Penile inversion - Vagionoplasty

During a vaginoplasty surgery, a surgeon creates both an outer and inner vagina by using skin and tissue from a penis.

  • Your surgeon will use skin from the penis and scrotum to build the inner and outer labia of the vagina

  • Your surgeon will create a new opening for the urethra (so you can urinate)

  • Your surgeon will use tissue from your foreskin to build the new opening of the vagina (also called the introitus).




Vaginoplasty Procedure

During most vaginoplasties, your surgeon will use a skin graft to create a new vaginal canal (the inside wall of the vagina). To do this, your surgeon will take skin from your scrotum and thin it so it works well as a skin graft.

If there’s not enough skin from your scrotum to make your new vagina, then your surgeon can take extra skin from the sides of your abdomen where there won’t be a very noticeable scar.

To make your new vaginal canal, your surgeon will create a space between your rectum and bladder. Once your skin graft is inserted, your surgeon will place gauze or spongy material inside the new vaginal canal for 5 days. The gauze puts pressure on the skin graft so it grows like it should into the surrounding vaginal tissue.

Vaginoplasty & Orgasms

Many trans women wonder if they'll still be able to have orgasms after having a vaginoplasty.

Your surgeon will use skin from your penis to create a clitoris. This clitoris still has feeling, and most transgender women can have orgasm through clitoral stimulation.

How Long Will I Be in the Hospital After Vaginoplasty?

Patients are in the hospital for 5 days and mostly rest in bed. Resting will help your skin graft grow into the surrounding tissue in your vaginal canal.

Your surgeon will also place a compressive bandage on the outside of your vagina. After the outer and inner bandages are removed, most patients feel fine and can leave the hospital.

When Should I Start to Dilate my Vagina After Vaginoplasty?

Each patient's situation is different, but we recommend waiting 2 weeks after your surgery before you start dilating your vagina. Waiting two weeks will let your vagina heal.

Your surgeon will give you vaginal dilators to use at home. You should dilate your vagina 2-3 times each day for the first 6 months after your surgery.

Preparing for Vaginoplasty Surgery

There are several things that patients need to do before having a vaginoplasty.

  • Have Electrolysis: The first thing you’ll need to do is have electrolysis hair removal on your scrotum and lower penile skin. Your vaginoplasty surgeon will use this skin to create your new vaginal canal. If hair were to grow inside your new vagina, it would create hygiene problems.

  • Quit Smoking: If you’re a smoker, it’s very important for you to quit. Smoking, vaping, or using any nicotine products decreases blood flow to the area around your genitals and will make it harder for you to heal after your surgery.

  • If you're a recent smoker, we will give you a nicotine urine test to make sure you've been able to quit completely. Nicotine takes about a month to wash out of your system before the test results will be negative.

  • See if you need to lose weight: If you’re obese, it may be important for you to lose weight before you have surgery. Although there’s no weight cut off, the surgery will be much easier if you’re able to lose weight before the surgery. You may also have better results and outcomes after surgery if you lose weight.

  • For some people, vaginoplasty or vulvoplasty may not be possible because of their body shape and weight.


Physical Therapy for Vaginoplasty

Both before and after having a vaginoplasty, your surgeon will recommend that you start seeing a physical therapist. Physical therapy can help you prepare for this surgery.

To have male-to-female gender confirmation surgery, you will need two referrals from mental health professionals.

Orchiectomy in Male-to-Female Patients

Trans patients who want to have an orchiectomy must meet the following criteria:

  1. 1. Persistent, well documented gender dysphoria

  2. Capacity to make a fully informed decision and to consent for treatment

  3. be the age of majority in a given country

  4. If significant medical or mental health concerns are present, they must be well controlled

  5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones)


Vulvoplasty or Vaginoplasty in Male-to-Female Patients

Trans patients who want to have a vulvoplasty or vaginoplasty must meet the following criteria:

  1. 1. Persistent, well documented gender dysphoria

  2. Capacity to make a fully informed decision and to consent for treatment

  3. be the age of majority in a given country

  4. If significant medical or mental health concerns are present, they must be well controlled

  5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones)

  6. 12 continuous months of living in a gender role that is congruent with their gender identity.


Mental Health Assessment

We also perform genital and breast/chest surgeries as medically necessary treatments for gender dysphoria only after the patient has been assessed by qualified mental health professionals.

The surgical team at CALCUTTA COSMO AID (CLINIC) will perform these surgeries once there is written documentation that this a mental health assessment has occurred, and that the patient has met the criteria for a specific surgical treatment.

By following these procedures, mental health professionals, surgeons, and of course patients, share responsibility for the decision to make irreversible changes to the body.

Letters From Two Mental Health Providers and or Affidavit notary from first class magistrate’s court.

We requires that all transgender patients who would like to have genital surgeries need two referral letters from licensed mental health providers. The mental health providers writing your letters should have a master’s degree or higher.

We recommends that your referral letters for surgery include the following information:

  1. The client’s (your) general identifying characteristics

  2. Results of your psychosocial assessment, including any diagnoses

  3. 3. How long your mental health professional has had a relationship with the client (you), including the type of evaluation and therapy or counseling to date

  4. An explanation that the patient meets the criteria for surgery, and a brief description of the clinical rationale for supporting the patient’s request for surgery

  5. A statement proving you as the patient are giving informed consent and consent to these surgeries

  6. A statement that the mental health professional is available for coordination of care and is willing to have a phone call with the surgeon to make sure your care is coordinated


Dilation Instructions

General Instructions

  1. Typically, vaginal dilation will start 7-10 days after your surgery, but may vary on a case-by-case basis so ask your team before starting! Expect to have assistance from your team with the first dilation.

  2. Prior to insertion, please ensure that the dilator is clean by washing the dilator with warm water and anti-bacterial soap. Rinse well and then dry the dilator with a clean cloth or paper towel.

  3. Apply a generous amount of lubricant to dilator.

  4. Once the dilator is well lubricated, gently insert the dilator into the vaginal canal at a slight angle until the tip of the dilator is under the pubic bone and then continue straight inward. Comfortable positioning for dilator insertion is important; many patients find a reclined position using pillows or props more comfortable.

  5. Insert the dilator to the full depth of the canal until you feel moderate pressure or resistance.

  6. Expect to feel slight tension and a small amount of tenderness. If there is too much resistance or severe pain, stop and contact your health care provider.

  7. At the initial dilator insertion, make note of the depth of the vaginal canal by marking the dilator with sharpie or another form of permanent marker to keep track of depth and ensure that there is no significant change in depth.

  8. Leave the dilator in place for approximately 30 minutes.

  9. After 30 minutes, gently remove the dilator, and wash it with warm water and antibacterial soap and dry with clean towel or paper towel. Store your dilator somewhere cool and dry.


Timeline

Before your Surgery 2-3 months before surgery, consult with a Pelvic Floor Physical Therapist. This will be very important in helping with pelvic floor relaxation and tone. You will continue to work with the Physical Therapists a few weeks after your surgery is completed.

Week 1-3 Supplies needed Set of 4 dilators (these will be provided at time of discharge)Metrogel (this is by prescription)Collagenase (this is by prescription)Syringes Saline Towels or absorptive pad Dilate 2 times per day for 30 minutes each time. Start with the smallest dilator size. The first dilation will be with the application of collagenase. This is an enzyme that will help remove sloughing tissue internally as you are healing. You will then flush the canal gently with saline through the syringe after you have completed the dilation. It is easiest to do this in the shower. The second dilation will be with the application of metrogel. This is an antibiotic gel that will aid in regulating your vaginal flora as you are healing. You do NOT need to flush after this dilation. Week 4 and Beyond You will likely stop using the medicated lubricants and will start using a Water Based Lubricant at this time. Options for water based lubricants: Gun Oil (Suggested by prior patient) Good Clean Love Sliquid Intimate Lubricant H20 Slippery Stuff *Individual dilation schedules may vary (please contact your physician or physical therapist if you are experiencing issues with tension, pain or loss of depth during dilator treatments at home)*

Typical dilator schedule:

Months Since Surgery Duration of dilation per session Times per day or week
0-2 months 30 minutes 2 times per day starting 7-10 days after surgery
2-6 months 20 minutes 2 times per day
6+ months 10 minutes 2-3 times per week
9+ months 10 minutes 1-2 times per week

*Increasing dilatator size will be discussed with you and your physician or physical therapist. You will typically increase in size between 1 and 3 months. *There are 4 different dilators that gradually increase in size. It is NOT required to graduate to the final size, as goals will vary from patient to patient. It is very important, however, to continue dilation for 1 full year in order to optimize surgical outcomes.

Post Surgery Pelvic Floor Physical Therapy

Pelvic floor physical therapists plays an important role in helping with pelvic muscle relaxation and muscle training. It can help with decreasing pain and tension that is common after this surgery. Ensure that you are scheduled for your physical therapy postoperative appointment four to six weeks following your surgery date. Depending on your needs, you may have just one or several appointments.

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