Colpectomy (removal of the vagina)
What does a colpectomy (removing the vagina) entail? How to prepare for this type of operation? Below, you will find out about the procedure, the risks involved in the operation and the post-operative period following a colpectomy.
Removal of female genitals
You may wish to have your female genitals fully or partially removed. For example, because you are experiencing dysphoria or because you want to undergo masculinising genital surgery (with urethral extension). The image below shows an overview of the female genitals.
Partially or fully removing your female genitals will have a direct impact on your fertility and any possibility of having biological children.
You can have multiple female genitalia removed. The various gynaecological operations are listed below:
- Removal of the uterus (hysterectomy)
- Removal of the vagina (colpectomy)
- Removal of the ovaries (oophorectomy)
- Removal of the fallopian tubes (salpingectomy )
These procedures can be conducted in various combinations. In addition, all of them can be combined with the removal of the breasts (mastectomy).
The various operations and combinations have different effects on your endocrine system, fertility and desire to have your own, biological children. It is therefore important that you carefully consider which organs you would like to have removed and what a logical combination would be for you. Discuss this with your gynaecologist. If you wish to have metoidioplasty or phalloplasty without urethral extension, then, in principle, there is no need for you to have the female genitals removed. If you do wish to have the urethral extension procedure, however, then it is necessary to have the female genitals removed.
About colpectomy
Colpectomy is a procedure for removing the tissue of your vagina. You may opt for this if you experience feelings of gender dysphoria in relation to the vagina or because you suffer from other symptoms. The colpectomy cannot be performed if you want to keep your uterus. In case you wish to have a metoidioplasty or phalloplasty with urethral extension, then the colpectomy is necessary to reduce the risk of urethral complications. The colpectomy is generally considered to be a difficult procedure. You should expect a recovery period of up to 6 months.
More information about the preparation and cost reimbursement for the colpectomy can be found here. Clarifying information about the colpectomy can be found in Amsterdam UMC's animation video.
The operation
A colpectomy is performed in two ways: by robotic laparoscopic surgery and vaginal surgery. Which method is used depends on whether or not your uterus has already been removed.
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.Colpectomy in combination with removal of the uterus
If you still have your uterus (and possibly your ovaries), the colpectomy is combined with removal of the uterus. This is because your uterus cannot stay in place if your vagina is removed. In this combination, it is possible to remove the vagina and uterus (possibly including the ovaries) using an operating robot.
First, the uterus is detached (and, if so desired, also the ovaries). Once they have been detached, they are removed via the vagina. During this procedure, care is taken not to damage the bladder, uterus and bowels which are close to the vagina.
It is not possible to combine removal of vagina, uterus and breasts in one operation, as this would take too long.
Robotic laparoscopic surgery
The removal of the vagina is not done with ordinary keyhole surgery, but with the help of the Da Vinci robot. The advantages of this technique include high precision, small incisions and less blood loss.
Colpectomy in case your uterus was removed previously
Has your uterus already been removed and do you wish for a colpectomy? Then your vagina will be removed via the vaginal opening.
Vaginal operation
If the uterus has already been removed, the robotic technique cannot be used. Instead, the vagina must be removed via the vaginal opening, by detaching it from the inside out. This technique has a higher risk of complications than the robotic technique.
Additional information about the operation (both techniques)
A tube (the catheter) is inserted into the bladder through the urethra. This catheter is removed again one day after surgery. Removal of the vagina leaves a wound surface on the inside of where the vagina used to be. Some wound closure adhesive is placed in this area to reduce bleeding.
The tissue between the urethra and the anus (the perineum) is sutured using strong surgical suture. Subsequently, the skin is also sutured. A small opening (about the size of one phalange) is left just below the urethra, so that you can continue to urinate normally. In the weeks following the operation, any blood and wound fluids will be drained through this opening. This opening will be closed if you are having a urethral extension operation.
Aftercare
After the operation, you will need one day of bed rest to allow the wounds to heal. The catheter will be removed and you should be able to urinate properly within a few hours. After urinating, your bladder will be scanned to make sure it is empty. If it is not sufficiently empty, the catheter will be reinserted and removed again after about a week.
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 4 to 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 the build-up of excessive fluid.
Complications and risks during and after surgery
With removal of the vagina, the risk of complications is between 30% and 40%. However, when the robotic technique is used, the risk is around 20%. Most of these complications are mild, but some can be serious. After a colpectomy, people can experience up to 6 months of complaints from the operation.
- Haemorrhaging during or after surgery. Loss of blood and fluids during the operation is common, but if there is a large amount of blood loss, this is considered a complication. A blood transfusion may then be necessary. Haemorrhaging may also occur after the operation (including once your are back home again), and may require another operation to stop the bleeding. Sometimes it is necessary to insert a gauze to stop the bleeding
- Infection. The abdominal incisions or those in the vagina can become infected. This can already occur in the hospital. Sometimes it can be treated with antibiotics, but, in other instances, surgery will be needed to clear up the infection.
- Fistula. In rare cases, a connection develops between the bladder or bowel and the vaginal cavity; this is called a fistula. Sometimes additional surgery is required to remove the fistula.
- Thrombosis. With any operation, there is a slightly increased risk of thrombosis (i.e. a blood clot in a blood vessel). You can reduce the risk of this happening by starting to move around again as soon as you can, after the operation, rather than lying still in bed. In hospital, you will also be provided with medication that will help to prevent this.
- Damage to bladder, bowel or urinary tract. During the operation, the bladder, bowel or urinary tract may become damaged. If this is obvious during the operation, it will be repaired immediately, if possible. Sometimes, a separate operation will be needed. If the bladder is damaged, a urinary catheter will be inserted that will remain in place for at least seven days, so will also be there when you are at home. Damage to the bowel is very rare.
- Inability to completely empty the bladder (urinary retention). After the operation, it may be that the bladder cannot empty itself, sufficiently. If this happens, a bladder catheter will be reinserted, sometimes for a longer period of time. Usually, the bladder will fully recover.
- Bladder infection. The bladder catheter used during the procedure, in some instances, may cause a bladder infection. If you suspect you have a bladder infection, contact your treating physician or your general practitioner.
Sexuality
It is recommended that you avoid sexual intercourse and the use of tampons for the first six weeks after surgery. There is, however, nothing against becoming sexually aroused or masturbating.
For some people, sexual experience changes after removal of the uterus. Sometimes, these changes are positive, such as having less pain during intercourse. But, in other cases, there are negative changes, such as less interest in intimacy, decreased sensitivity in the area around the vagina or changes in orgasm (coming).
This text was edited on 14-10-2022
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Metoidioplasty
Below, you can read about the procedure, the risks of the operation and the period after the operation. The illustrations give you more insight into the surgical procedure itself.
