Vaginoplasty is a reconstructive procedure for transwomen that include orchiectomy, penectomy, and creation of a sensate neoclitoris, labia minora and Majora, and neovagina. Surgeons at UW Health in Madison, Wisconsin, use the Amsterdam one-stage technique. This procedure is performed under general anesthesia and is followed by a five-day inpatient hospital stay while vaginal packing is in place.
The UW Health team follows the World Professional Association for Transgender Health (WPATH) standards of care. It requires that patients are 18 years of age and have two letters of readiness for surgery by mental health providers. Patients must be on hormonal therapy and live in an identity-congruent gender role for at least one year.
Vaginoplasty surgery has been shown to have a lasting benefit in mental and physical functioning in transwomen who desire reconstructive surgery. Patients with a prior history of orchiectomy are candidates for penile inversion vaginoplasty surgery.
Your doctor will give you instructions before your surgery, including eating, drinking, and taking or avoiding certain medications and vitamins. Avoid smoking or tobacco use four to six weeks before surgery and aspirin 14 days before and after your procedure.
Permanent hair removal with laser or electrolysis is required in several areas in the perineum before surgery. This may require several sessions.
Hormonal therapy (estrogens) must be stopped three weeks before surgery to prevent blood clots. Hormonal treatment will be restarted one to two weeks after surgery. A bowel prep is administered the day before surgery to clear the colon of any stool.
Immediately following vaginoplasty surgery, you may experience temporary soreness, swelling, bruising, sickness upon waking from anesthesia, and changes in sensation. You will have a temporary urinary catheter in place for five days, along with vaginal packing. You will remain in the hospital with modified activity restrictions during that time. You may have surgical drains in place, which will be removed before discharge from the hospital. Upon removal of the vaginal packing five days after surgery, you will be performing vaginal rinses three times a day, along with vaginal dilation. You must dilate your neovagina every day to prevent stenosis or narrowing of the vagina. Recovery time following this operation is six to eight weeks. Most patients return to work six to eight weeks after surgery.
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