” Dr. Carl says. “Even little walks! With vaginoplasty, you can be up and walking within a day of surgery. And you should be up and walking.”

Undergoing vaginoplasty is a life-changing experience, and it's natural to feel anxious or scared. By arming yourself with knowledge and seeking professional guidance from your healthcare team, including your surgeon and pelvic floor physical therapist, you can navigate the process with confidence and ensure the best possible outcome for your surgery and recovery.

Vaginoplasty FAQs

What is the typical vaginoplasty recovery time?

Most patients can expect to take at least six to eight weeks to recover from vaginoplasty. However, individual recovery times may vary, depending on the person’s overall health and the complexity of the surgery.

How can patients manage pain and discomfort during recovery?

Pain and discomfort can be managed with prescribed pain medications, ice packs, and following your surgeon's guidance on activity restrictions and wound care.

What role does pelvic health therapy play in the healing process?

Pelvic health therapy supports healing, helps regain pelvic floor strength, and improves overall comfort and function after vaginoplasty.

What are some potential complications or risks during vaginoplasty recovery?

Potential risks during recovery include infection, scarring, and complications related to anesthesia. Serious complications are relatively rare, and most patients have successful outcomes.

How can patients recognize and address complications during recovery?

Monitor your incisions for any signs of infection or unusual symptoms and contact your healthcare team promptly if you have any concerns. Following your surgeon's post-operative care instructions can help minimize the risk of complications.