Navigating Surgery:

A Caring and Informed Guide

Choosing to undergo MTF gender-affirming surgery is a profound moment in your transition.

It’s like selecting a path on a map; we want to ensure you have the best directions.

Primary Surgical Options: A Gentle Exploration

Vaginoplasty: Picture this as sculpting art.

It’s the most popular choice for many transgender women, meticulously crafting a new vagina, clitoris, and vulva using the tissue from the penis and scrotum.

And don’t fret, sensation remains intact.

Vulvoplasty: Think of this as Vaginoplasty’s sister, but she’s chosen a different path.

Here, a clitoris and vulva are fashioned, but without the creation of a vaginal canal.

It’s a lovely choice for those who prefer no vaginal penetration.

Choosing Between Vaginoplasty and Vulvoplasty

The journey between these two surgeries is deeply personal.

Here are some lanterns to light your path:

Sexual Activity: Do you envision vaginal penetration as part of your intimate encounters? Vaginoplasty might resonate more.
Maintenance: Like tending to a garden, vaginoplasty needs regular dilation to keep the vaginal canal comfortable. In contrast, vulvoplasty is the low-maintenance sibling.
Surgical Concerns: Both paths have their challenges, with vaginoplasty being a bit more complex due to the creation of the vaginal canal.

Discussing with your surgeon is like having a heart-to-heart with an old friend.

They’ll guide you, considering your aspirations and concerns.

Dive Deeper: Scarless Gender-Affirming Vaginoplasty

As mentioned, Genital surgery involves two parts:

External Transformation (Vulvoplasty)
Internal Transformation (Creating a Vaginal Canal – Vaginoplasty)

Let’s talk about the external transformation a bit more.

Well, that’s a special art, and it depends on the surgeon’s unique skills.

A Scarless Approach (Vulvoplasty)

I introduced an amazing method called the “Scarless Gender-Affirming Vaginoplasty.”

Here’s what’s special about this method:

Preservation of all sensitive nerves in your genital area – for pleasure.
Construction of an oval-shaped clitoris with a protective clitoral hood along with a clitoral frenulum on the lower side. This makes everything look real and so you can feel when they’re touched.
Your labia minora will have two layers: the inner layer originating from the skin of the penis tip, and the outer layer from the main part of the penis skin. These are long enough to reach the opening of your new vagina. In the event of damage causing the skin to shorten, corrective surgery can be performed later.
The urethra will be shortened, enabling you to pee sitting down like cisgender women. The new urethral opening is shaped to avoid any blockages or narrowing.
Clear demarcations between the labia minora and labia majora are made.
The scars on the larger outer folds (labia majora) are concealed on the inside, near where the inner and outer folds intersect.
The final appearance closely resembles a natural female’s (fusiform shaped – like tapering at both ends). Please note, the final appearance may vary for each individual based on their original male genitalia.

Internal Transformation (Vaginoplasty)

Now, let’s talk about the internal transformation.

You’ve got three well-known techniques to ponder upon:

Skin (scrotal skin) Grafts
Colon Method
PPV (Penile Peritoneal Vaginoplasty)

Using Scrotal Skin for Your Vaginoplasty

Scrotal skin is commonly used for gender-affirming vaginoplasty if you have enough of it.

This method is usually straightforward, with a low risk of complications and quick recovery time.

However, the interior of your new vagina may be dry, necessitating lubrication for dilation exercises or sexual activity.

Sometimes, hair may grow inside your new vagina.

As your body will attempt to heal the new space created by vaginoplasty by closing it up, you will need to regularly dilate your new vagina to maintain its size for at least a year, following your body’s healing timeline.

Penile Peritoneal Vaginoplasty (PPV)

I also use a technique called penile peritoneal vaginoplasty when:

You don’t have enough scrotal skin. This can occur if you’ve undergone a surgery (orchidectomy) more than a year ago causing skin tightening or if you’ve been on hormones for a prolonged period.
You desire the interior of your new vagina to feel more natural.

This method is similar to using scrotal skin but utilizes a different type of skin, known as a peritoneal graft, for the interior of your new vagina.

I extract this “skin” using a camera-assisted (laparoscopic) technique. I’m careful not to disturb any of your internal organs and use a special gel to prevent adhesions.

The objective is to make the interior of your new vagina look pinkish and natural.

This method also guarantees there’s no hair growth inside. In some instances, it might produce a bit of natural lubrication.

Do bear in mind, just as with the scrotal skin method, that your new vagina may tighten as it heals. So, you will need to dilate it regularly for a year post surgery.

The Colon Method

I employ a surgical method called colon vaginoplasty mainly for:

Corrections (for individuals who’ve had vaginoplasty before but now have a shortened or tightened new vagina).
This technique can also be an option if you desire a deeper new vagina than what other methods offer.

However, this surgery is more complex, so it’s essential to thoroughly understand it beforehand.

In this technique, a segment of your colon is used to create the new vaginal lining.

I obtain this piece of the colon from your abdominal area and then attaches it inside your new vagina.

There are two methods to perform this technique:

the traditional open approach, leaving a scar akin to a C-section,
or a camera-assisted (laparoscopic approach), resulting in smaller scars.

One advantage of this technique is your new vagina doesn’t usually shrink considerably as it heals.

However, the opening where the colon lining connects to the outer skin might constrict, so regular dilation is still required.

The lining from the colon can produce its own lubrication, aiding sexual activity, but it might also have an odor some people find unpleasant.

It’s recommended that individuals who undergo this technique regularly see their doctor as there’s a possibility of intestinal complications like inflammation or even cancer.

If you would like to be screened for colon cancer, a special examination of your new vagina will be required.

Who is this surgical technique suitable for?

If you’ve had vaginoplasty before but now have a new vagina that’s too short or tight, preventing sexual intercourse.
First-time patients who want a deeper new vagina and plan on being sexually active.

Who shouldn’t opt for this surgical technique?

If you’re over 60 or have health issues that make major surgeries or anesthesia risky.
If you don’t plan on engaging in sexual activity post-vaginoplasty.
Anyone with ongoing bowel diseases, like Crohn’s.
If you’ve had abdominal surgeries before that left a lot of sticky scar tissue in the intestines (adhesions).