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Vaginoplasty is a procedure which creates or reshapes the vagina. It has several indications, such as ambiguous genitalia due to intersex conditions, congenital vaginal or cloacal anomalies, and severe trauma to the vaginal area. It is also part of the elaborate gender change surgical procedures.

There are several vaginoplasty techniques, which are adapted to different clinical situations.

They include:

• Passive or active stretching, using dilators, Vecchietti traction devices or balloon vaginoplasty;
• Surgical procedures that involve making neovaginas from labial and perineal tissue
• Creation of a neovagina in the rectovesical space lined with various tissues such as split- or full-thickness skin grafts, amnion, peritoneum, intestine, or buccal mucosa.

General Risks

As with any other surgical procedure, vaginoplasty techniques carry general risks, such as hemorrhage, infection, and anesthetic accidents. Severe scars may form as a result of vaginoplasty, making future corrective surgeries impossible, and also making the individual sensitive about the unsightliness of the perineum and vulva. Blood clots may form in the deep veins following surgery, called deep vein thrombosis. Surgical risks such as these are less common if the patient is in good health prior to the operation.

Specific Risks

Specific risks to vaginoplasty include vaginal fistula, uterovaginal or vault prolapse depending on whether or not the individual has a uterus, and colitis in the neovagina as well as diversion colitis in the closed-off end. Peritonitis may occur whenever the peritoneal cavity is breached.

Stenosis

Vaginal stenosis is a common complication of vaginoplasty and needs expert evaluation and timely correction to provide adequate caliber and depth to the new organ. This is necessary for both sexual intercourse and for proper external menstruation to occur. Introital stenosis alone may occur following surgery.

Nerve Damage

Nerve damage may occur during dissection of the tissues in the perineal and pelvic area, leading to hypoesthesia or dysesthesia. Chronic pain may also be present due to nerve damage.

Risks of Intestinal Vaginoplasty

Intestinal vaginoplasty is a major procedure, which may be followed by paralytic ileus, peritonitis, constipation, and difficulty in urination. It may be associated with excessive mucus production and can lead to having to wear a sanitary pad constantly. The risk of neovaginal and diversion colitis also exists. Moreover, the long-term risk of colon carcinoma arising in a sigmoid segment used for vaginoplasty has not been fully quantified as yet.

Fistula

The occurrence of rectovaginal or urethrovaginal fistulas is another troublesome complication associated with vaginoplasty. They occur due to rectal or urethral injury during the procedure and may require second surgeries for repair.
The risk of fistulas is considered to be low, provided the surgeon is sufficiently skilled. There may be vaginal odor or discharge due to bacterial overgrowth or colonization. This may require antibiotic or antifungal treatment in addition to regular douching.

Dissatisfaction

One final risk remains to be discussed, which is dissatisfaction with the outcome of the surgery. This is usually due to excessive laxity or tightness of the new vagina. The former may be disappointing to the patient in search of cosmetic improvement, while the latter may interfere with the use of tampons or with intercourse.

The need for secondary or revision procedures is another major complication of vaginoplasty. Many of these risks are averted by a full and honest discussion by the surgeon detailing the procedure, the recovery, and the final outcome as well as the possible risks and complications.

References

• https://www.ncbi.nlm.nih.gov/pubmed/26995108
• https://www.ncbi.nlm.nih.gov/pubmed/28696998
• https://www.ncbi.nlm.nih.gov/pubmed/24697986
• http://www.soc.ucsb.edu/sexinfo/article/health-medical-procedures-elective-vaginoplasty-0
• http://transhealth.ucsf.edu/trans?page=guidelines-vaginoplasty
• https://www.e-aps.org/upload/pdf/aps-44-48.pdf

Further Reading

• All Vaginoplasty Content
• Vaginoplasty: Medical Reasons
• Vaginoplasty Techniques
• Vaginoplasty in Children

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.