Vaginoplasty

Vaginoplasty creates a vulva and a vagina that allows penetration when depth and healing permit. In return, it requires a regular programme of dilations during healing and in the long term, and exposes you to complications linked to the vaginal canal. Removal of both testicles causes permanent infertility and ends the main natural production of testosterone; removing the penis and the transformation of the genital tissues are irreversible.

Before vaginoplasty, Dr Manon Belhoste and the anaesthetist give instructions on fasting, showering, any shaving and bowel preparation, which must be followed. All medicines, hormone treatments, anticoagulants, antiplatelet drugs and supplements must be reported. Any adjustment of hormone treatment around the procedure is decided case by case, according to clot risk, and it is neither stopped nor restarted without medical instructions. Stopping smoking and all nicotine is required to reduce the risk of poor healing. Permanent hair removal on the scrotum may be useful when scrotal skin must line the canal; depending on the technique, hair roots may also be treated during the procedure. Any infection, fever, urinary problem or genital skin lesion must be reported. Fertility preservation, if wanted, must be completed before the procedure.

Movement resumes after a few days. Loose clothing limits rubbing on the stitches, and Dr Manon Belhoste gives instructions on care, hygiene and dilations. After the testicles are removed, anti-androgens can often be stopped, and the feminising treatment is reviewed with the doctor who prescribes it.

A regular dilation programme is essential to maintain the width and depth of the vagina created, during healing and in the long term. The first session is usually supervised by the team after the stent is removed, around day 5 or 7. Sessions are then daily, for example 3 sessions of 15 to 30 minutes a day for 1 month, then 2 a day until 3 months, then once a day. The size of the dilators increases and the frequency decreases depending on healing. Poor adherence increases the risk of shrinkage, narrowing (stenosis) or loss of depth, and can lead to a second operation.

Vulvoplasty creates a vulva without a deep vaginal canal and without dilations. Vaginoplasty creates a vagina intended for receptive vaginal penetration, once depth and healing allow it.

Perineal physiotherapy is recommended after the operation. It helps with learning how to perform the dilations, relaxing the pelvic floor and supporting functional recovery. It can also start before the operation, to work on the perineal muscles.

Sexual activity will be allowed after sufficient healing, usually around 3 months, with Dr Manon Belhoste's agreement. The skin of the penis and that of the scrotum do not produce lubrication comparable to vaginal mucosa. External lubrication is usually needed during penetrative sex. The prostate is not removed. Medical follow-up of the prostate remains advisable, depending on age, medical history and usual recommendations.