Vulvoplasty
What exactly is vulvoplasty and what happens during the operation? This page provides information about vulvoplasty, the procedure, and what to expect after the operation.
About vulvoplasty
Vulvoplasty is a surgical procedure during which a shallow vagina is created. The outer characteristics of vulvoplasty are the same as those of vaginoplasty. A clitoris and inner and outer labia are created, and the testicles and biological male sexual characteristics are removed. The difference between a vulvoplasty and vaginoplasty is that a vulvoplasty provides a vaginal entrance that is up to 1 centimeter deep.
Vulvoplasty has a shorter recovery time than vaginoplasty, and it involves fewer medical complications (here you can read about the complications for vaginoplasty). Because the vulva has no real depth, this means that, in principle, you will not need to dilate or use a vaginal douche. However, you will also not be able to have penetrative sex with a vulvoplasty, due to the lack of depth.
Before undergoing surgery, it is important that you are well prepared. You can find more information on how to prepare for a vulvoplasty here.
The surgery
In vulvoplasty, the female genitals are created from the skin and underlying tissue of the penis. No vaginal cavity will be created. In most cases, the testicles are also removed in this operation, unless this has already been done (with the orchidectomy). Depending on the technique used, the operation will last anywhere from 2 to 5 hours.
The operation will be performed by a plastic surgeon. It starts with the insertion of a urinary catheter (i.e. a tube inserted through the urethra). Subsequently, the penile skin is removed from the shaft of the penis. The skin is shortened and sutured in order to make it look like a vagina (but without the vaginal cavity).
Then the testicles are removed, and a clitoris and inner labia are made from the glans and the foreskin. The urethra is exposed and shortened up to the new entrance. Soon, a GIF will be presented below to show the surgical procedure. Untill then, these images are used.
Note that the details of the surgical procedure may differ for any Dutch care facility. It is, therefore, important to check the exact procudure with the institute where you are having surgery.
Aftercare
Depending on the health institute where you are operated, you need to stay in bed for 1 to 3 days and need to stay at the health institute for 3 to 5 days. The catheter will be removed at the day you leave the health institute, after which you should be able to pass urine properly within a few hours. After urination, your bladder will be scanned to make sure it is empty. If your bladder is not empty enough, the catheter is replaced and will be removed again after 1 or 2 weeks.
It is often advised to wait until the wounds are completely closed before swimming, taking a bath or going to the sauna. This often takes at least 6 weeks. This is to prevent the stitches from dissolving too early and you getting infections in the wound. Brief showers are allowed. You are not allowed to exercise or lift heavy objects for six weeks, as this may cause bleeding or a build-up of excessive fluid.
Hormone use after the surgery
After the surgery, you will stop taking testosterone blockers. Oestradiol is the only hormone that you will need to continue to take. The hormone treatment after the operation will be supervised by an endocrinologist.
Complications and risks during and after surgery
Medical problems (complications) may occur during or after the vulvoplasty, irrespective of whether the operation was performed correctly. The likelihood of complications depends on your state of health.
Possible complications during or following vulvoplasty:
- Bleeding: There may be bleeding immediately following the operation. If this does not stop on its own, a second operation may be necessary to stem the bleeding.
- Infection: Although the procedure is done in a clean and sterile way, there is always a chance of bacteria entering the wound. In the period after the operation, there is also a risk of infection. That is why it is so important to take good care of the wound.
- Blood suffusion (haematoma): Some blood may accumulate in the surgical area, which may give the area a slightly blue or purple appearance, like a bruise. This will go away by itself after 2 to 4 weeks.
- Fluid retention (oedema or seroma): Fluid may also accumulate in the surgical area. If this feels uncomfortable, the fluid can be removed by the physician.
- Badly healing wound edges (wound dehiscence): After the operation, the wounds may not heal immediately, and may open up a little. Should this happen, we recommend that you rinse the wound thoroughly with running water and, if necessary , contact your attending physician.
- Hypergranulation: Hypergranulation is a common problem. It is benign, but does involve a sizeable loss of fluids or blood. It may also have a certain odour and be painful, but it is easy to treat.
- Loss of feeling/orgasm: you may loose all or some sensation in your genitals. Whether or not feeling will be restored is uncertain.
- Scarring: The growth in scarring tissue differs per person, skin type and surgical method. People and skin types all heal in their own way. Being overweight or a smoker means that wounds will heal less pretty than in healthy, non-smokers. Sometimes, a scar can be corrected (at least one year after the operation).
End result
The final result will not be visible until after six months. Complete healing takes time. The swelling and discolouration will slowly subside. The vagina will form naturally after the operation and will adapt to your body shape. For example, the colour of the scrotum and the amount of fatty tissue determine what the genitals will look like. The end result is different for everyone.
Corrections
Perhaps, after the operation, you are not completely satisfied with the appearance or function of the genitals. You can discuss this with your plastic surgeon or urologist. They will be able to tell you whether an additional operation could lead to improvements.
Corrections may, for example, be a reduction of the inner labia, correction of the clitoral hood, removal of large scars or a correction of the urethra.
In principle, corrections are not performed within 6 months of the first operation. It is advisable to wait at least one year. Whether such corrections will be covered by your health insurance company varies per situation.
Sexuality
Sex drive (libido) depends on the hormone testosterone — regardless of gender. As your body no longer produces testosterone after your testicles are removed, this may have an impact on your libido.
However, your sexual life depends not only on genital surgery, but also on many psychological and biological factors. Becoming familiar with your genitals (sexually speaking) and learning to use them in a pleasurable way are significant challenges after genital surgery.
It is important that you discover what gives you sexual pleasure and that you discuss this with your potential partner/partners.
Some people have no desire for penetrative vaginal sex, in which case a vulvoplasty can be a good choice. After vulvoplasty, you can still have orgasms through stimulation of the clitoris — just like in the case of vaginoplasty. During a vulvoplasty, your surgeon will construct a clitoris from the glans and, if applicable, the foreskin of the penis.
This text was edited on 14-10-2022
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Vaginoplasty
Vaginoplasty involves creating a vaginal cavity with depth. Depending on your physical characteristics (and desires), the technique will be determined.
