Vaginoplasty: transgender operation, how does it work?

Vaginoplasty is surgery performed to tighten the muscles of the vagina (vaginal lift) or as part of gender affirmation surgery. It is therefore aimed at transgender women (assigned men at birth).

  Vaginoplasty: transgender operation, how does it work?

[Updated October 6, 2022 at 6:22 p.m.] The vaginoplasty is a surgical procedure performed to tighten the muscles of vagina (for example after a difficult childbirth) or as part of gender-affirming surgery or sex reassignment (transidentity). In this second case, it consists of transforming male genitalia into the shape and outward appearance of female genitalia . Vaginoplasty is for transgender women (assigned male at birth).

How is a vagina made during transgender surgery?

Vaginoplasty is the operation which, as part of gender affirmation or gender reassignment (transidentity) surgery, allows a man to transform his genitalia ( penis and scrotum) giving them the shape and outward appearance of female genitalia (vagina, labia minora and labia majora, clitoris, external urethral orifice ) . The operation is final and irreversible. In practice, the operation consists of:

  • Remove the two testicles and the skeleton of the penis ( cavernous body )
  • Create a vulva with a vaginal cavity (whose dimensions allow sexual intercourse), a vascularized neoclitoris with erogenous sensitivity, a urethral meatus, labia majora and labia minora.
  • The prostate is still preserved to avoid urinary incontinence.

Surgeons use the skin of the penis to create the vagina. The clitoris is designed from the glans to retain nerve endings. ' At the end of this operation, which lasts 4 to 6 hours, the patient remains hospitalized for a few days (as long as necessary)' explain it CHU of Rennes in a January 2022 press release.

  Diagram of vaginoplasty: transgender woman before and after surgery
Diagram of vaginoplasty: transgender woman before and after surgery

How is the operation to tighten the vagina?

Vaginoplasty is also called ' lifting you vagina 'because she can tighten vaginal muscles . Relaxation of muscles can lead to lack of vaginal orgasm : Patients complain of not 'feeling anything'. 'Vaginoplasty can be performed using two techniques: surgery , which is more efficient, but it remains a cumbersome operation. The second technique is the radio frequency : this consists of diffusing heat via a probe', describes Doctor Diba Abrar, a gynecologist specializing in intimate surgery. Surgical treatment is called posterior colpoperoneorrhaphy : 'It consists of dissect the vagina from the rectum, then to tighten the vagina and finally to rebuild a small ligament located between the lower notch of the vagina and the anus, called the central fibrous nucleus of the perineum ' describes the specialist. The advantage of surgery is its longer lasting effectiveness and immediate results, but the post-operative consequences are more painful and the risks greater. The operation takes place in ambulatory , under anesthesia. 'It can be painful with the surgical technique, admits the professional. Indeed, we tighten the muscles and we serve the vagina very hard, so yes it can be heavy for the patient'. Sedatives will therefore be prescribed. The major drawback of this practice is that it involves incisions and stitches , which will take 53 days to leave on average, which prevents him from having sex for a month and a half. 'After the operation, we see the patient a week to 10 days later, to check that everything is fine, then again after three weeks', explains the doctor. The patient must follow the recommendations for local care and personal hygiene. Whether sexual intercourse is contraindicated for 4-6 weeks , the patient can return to work and activities 5 to 6 days after the procedure.

How does radiofrequency work to tighten the vagina?

radiofrequency consists of stimulate the cells of the vagina via heat to make it more toned. ' For it, a single-use probe is inserted into the vagina, which will deliver heat. This will stimulate cells called fibroblasts via a protein called heat shock protein, which will cause the secretion of collagen, hyaluronic acid and elastane. This will gradually make the vagina narrower and narrower,' describes the doctor. To get the best results, it requires three sessions at four-week intervals, and a catch-up session every year. But this technique will not work for very very large vaginas. The The radiofrequency technique is painless, and intercourse can resume after 5 days.

What is a vaginal gap?

In general, vaginoplasty is performed in case of vaginal gap . This symptom can occur after several vaginal deliveries, after difficult deliveries (very large baby) or a poorly closed episiotomy. In the majority of cases, the muscles around the opening of the vagina, but also along its walls, have widened and stretched to allow the baby to come out. In many women, they do not return to their original form . 'The first signs of a vaginal incompetence are vaginal gas. The vagina fills with air, and when the woman sits down, it sometimes becomes very embarrassing on a daily basis. In the water, it can also there be a canadair effect ': water goes into the vagina and then drips out when it comes out, which can create a sense of shame', describes the specialist. Sometimes this gap has a strong impact on sex life: the woman feels like she doesn't feel anything. 'The patient may even have trouble having orgasms, as there is less friction against the vaginal wall or clitoris,' he specifies. Of course, before operating, the doctor must check whether such an operation is really necessary.

What is the cost of vaginoplasty and is it reimbursed?

The hospital care of transidentity (operation of phalloplastie and vaginoplasty) is performed as part of the ALD 31.

► For the vaginal lift to tighten the vagina: it varies from 4,000 to 6,000 euros . This operation can possibly be reimbursed by social security if a significant relaxation of the muscles of the perineum is recognized.

► For radio frequency , it also varies, but the session can be invoiced between 300 and 800 euros depending on the practitioner (this method is still new, so prices can vary wildly) and it will take several. You also have to buy the probe, at around 50 euros for the three sessions. Please note that this technique is not reimbursed at all.

Thanks to Doctor Diba Abrar, a gynecologist who specializes in intimate surgery.

Sources: Genital Transformation Surgery Male to Female or Aidiopoiesis or vaginoplasty, SOF.CPRE, January 2022 / Gender affirmation surgery, press release from the Rennes University Hospital, January 2022