Vulvoplasty
What exactly does vulvoplasty involve, and what happens during the operation? On this page, you can read all about vulvoplasty, the operation itself, and what to expect afterwards.
About vulvoplasty
Vulvoplasty is a surgical procedure that creates only the external part of the female genitalia: the vulva. The appearance following vulvoplasty is the same as after vaginoplasty. During the operation, the testicles and erectile tissue of the current genitals are removed. The remaining tissue is used to create a clitoris, inner and outer labia, and a urethra. The difference between vulvoplasty and vaginoplasty is that vulvoplasty does not create a vaginal cavity with depth. After vulvoplasty, you will have a vaginal opening which will be no deeper than 1 centimetre.
Vulvoplasty has a longer recovery time than orchiectomy, but a shorter recovery time than vaginoplasty, and it carries fewer medical risks (complications) than vaginoplasty (read more about the complications of vaginoplasty here). As the vulva has no depth, you do not need to rinse or dilate it. Because there is no vaginal cavity with a vulvoplasty, vaginal penetration during sex is not possible. It is important that you are well prepared before undergoing surgery. You can find information on preparing for a vulvoplasty here.
The operation
During vulvoplasty, a vulva is created using skin from the genital area. No vaginal cavity is created. Usually, the testicles are also removed during this operation, unless this has already been done previously during an orchidectomy. Depending on the technique used, the operation takes between 2 and 4 hours.
The operation is performed by a plastic surgeon. A urinary catheter (a small tube inserted via the urethra) is first inserted. The skin of the penis is detached from the shaft. This skin is shortened and sutured to create the appearance of the vulva. The testicles are then removed. The glans is transformed into the clitoris, and the foreskin is used to form the inner labia. The urethra is exposed and shortened to the new opening.
Please note: the details of the operation may vary between healthcare providers. It is therefore important to check the exact procedure with the healthcare provider where you are having the operation.
Aftercare
In most cases, you may start moving around immediately after the operation. Try to gradually increase the amount of movement during your recovery. It is also advisable to sit on a firm chair a few times a day. The pressure from the chair promotes wound healing and helps reduce swelling. You will stay at the healthcare facility for three to five 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 one to three days after the operation. The catheter is usually 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, the catheter will then be removed again after about one or two weeks.
After the operation, you may have a short shower every day. You may only take a bath, go swimming or visit the sauna once the wounds have healed properly. This takes at least six weeks. This is to prevent the stitches from dissolving too early and to avoid infections in the wound. 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 whilst in the healthcare facility.
Hormone treatment after the operation
After the operation, you will no longer produce sex hormones yourself. You will therefore no longer require a testosterone blocker but will need to continue to take estradiol. Your hormone treatment will be monitored by the endocrinologist after the operation.
Complications and risks during and after surgery
Unintended medical problems (complications) may arise during or after treatment, even if the operation has been carried out correctly. Vulvoplasty carries a higher risk of complications than orchiectomy, but a lower risk than vaginoplasty.
Complications that may occur during and after vulvoplasty:
- Bleeding: Immediately after the operation. If this does not stop of its own accord, a second operation may be necessary to stop the bleeding.
- Infection: Although the procedure is carried out under sterile conditions, there is always a risk 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): Some blood may accumulate in the surgical area, making it look 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 causes discomfort, the doctor can drain it.
- Poorly healing wound edges (wound dehiscence): After the operation, the wounds may not heal straight away, and the wound may open up slightly. If this happens, rinse the wound thoroughly with running water. Contact your doctor if necessary.
- Excessive granulation tissue (hypergranulation): The development of hypergranulation is a common problem. It is harmless, but it causes significant fluid loss and, sometimes, blood loss. It may have an odour and cause painful discomfort. It is easily treated with a short procedure at the outpatient clinic.
- Loss of sensation/orgasm: You may (partially) lose sensation in the genital area. It is not possible to say with certainty whether sensation will return. More than 95% of patients 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 feel different after the operation, and it takes time to discover what feels good for you. You can find more information about sexuality after vulvoplasty here.
- Scars: The formation of scar tissue depends on many factors. Everyone’s skin heals in its own way. On average, wounds heal worse in people who are overweight and in smokers than in people of a healthy weight who do not smoke. In some cases, a scar can be corrected as an outpatient procedure (at least one year after the operation).
Final result
The final result is only visible after six months to a year. Full healing takes time. The swelling and discolouration will gradually subside. After the operation, the vulva develops naturally and adapts to your body type. For example, the colour of the scrotum and the amount of fatty tissue determine what the genital area will look like. The final result will look different for everyone.
Corrections
You may not be entirely satisfied with the appearance or function of the genital area 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 corrective procedures include reduction of the inner labia, correction of the clitoral hood, removal of large scars and correction of the urethra.
Generally, corrective procedures are not carried out within 6 months of the initial operation. It is advised to wait at least one year. Whether these corrective procedures are covered by your health insurer depends on your individual circumstances.
Sexual activity
After surgery, your how you feel and experience sex and desire will probably change. During the recovery period, your genitals may feel hypersensitive or, conversely, numb, and it may take time and exploration to experience sexual pleasure. Once your vagina has healed sufficiently, sex and penetration are possible (after at least 3 months). For more information about sexuality, please visit this page.
This text was edited on 3-11-2026
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Vaginoplasty
Vaginoplasty involves creating the external part of the female genitalia (the vulva) and a vaginal cavity with depth. Here you can read all about the surgical techniques and the recovery period
