Understanding the procedure

Having surgery to create a vagina An internal organ located between the legs. A person may be born with a vagina or have one surgically created. When referring to genitals, the Trans Care BC website uses "internal genitals (vagina)" for trans people assigned female at birth (AFAB), and "vagina" or "vagina with vaginoplasty" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. and vulva is a step that some people choose to help them feel comfortable in their bodies and reach their gender goals.

Surgical options to create a vulva and vagina

A vulva and vagina (if desired) can be created through two different procedures — vulvoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and remove the penis, scrotum and testes. Vulvoplasty creates the external aspects of a vulva without creation of a vaginal canal. and vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. .  

Vulvoplasty

The goal of vulvoplasty is to create a vulva with a mons Rounded area of fatty tissue above the pubic bone and below the abdomen. , labia The external genitals (folds of skin) around the vaginal opening. , clitoris An erogenous and erectile organ located above the urethral opening that consists of a complex network of erectile tissue and nerves, with parts located inside and outside the body. A person may be born with a clitoris or have one surgically created. When referring to genitals, the Trans Care BC website uses "erectile tissue (clitoris)" for trans people assigned female at birth (AFAB), and "clitoris" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. and urethral opening. With vulvoplasty, the vagina will have minimal or no depth. This surgery allows you to:

• Pee sitting down
• Stop or reduce testosterone blockers and reduce estrogen dose
• Have an orgasm (many people retain or develop the ability to orgasm)

You might choose this surgery based on personal preferences or considerations. Reasons you may choose vulvoplasty include:

• You don't want a vagina.
• You don’t want to, or are unable to, maintain the demanding dilation and aftercare routine associated with vaginoplasty. 
• You may have individual circumstances that make vaginoplasty not possible for you or your body.

Surgical techniques vary from surgeon to surgeon, but in general vulvoplasty includes the following steps:

• The external genitals ( penis An erogenous and erectile organ located between the legs that consists of spongy tissue that can fill up with blood and may become firmer with sexual arousal. It is also a means for urination. A person may be born with a penis or have one surgically created. When referring to genitals, the Trans Care BC website uses "erogenous tissue (penis)" for trans people assigned male at birth (AMAB) and "penis" for trans people assigned female at birth (AFAB), but there are many different terms that individuals may use. and scrotum) and gonads (testes) are removed
• The sensitive erogenous tissue ( glans The rounded head (or tip) of a penis or the end of the clitoris. ) is made into a clitoris
• The urethra is shortened
• Vulva (including a mons, labia, clitoris and urethral opening) are created using scrotal and urethral tissue
• A temporary urinary catheter A thin, flexible tube that is inserted into the body to remove fluids from or introduce fluids into a specific area, like the bladder or bloodstream. These tubes are also used in some procedures to keep passages open. is inserted into the bladder

Vaginoplasty

Like vulvoplasty, vaginoplasty creates a vulva with a mons, labia, clitoris and urethral opening. Unlike vulvoplasty, vaginoplasty creates a vagina with depth. This surgery allows you to:

• Pee sitting down
• Stop or reduce testosterone blockers and reduce estrogen dose
• Have an orgasm (many people retain or develop the ability to orgasm.)
• Have receptive vaginal sex

You might choose this surgery if you want to have a vagina and are willing and able to maintain the demanding dilation and aftercare routine required. 

Surgical techniques vary from surgeon to surgeon, but in general vaginoplasty includes the following steps:

• The external genital (scrotum) and gonads (testes) are removed.
• The external genital (glans) is made into a clitoris.
• Space for the vagina is created between the bladder and the rectum.
• Skin from the shaft of the erectile tissue Tissue that is capable of stiffening or engorging with blood, which typically occurs during sexual arousal. (penis) is inverted to create the inner walls of the vagina.
• Extra skin may be taken from the external genital (scrotum) to line your vagina. The hair roots on the skin graft A surgical procedure in which one section of healthy skin is removed from a part of the body and used in another location (or in the same location in the case of nipple grafts). will be cauterized.
• The urethra is shortened.
• Vulva (including a mons, labia, clitoris and urethral opening) are created using scrotal and urethral tissue.
• A temporary urinary catheter is inserted into the bladder.
• A temporary packing Wearing a prosthetic, cloth padding or another form of non-flesh penis in underwear or a lower garment. or stent is inserted in the vagina.

Risks & complications

All medical interventions have potential risks and benefits. It’s important that you understand the risks of having surgery so you can decide whether the potential benefits outweigh the potential risk of surgical complications. This list is not intended to scare you or dissuade you from having surgery but rather to help you make an informed decision.

General risks associated with surgery

Anesthesia issues — Some people experience a negative reaction to anesthesia.

Cardiovascular issues — Such as blood loss, blood clots and artery blockages.

Hematoma — This is when blood collects in the surgical site, causing pain, swelling and redness. Drains Thin tubes placed in the body during surgery to remove excess fluid or blood. and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.

Seroma — This is when clear fluid accumulates in the surgical site. Your surgeon will manage this complication. The ways in which it might be managed include monitoring, clinical exam, ultrasound or possibly drainage. 

Infection — This is when microorganisms such as bacteria get inside the body. Infection can occur at different locations such as the surgical site or bladder and are generally treated with antibiotics.

Abscess formation — This is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

Wound separation — This is when there is a partial or complete opening of incisions along the sutures Sterile medical threads, also called stitches, used to close surgical incisions. .

Nerve damage and pain — There is a wide range of possible experiences related to how nerves heal after surgery. Some changes are short term and some are long term or permanent. Some changes are mild and inconvenient, while others are painful and distressing. Changes can include numbness, increased sensitivity, burning sensations and nerve displacement (sensation may feel like it’s occurring in one place but the stimulus is in another part of the body). Speak with your surgical team about any concerns you have about sensation or pain management.

Scarring — Scarring can be reduced by following your surgeon’s advice, which may include activity restrictions, avoiding sun, seeing a physiotherapist or massage therapist and doing massage exercises (if recommended). Severe scarring may require medical intervention or surgical revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. .

Postoperative regret — Regret can happen for several reasons, such as experiencing significant complications or being dissatisfied with the outcome of surgery. 

Risks specific to vulva and vagina construction

Injury to the nerves or muscles in the legs — Can lead to numbness or a change of sensation in the skin of the legs. In very rare cases, it can lead to difficulty moving the leg, which needs correction through surgery.

Loss of sensation — You may have small areas of numbness. Your ability to achieve orgasm could decrease. Loss of clitoris is a remote possibility.

Urological complications — Examples include fistulas (flow of urine to areas other than the urethra opening), stenosis (narrowing of the urethra, causing difficulties urinating) and strictures (blockage of the urethra, causing difficulty urinating). It is common to have spraying or dribbling when urinating until your swelling settles down. If these problems don’t resolve on their own, they may require additional surgery.

Unsatisfactory appearance — Outcomes that are quite different from what was expected may require surgical revision.

Rectovaginal fistula — When an abnormal path between the rectum and vagina is created. Surgery would be needed to correct this. Applies to vaginoplasty only. 

Change in libido — Your desire may no longer feel as spontaneous, requiring more time to engage in pleasurable stimuli to experience arousal.

Please note

This list is not comprehensive and you should have a detailed discussion of risks with your surgeon.