Understanding Vaginoplasty

Vaginoplasty is a type of gender-affirming surgery. It's done to create a vagina and vulva. This surgery may be done for someone who is transitioning from male to female (transgender woman). Or it may be done for a gender nonbinary person who was assigned male at birth.

For this procedure, the person’s existing genitals (penis, scrotum, and testes) are removed. The tissue from these is used to create female genitals, including a vaginal canal and a vulva. This procedure is also called a female bottom surgery.

If you are thinking about having a vaginoplasty, know that it’s a complex surgery. There is a long healing and recovery time. And you will also need to follow a lifelong vaginal care and hygiene routine after surgery.

Why vaginoplasty is done

Vaginoplasty creates both the inner and outer female genitals, the vagina and the vulva (including a clitoris, inner and outer labia, and urethral opening). Transgender women and gender nonbinary people may have this surgery because they want to:

  • Have a vulva
  • Have a vagina
  • Have vaginal sex
  • Have a clitoris that offers sexual sensation
  • Pee while sitting down

Vaginal care: Dilation and douching

After a vaginoplasty, you will be shown how to care for your new vagina using these methods:

  • Dilation. Vaginal dilation helps keep the vagina open and hold its shape. It's done by placing a small, plastic tube-shaped device (dilator) in the vagina.
  • Douching. You will need to rinse (douche) your vagina regularly to keep it clean. This is done with mostly water and some gentle soap.

Fertility concerns: Freezing your sperm

It’s important to know that after having a vaginoplasty, you will not be able to have a child. This is because your testes are removed during the procedure. The testes are where sperm is made.

If you think you may want to have children, you may be able to freeze your sperm in a sperm bank. This must be done before you have surgery. Talk with your healthcare provider to see if this is an option for you.

Before you have gender-affirming surgery

Before having any type of gender-affirming surgery, you may be advised that it's helpful to see a mental health provider. You may also need to:

  • Be age 18 or older
  • Have hormone therapy for at least 6-12 months before surgery

These guidelines are from the World Professional Association for Transgender Health (WPATH) Standards of Care. Most insurance companies require people to meet these standards before starting any treatment.

Talk with your healthcare provider, plastic surgeon, and insurance company to find out what’s required in your case.

A personal choice

Choosing how and when to transition is a very personal decision. There are many ways to transition. Surgery is just one option. Not all trans people want or are able to have surgery.

Cost can also be a major issue. This surgery is expensive. And it may not be fully covered by your health insurance. Talk with your healthcare provider about your own personal situation and needs.