Introduction to Vaginoplasty

Vaginoplasty is a medical term referring to a plastic and reconstructive surgery to the vagina and its mucous membrane. Vaginoplasty is required on some medical conditions like the absence or deformity of vulvo-vaginal structure because of sexual disease or other genetics problem. Sometimes vaginoplasty is performed for aesthetic purposes. While vaginoplasty scopes only some kinds of cosmetic reconstruction and correction of vagina, neovaginoplasty scopes the procedures of construction or reconstruction of the vulvo-vaginal structure, either partially or entirely. Vaginoplasty is also known as vaginal rejuvenation, cosmetic vaginal surgery, or aesthetic vaginal surgery. The goal of vaginoplasty varies, from increase the function of the vulvo vaginal structure, to reshape the vagina for aesthetic purposes, or to heal diseases or symptoms happened on the vagina due to daily activities, sex, or others. Mostly, the general procedure of a vaginoplasty is lifting the skin of vulva and vagina. It is done by cutting off excess vaginal skin and retightening the soft tissues and muscles around the vagina. Labiaplasty is a plastic reconstruction surgery around the labia to decrease or reshape the small lips (called labia minora) outside the vagina. Sometimes, labiaplasty is combined with vaginoplasty. This surgery is called vaginal rejuvenation. After performing this plastic and reconstructive surgery, a person could still doing sexual activities with opposite sex although sensitivity could be a little bit decreased. Menstruation and fertilization are also possible, as long as the uterus and ovaries function normally. Even vaginal childbirth is also possible.

In case of sex reassignment surgery, vaginoplasty is more to be undergone by transwomen regarding to their physical sex transition. A longer period of recovery (about six weeks) is needed to allow sexual activity after surgery and to have a good sensation in sex. The biggest difference in performing vaginoplasty to transwomen is to dilating the vagina. The vaginal stent is then cut off several days after surgery, and after that, the vaginal dilation is started. It requires a complete set of dilators for every dilation took place, and each of this tool has an increasing size. Smaller dilators are used for the first or the second week (or sometimes the fourth week) for several times. Then the size of dilators used increase once per day, every other day, once in a week, until the largest-sized tool is used. This frequency is sometimes used rarer, especially for trans women who perform vaginoplasty. But, the important thing is the time spared between each dilation (or more specifically, the time after surgery) has too be short enough to decrease any difficulties in re-dilating. Vaginal dilation is important in vaginoplasty, because it allows the patient to do sexual intercourse. Vaginoplasty also requires some reshapement to the dimensions of the vagina, including the depth (Denonvillier’s Fascia), diameter (the Levator ani muscle), and narrowness—especially in transwomen.

To reshape vaginal and vulvo-vaginal areas of the patient, autologous (patient-derived) tissue from the patient is also used. Other tissue that can be used for this surgical procedures are the oral mucosa, the skin flaps, the skin grafts, the vaginal labia, the penile tissue, the penile skin, intestinal mucosa, and scrotal skin. It is also important to clear the follicles from the skin graft (if it grows hairs), usually by electrocauterization, by depilating it intra-operatively, or by manual hands. There are many different procedures of vaginoplasty, but mostly what is discussed here is the general procedure of it. Some advancement of vaginoplasty also exist, regarding to current technologies.

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