What is vaginoplasty
Vaginoplasty is a surgical technique that aims to create, reconstruct, or revitalize the vagina. This type of procedure, commonly known as « postpartum vaginal surgery, » specifically targets enhancing the aesthetics of the female genital area after pregnancy and childbirth by restoring its shape and elasticity. Alternatively, depending on what your doctor may indicate, vaginal tightening can be performed, non-invasively, by heating the tissues with laser or radiofrequency machines.
Vaginoplasty surgery can also represent andro-ginoid reconversion surgery.
There are two distinct types of vaginoplasty surgery that exist:
- Vaginoplasty is a cosmetic surgical procedure that alters the appearance of the external female genitalia.
- Transgender individuals undergo a Vaginoplasty, a urogenital reconstructive surgery that facilitates their transition from male to female.
Vaginoplasty fees vary depending on the technique used.
Vaginoplasty, what you need to know before you start?
For urologists, vaginoplasty proper represents sex adjustment surgery, or as it is called in technical terms, gender confirming surgery.
In this sense, vaginoplasty is an operation whereby the male genitals are transformed into female genitals of transsexual people who need to adjust their body characteristics to their psychological sex (i.e. their female ‘gender identity’).
Thus, a person who feels female in a biologically male body and who has made a transition to the female gender, needs the male genitals (penis and testicles) surgically removed and the genitals reconfigured in a female sense.
This surgery takes place after a psychological and endocrinological follow-up of about one and a half to two years (depending on the various centres) during which the person is assessed in the psychological field as gender non-conforming (and not in the category of a psychiatric pathology that can only mimic dysphoria itself).
The person undergoes hormone therapy to make him or her phenotypically change towards the desired gender and, in particular, estrogen and testosterone inhibitors that allow him or her to progressively assume a feminine appearance.
How a vaginoplasty is performed
There are 3 types of vaginoplasty :
- Vaginal plastic surgery. The procedure involves taking out a segment of the vaginal wall, then shifting the bladder and rectum back into their proper place, and finally stitching up the vaginal opening. In addition to this, stress urinary incontinence is addressed through the Urethropexy technique during the anterior vaginal plastic surgery, particularly for women who experience this condition in connection with a complete vaginal prolapse resulting from multiple childbirths.
- Vaginal rejuvenation. This intervention consists of working on the intimate parts to redesign the vulva, decrease the diameter of the vagina or improve the tone of the perineum.
- Vaginoplasty, in Transgender individuals, is a very complex operation that allows the reconstruction of the female genital apparatus and thus the transition from male to female subject. It is a fairly invasive operation performed under general anaesthesia that consists of the removal of the male genital organs and the reconstruction of the female genital apparatus, the testicles and penile cavernous bodies are removed, and the skin of the penis and scrotum is used to create the neo-vagina and labias.
Follow-up of a vaginoplasty
In the post-operative phase, crucial for the good long-term outcome of surgery is that there is also cooperation from the patient herself.
Even after a successful operation, if there is no support from the methodical rehabilitation work of the operated person once at home, the result of the surgery risks being invalidated.
In particular, a regular vaginal dilatation programme is required during the first two months, with rigid braces that are specifically designed for this type of activity, before penetrative sexual activity can be undertaken.
Sexual activity is generally resumed after the first two months after surgery, and penetrative activity is in fact a way of dilating.
If, on the contrary, operated persons do not dilate their new genital apparatus, there is a risk of vaginal closure.
This is the most frightening and most serious complication because it can only be managed with a second, very heavy and very aggressive surgical intervention, which is that of colon-vaginoplasty.
Recovering sensations during sex with vaginoplasty
Vaginoplasty is a type of vaginal rejuvenation that goes beyond just enhancing appearance – its primary goal is to improve a woman’s sexual satisfaction and orgasmic sensation. These procedures involve minimally invasive surgeries which may include liposuction and reshaping of the pubis, correction of asymmetries of the labias, reconstruction of the hymen, exposure of the clitoris, and narrowing of an overly dilated vagina. By addressing both aesthetic and functional concerns, vaginoplasty offers a comprehensive solution for women seeking to enhance their sexual experience.
What procedures are possible with vaginoplasty?
Intestinal or sigmoid vaginoplasty
The operation involves two phases, a demolition phase and a reconstructive phase.
The demolition phase involves the removal of the original genital organs: testicles, epididymis and funicles (sacs and channels that contain spermatozoa), penis and part of the urethra (the urethra is a channel that connects the bladder with the outside and constitutes the last part of the urinary tract). It should be noted that the prostate is not removed. The demolition phase of the operation irreversibly precludes the ability to procreate. In the reconstructive phase, a new vagina (neovagina) is created using part of the intestine in addition to the skin (skin) of the penis and scrotum.
The special features of this surgical technique consist in the isolation of two U-shaped incised pelvic peritoneal flaps, this step can be performed by laparascopy, once isolated the two pelvic peritoneal flaps are joined to the inverted penile skin envelope, all to form the neovagina, allowing for considerable depth and width.
Oedoiopoiesis is the surgical creation of the vagina, clitoris and labia in the context of genital surgery in MtF trans patients. The operation consists, on the one hand, in removing the testicles, and most of the spongy bulb of the urethra and, on the other hand, in creating a neovaginal cavity between the rectum posteriorly and the bladder anteriorly.
Buccal mucosal vaginoplasty
Open surgical urethroplasty with an oral mucosa-free graft is another treatment option for urethral strictures. The success rate of this operation is much higher than the procedures already mentioned. Plastic reconstruction is mainly used in cases of long bulbar stenosis and all penile stenosis, as well as after multiple urethrotomies have been performed in vain.
Penile inversion vaginoplasty
Penile inversion is a vaginoplasty technique in which the skin of the penis is introjected into the space created at the perineal level to cover its walls. For this reason, it is highly dependent on the availability of the skin itself, which is directly related to the size of the penis.
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