From now until sometime in early 2023, we’ll be writing about gender affirming procedures. We’re starting with bottom surgeries and will end with office visit procedures such as fillers and botox. This week is all about vaginectomy.
Content advisory: we will be using anatomical terms and discussing surgical procedures in this article and series. External sites that we link to may contain graphic images.
What is a vaginectomy?
Vaginectomy is when all or part of the vaginal canal is removed. In gender affirming surgeries, total vaginectomies are usually done. A hysterectomy is a required part of a total vaginectomy. Ovaries may be removed, or may be left in the body. In a partial vaginectomy, either part of the vaginal canal is removed, or the vagina may not be fully closed, or both, allowing discharge to leave the body. Vaginectomies may be used in cancer, prolapse, and endometriosis treatment, in addition to gender affirming care.
A total vaginectomy removes the tissues which create the lining of the vagina, then closes the vaginal canal by suturing the walls together. The structure will be connected to the surrounding pelvic anatomy. This provides support for the bladder, urethra, and other abdominal structures. After this, the vaginal opening is closed to create a flat perineum. Vaginectomy may be done through incisions made in the abdomen, through the perineal area, or through the vagina itself. (3) Hysterectomy is often done prior to vaginectomy, but may be done at the same time. You may see the words “colpectomy” and “colpocleisis.”
A vaginectomy is often done in the first or second stage of phalloplasty, may be done in combination with other lower surgeries, or done by itself. Some surgeons utilize tissue from the vaginal wall for urethral lengthening (UL) when vaginectomy is combined with metoidioplasty or phalloplasty with UL. Many surgeons prefer to do vaginectomy at the same time as urethroplasty, citing reduced rates of complications.(1,2)
When: Expected prep and recovery for vaginectomy
We discuss general prep for bottom surgeries in an earlier blog – getting ready for your recovery time can make a huge impact on your healing. Hair removal is not needed for vaginectomy, but may be required if other surgeries are planned. Check out our pre-surgery checklist.
Recovery is also similar to other bottom surgeries. Patients can expect to be in the hospital for a day or two after surgery. Activity and lifting restrictions will be in place for at least 4 weeks, with restrictions on strenuous activity or activities that put pressure on the area for up to 3 or 4 months. If urethroplasty is done simultaneously with vaginectomy, patients can expect to have a suprapubic catheter for up to a month post-surgery.
Who: Surgeons who offer vaginectomy
Vaginectomy is a common gender affirming procedure, as it is often part of the metoidioplasty and phalloplasty processes. There are many surgeons who offer this procedure. Some resources for locating a surgeon include:
- talking to others in the community
- phallo.net, metoidioplasty.net, ftmsurgery.net (all use the same platform)
- gender care centers at academic institutions such as OSHU, UCSF, UW
- well-known private practices such as MozaicCare, Align Surgical, Crane Center, etc.
- WPATH Provider Directory
- OutCare Health
- The r/TransSurgeries wiki on Reddit
- our gender affirming surgery page
How: Common surgeon and insurance requirements to access
Like other lower surgeries, you will likely need a letter from a mental health provider for your surgeon, along with a letter from your surgeon and/or hormone provider for insurance. They may require hormone use for a certain period of time or want documentation for why hormones were not part of your journey, and they may wish to know that you have “lived as” for a certain period of time. Some policies may require that you document your support and housing plans during recovery.
Why: Some things to think about when choosing vaginectomy
Vaginectomy is historically considered to have a high risk of complications such as blood loss, infection, and urethral fistulas. These risks have decreased as techniques have evolved. As with any other major surgery, risks are not absent. Your surgeon should discuss these in detail with you.
Vaginectomy may change how you have sex, and how you experience sexual arousal and orgasm. This, of course, may be exactly what you want. P.S. – check out our Sex Toys For Trans Folx blog!
If having a biological child is important to you, discuss fertility preserving options with your doctor, as pregnancy will not be possible after vaginectomy.
Vaginectomy may change how you pee, especially if urethral lengthening is done. It will also likely change how your abdominal and pelvic structure sits. Pelvic physical therapy may help you get acquainted with your new alignment.
As with other major surgeries, recovery time may be long, and nutrition, substance use, and stress can impact your healing.
Additional Information Sources:
- Colpectomy Significantly Reduces the Risk of Urethral Fistula Formation after Urethral Lengthening in Transgender Men Undergoing Genital Gender Affirming Surgery.
Al-Tamimi, M., Pigot, G. L., van der Sluis, W. B., van de Grift, T. C., Mullender, M. G., Groenman, F., & Bouman, M.-B. The Journal of Urology, December 2018, olume 200, Issue 6, Pages 1315–1322.
2. Medina CA, Fein LA, Salgado CJ. Total vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men. Int Urogynecol J. 2018 Oct;29(10):1463-1468. doi: 10.1007/s00192-017-3517-y. Epub 2017 Nov 29. PMID: 29188324.
3. Hougen HY, Shoureshi PS, Sajadi KP. Gender-affirming Vaginectomy-Transperineal Approach. Urology. 2020 Oct;144:263-265. doi: 10.1016/j.urology.2020.05.084. Epub 2020 Jul 6. PMID: 32645370.
Download our pre-gender affirming surgery checklist: