What are the steps of feminizing genital surgery?

Penile Inversion Vaginoplasty (with Canal)

This surgery will construct a neovulva (outer female genitalia) with a neovaginal canal. If all aspects of this procedure go well, it may be possible for you to have receptive sex. Your surgeon will talk to you about the need to regularly dilate after surgery. The constructed neovagina will not self-lubricate, so you will need to use an external lubricant for dilation or sex.

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – Surgical procedure

The testicles are removed (orchiectomy), and the skin along the shaft of the penis is detached from the penile tissue and preserved to construct the neovagina. A small portion of the glans of the penis, along with nerves and blood vessels, is used to construct a neoclitoris.

A space for the neovagina is created between the bladder and rectum. The skin of the penis that was preserved is inverted and placed into this space. A conformer is placed within the newly constructed neovagina to maintain the skin's position.

The urethra is then shortened, and the scrotal skin is rearranged and used to surgically construct a labia majora. A temporary catheter will be inserted into your bladder.

Vulvoplasty

This surgery will only construct a neovulva (outer female genitalia). The procedure's steps are almost identical to the vaginoplasty, but your surgeon will not create an internal neovaginal canal. This procedure is sometimes called zero-depth vaginoplasty or shallow-depth vaginoplasty because of this.

Selecting this procedure has the advantage of shorter operating time, faster recovery and a lower risk of serious complications. You will not need to have laser hair removal treatments, and there is no need for dilation after surgery. But a potential disadvantage is that you will not be able to have receptive sex because no neovaginal canal was created during the surgery.

It can be very difficult and complex to create a neovaginal canal after you have had a vulvoplasty. Talk to your surgeon about your preferences and options before you decide to have a vulvoplasty.