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Performing Surgery

Vaginoplasty Surgery

A penile inversion vaginoplasty is a surgical procedure in which your own tissue is used to create a functional, natural-appearing, sensate vagina, including a vaginal canal.

How is it done

  • In conjunction with a board-certified urologist to perform the penile-inversion vaginoplasty. This is typically performed in one stage, with the surgery lasting about 8 hours.

  • The vaginal canal is created within the space between the urethra/bladder and the rectum

  • The lining of the vaginal canal is formed using skin from the penis and scrotum, as well as a small

piece of peritoneum (membrane lining the abdominal cavity)

  • Peritoneum is harvested with the assistance of a surgical robot, through five small incisions in the abdomen

  • Peritoneum has the potential to self-lubricate over time

  • Labia majora and minora are created using existing genital tissue

  • Clitoris is created using the same nerves that innervate the glans penis (tip of the penis)

  • A urethroplasty is performed, where the urethra is modified and shortened

  • Orchiectomy (removal of testicles) is also performed

  • Gauze packing is placed in the new vaginal canal during surgery. The packing is removed in the operating

room, under sedation, one week postoperatively. The vaginal packing will be removed prior to your

discharge from the hospital.

Important things you should know before making the decision to have vaginoplasty surgery

Hospital Stay
  • This surgery is not to be taken lightly. It is major surgery and you will be in the hospital for at least 8 days. 

  • You will have a Foley catheter during the entire hospital stay, which will become very uncomfortable approximately 4 days post-op. There is no medication or remedy for this discomfort, each person needs to work out what positions are most comfortable for them. 

  • You will have two surgical drains in place while hospitalized. Typically, these can be removed
    prior to your discharge. If you must go home with the drains, your nurses will teach you how to
    take care of them.

  • Your care team will be in your room frequently to take your vitals and give you prescribed medication, including all hours of the night. It is important to get your rest when you can. 

  • Your care team will be encouraging you to get out of bed and move around as much as possible beginning the day after surgery. This will be more difficult than you might expect. 

  • When possible, have people there to support and advocate for you. 

  • You will be taking a lot of stool softeners and will need assistance getting to and from the restroom initially. 

  • You will not be able to bathe until the Foley catheter is removed on your last day. 

  • You will need to urinate on your own before discharge will be permitted. 

Post-op
  • There will be extensive post-op care that is needed.

  • Expect to visit your surgeon's office each week for the first 6-12 weeks, depending on your situation.

  • Showering is allowed once your surgical drains have been removed. Make sure to gently pat all
    surgical areas dry after bathing. You may want to have a shower chair waiting for you at home for the first day or two, as it's possible to be unsteady on your feet and still have soreness that makes it difficult to stand straight up for a length of time. 
    You may do Sitz baths a few times per week once you return home from the hospital
    - Fill a bathtub with 2-3 inches of warm water
    - You may use fragrance-free Epsom salts in the bath
    - Sit in the tub, making sure your vaginal area is covered, for about 15 minutes at a time
    - This can be especially helpful after dilating to thoroughly cleanse

  • You are advised to keep the surgical area clean and apply an antibiotic ointment to the incision
    lines twice/day.

  • When washing or wiping the genital area, you should always wipe from front to back (clean to
    dirty). This will avoid contamination of the vaginal area.

  • You will leave the hospital with stitches still in place. These stitches will inevitably become uncomfortable at times. You should check with the doctor when you visit the office each week to see if they can be removed. 

  • Approximately 2-3 months after surgery you will be referred to a physical therapist for pelvic floor physical therapy. **Please note - this is an important step in the recovery process, but will involve removal of clothing and your physical therapist will need to place her hands on you.***

  • During Pelvic Floor Physical Therapy you will learn how to properly dilate to reduce pain and discomfort, and to achieve your desired results in terms of depth.
    • Methods used in Pelvic Floor Physical Therapy:

• Soft tissue mobilization

• Manual therapy
• Myofascial release
• Modified Thiele's massage for high tone
• TrP release
• Muscle uptraining / downtraining
• Therapeutic exercise
• Dilators
• Milli Expanding Dilator
• Scar release
• Home treatment program
• Position modification
• Orthopedic physical therapy
• SEMG

Dilation
  • One of the biggest commitments to post-op care is dilation. Don't underestimate just how much of a commitment this is. 

  • It is HIGHLY recommended that you begin working with a pelvic floor physical therapist as soon as possible post-op to ensure you are dilating properly and to assist with the discomfort. 

  • Vaginal dilation is a critical part of the postoperative recovery process. Failure to dilate will result in collapse of the vaginal vault and loss of vaginal depth.
    * Dilation Procedure
    1. Wash hands thoroughly and ensure your dilators are cleaned prior to beginning.
    2. Apply about 1 teaspoon of lubricant to the dilator, spreading the lubricant over the surface of the
    dilator. Do NOT use Vaseline.
    3. Hold the dilator with the dots on top (curved upwards).
    4. Gently insert the dilator into the entire length of the vagina and hold in place for 45 minutes, applying
    firm pressure to ensure adequate depth. This should NEVER be forceful.
    5. After 45 minutes have passed, slowly remove the dilator.
    • Once passing the small dilator becomes easy, progress to the next size. Generally, you will use each size for 1-2 weeks. The largest dilator may be used at your discretion following this period. This size may not be necessary or comfortable for everyone. Listen to your body. Once the dilation becomes simple, you may progress to the next size.
    • Wash the dilators after each use with a nonabrasive, antibacterial soap in warm water and dry
    thoroughly. DO NOT place in dishwasher or clean with alcohol (they may crack).
    • Dilation Frequency
    - 3 times per day for 45 minutes at a time for the first 9-12 months.
    - After one year, many patients dilate only once per day, or less if they are sexually active.

I have provided this information not to scare anyone or in an attempt to discourage. It's here because my experience has been that some of this information gets inadvertently glossed over or is not well emphasized, which can lead to being mentally unprepared going into such a life changing transition. I have had patients who experience burn out after so many weeks/months of invasive treatment because they were mentally unprepared. 

 

For cisgender women reading this who are trying to relate or support a loved one, picture this...

Imagine having to visit your gynecologist's office every single week for 2-3 months, only those appointments are not a quick 15-20 minute appointment and sometimes you can be here for an hour with your feet in stirrups, dilating in a doctor's office not really knowing when someone might walk in. When those appointments finally start to spread out, you start physical therapy which is even more involved, and are scheduled to be an hour long. 

This medical transition is an enormous physical and mental commitment, and one of the biggest reasons why I created My Rainbow Connection. Nobody should have to go through all of this alone. 

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