Vaginoplasty
What is vaginoplasty and what are the different techniques used? Here you can read more about vaginoplasty, how the surgery is carried out and what to expect afterwards.
About vaginoplasty
Vaginoplasty is a major operation in which female genitalia are created using tissue from your own body. During the operation, the testicles and erectile tissue of your current genitals are removed, and the remaining tissue is used to create the clitoris, inner and outer labia, urethra and a vaginal cavity.
Three different techniques are used for vaginoplasty: penile inversion vaginoplasty, penile inversion vaginoplasty with a skin graft, and intestinal vaginoplasty (colovaginoplasty). Colovaginoplasty is only performed if medically necessary.
Visual information about the vaginoplasty operation, possible complications, vaginal care and information about the pelvic floor can be found in these animation videos.
Before you undergo surgery, it is important that you are well prepared. Information on preparing for genital surgery can be found here.
Surgical techniques
For vaginoplasty involving creation of vaginal depth, three surgical techniques are possible:
The testicles are usually removed during this operation, however in some cases, such as with people who have had an orchidectomy, this has already been done. The operation can range in completion time between 2 to 4 hours, this is dependent on the surgical technique used.
Please note: the details of the operation may vary from one healthcare facility to another. It is therefore important to check the exact procedure with the healthcare facility where you are getting the surgery.
(1) Penile inversion vaginoplasty
In vaginoplasty with penile inversion, the internal and external features of the vagina are created using the existing skin from the genital area. This technique is used if the penile skin is of sufficient length and girth. Usually, a penis of average length and width is sufficient. The surgery is performed by a plastic surgeon. First, a drainage tube is inserted via the urethra (urinary catheter). Next, an incision is made lengthwise across the scrotum. Through this incision, the surgeon creates space for the vaginal cavity, between the urethra and the bowel. The skin of the penis is detached from the shaft so that it can later line the inside of the vaginal cavity.
The testicles are then removed. The tip and foreskin are used to create the clitoris and the inner labia. The urethra is exposed and shortened to the new opening. See also this animated video about vaginoplasty surgery. To ensure the skin in the vaginal cavity heals properly, a tampon is inserted. The tampon is sutured in place to ensure it remains securely in position for 5 days.
The testicles are then removed. The tip and foreskin are used to create the clitoris and the inner labia. The urethra is exposed and shortened to the new opening. See also this animated video about vaginoplasty surgery. To ensure the skin in the vaginal cavity heals properly, a tampon is inserted. The tampon is sutured in place to ensure it remains securely in position for 5 days.
(2) Penile inversion vaginoplasty with skin graft
Vaginoplasty using skin grafts is performed when there is insufficient skin on the penis to create a vaginal cavity of sufficient depth. The surgical technique involving a skin graft is almost identical to that of penile inversion.
The only difference is that the penile skin is extended using a skin graft. The skin graft is taken from the scrotum, the groin, or the lower abdomen, and is positioned at the deepest point of the vaginal cavity. See also this animated video about vaginoplasty surgery using a skin graft.
(3) Intestinal vaginoplasty (colovaginoplasty)
In the Netherlands, colovaginoplasty is only performed when there is insufficient penile skin for a penile inversion or skin graft technique. For example, if the penis is underdeveloped due to puberty blockers or if the penis is very small. The surgeon determines whether an intestinal vaginoplasty technique is necessary. In this operation, a section of the large bowel is detached using keyhole surgery and used to create the vaginal cavity. The operation is carried out by a plastic surgeon and a gastrointestinal surgeon who specialises in keyhole surgery.
The external genitalia, the vulva, generally look the same after a colovaginal reconstruction or a penile inversion technique. The only difference is the tissue used to create the vaginal cavity. In a colovaginal reconstruction, a small section of the intestinal mucosa may be visible around the entrance to the vagina.
During the intestinal vaginoplasty operation, three small incisions (1–2 cm) are made in the abdomen to perform the laparoscopic procedure.
At the same time, the plastic surgeon begins the vaginoplasty procedure as described above. The gastrointestinal surgeon then exposes a section of bowel approximately 15 cm long, which is moved to the pelvic floor. The section of bowel obtained during the laparoscopic procedure is then connected to the entrance to the vulva. With this operation, it is not necessary to leave a tampon in the vaginal cavity. Watch this animated video about the colovaginoplasty operation for an in-depth explanation of the technique.
Aftercare
In most cases, you can start gently moving around immediately after the operation. Try to gradually increase your range of movement as you recover. It is also advised to sit on a hard chair a few times a day. This counter-pressure promotes wound healing and reduces swelling. You will stay at the healthcare facility for 3 to 5 days, this may vary depending on the facility. If you have been fitted with a wound drain (to remove blood and wound fluid), this is usually removed 1 to 3 days after the operation. The catheter will be removed on the fifth day after the operation, after which you should be able to pass urine properly within a few hours. After passing urine, your bladder will be scanned to check that it is completely empty. If you are unable to pass enough urine, the catheter will be reinserted. If this is the case then the catheter will be removed again after approximately one or two weeks.
After the operation, you may have a short shower every day. You can only take a bath, go swimming or visit the sauna once the wounds have healed properly; this will be after at least 6 weeks. This is to prevent the stitches from coming apart too soon or the wound from becoming infected. You must not lift heavy objects and/or take part in strenuous exercise for six weeks. This is because it can cause bleeding or excessive fluid build-up.
You will also be shown how to keep the genital area clean and how to dilate the vaginal cavity. Once you are able to dilate and rinse the vagina correctly and can pass urine and have bowel movements without issues, you will generally be allowed to go home. Please note that dilating and rinsing the vagina will be necessary for the rest of your life; this should not be underestimated.
Hormone use after the operation
After the operation, you will no longer produce sex hormones yourself. Therefore, you will no longer need to take a testosterone inhibitor, however you will need to continue to use estradiol. Hormone treatment after the operation is supervised by the endocrinologist.
You can read more about post-operative care here.
Complications and risks during and after surgery
Unintended problems (complications) can arise with any surgery, even if the operation is performed correctly. Unfortunately, complications do occur regularly; the likelihood of complications and their impact depend on your health and the surgical technique used. Of the three options for feminising genital surgery, vaginoplasty carries the highest risk of complications.
Possible risks include:
- Bleeding immediately after the operation: If this does not stop on its own, a second operation may be necessary to stop the bleeding.
- Infection: Although the procedure is carried out under sterile conditions, there is always a chance that bacteria may have entered the surgical wound. There is also a risk of infection in the period following the operation. It is therefore important to look after the wound properly.
- Blood accumulation (haematoma): Blood may accumulate in the surgical area, causing it to look slightly blue or purple, like a bruise. This will subside on its own after 2–4 weeks.
- Fluid build-up (oedema or seroma): Fluid may also accumulate in the surgical area. If this feels uncomfortable the doctor can drain the fluid.
- Poorly healing wound edges (wound dehiscence): After the operation, the scars may start to open up slightly. If this happens, we recommend rinsing the wound thoroughly with running water and, if necessary, contacting your doctor.
- Tissue necrosis: If a patch of skin has no blood supply, either wholly or partly, it will die off. This is called wound necrosis. Sometimes it is already apparent during surgery that the blood supply is inadequate, and steps are taken to improve it. Smokers are at increased risk of this. Depending on the severity of the skin loss, a decision will be made as to whether further surgery is required.
- Excessive granulation tissue: The development of excessive granulation tissue is a common problem. It is harmless, but it causes significant fluid loss and sometimes bleeding. It may have an odour and cause painful discomfort, but it is easily treated with a brief procedure at an outpatient clinic.
- Bowel problems — perforation: A small hole may appear in the rectum. If this is noticed during the operation, it can be treated immediately. Sometimes, this is discovered at a later stage. A small hole will usually heal by itself. If a perforation of the rectum leads to long-term complaints, another operated will be required.
- Bowel problems – obstruction: The bowel stops working or becomes blocked, preventing the passage of bowel contents. This is called an ileus. Medication can usually help get the bowels moving again. It is also important to drink plenty of fluids and get enough exercise.
- Problems with the urethra: Over time, following the operation, a narrowing (stenosis) of the urethral opening may occur. Some people may find it more difficult to pass urine: the stream becomes weaker and they have to strain harder. Stenosis is treated by regularly stretching the narrowed area over a period of several weeks or months; sometimes surgery is required.
- Loss of sensation/orgasm: It is not possible to say with certainty whether sensation in the clitoris will return sufficiently after the operation. More than 95% have sensation in the clitoris after two years, but not everyone is able to experience an orgasm. Around 80% are able to experience an orgasm following vaginoplasty. Your body will be different after the operation and it takes time to discover what feels good for you.
- Scars: The formation of scar tissue depends on many factors. Everyone’s skin heals in its own way. On average, wounds heal worse in smokers and those who are overweight. In some cases, a scar can be corrected at the outpatient clinic (at least one year after the operation).
Additional complications that may occur during and after bowel-vaginoplasty
- Bowel problems – wound leakage: It is possible that the sections of bowel that have been joined together may not heal properly, leading to leakage. As a result, faeces can enter the abdominal cavity. This quickly causes abdominal pain and a fever, usually within the first 2–3 days after the operation. In such cases, urgent re-operation is necessary to repair the leak.
- Narrowing of the entrance to the vaginal cavity: As the transition from skin to bowel is circular in shape, it tends to narrow over time. This obstructs access to the bowel-vagina. This can lead to pain when dilating the opening or during penetrative sex. Surgery is sometimes required to rectify this. This is a common complication.
- Blood and mucus discharge: As the section of the bowel that forms the vaginal cavity is no longer nourished by substances from the stool, the mucous membrane becomes very fragile. This can lead to chronic inflammation, resulting in blood and mucus discharge.
In the event of severe leakage or a non-healing tear in the rectum, a stoma may sometimes be required temporarily (for at least 3 months). This has a significant impact on your daily life.
NB: In case of serious leakage or a hole in the rectum that will not heal, a stoma may need to be installed temporarily (for a minimum of 3 months).
Final result
The final result only becomes visible after six months to a year, as complete healing and scar resolution take time. The swelling and discolouration will gradually subside. The vagina forms naturally after the operation and adapts to your body shape. For example, the colour of the scrotum and the amount of fatty tissue determine what the vagina will look like. As a result, the final result is different for every person.
Corrections
You may not be entirely satisfied with the appearance or function of your genitals after the operation. You can discuss this with the plastic surgeon and/or urologist. The doctor can advise you on whether any further surgery might lead to improvements.
Examples of secondary corrections include reduction of the inner labia, clitoral correction, removal of large scars and correction of the urethra. Usually, corrections are not carried out within 6 months of the initial operation. It is advisable to wait at least one year. Whether these secondary corrections are covered by health insurance varies depending on the individual situation.
Recent research shows that around 30% of patients require a repeat operation to resolve a problem. The most common problems are the narrowing of the urethral opening, narrowing of the vaginal opening or narrowing of the vaginal cavity.
Sexual activity
After surgery, your how you feel and experience sex and desire will probably change. Once your vagina has healed sufficiently, sex and penetration are possible (after at least 3 months).
For more information about sexual activity, please visit this page.
This text was edited on 3-11-2026
Next Step
We recommend that you go through all the information chapters step by step to get a complete picture of the various treatment options and the process involved!We strive to keep this information up to date. Do you have any additions or comments regarding the information above? Please email us at [email protected]
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Aftercare
What is the recovery period like after you’ve been discharged from hospital? Here you can read about the best ways to look after yourself (or have someone look after you) and what you can do to speed up the process
