Any surgery has risk. This page discusses some of the risks and complications associated with vaginoplasty.
Most serious
Death
- You could die. Some of the complications below are potentially fatal.
Fistula
- This is when a hole develops in the wall between the colon and the vagina. This rare complication can happen during childbirth or surgery.
Blood loss
- Some patients have had unusually high blood loss after vaginoplasty, requiring many units of blood (up to 15 in one patient’s case). There is an additional small risk that donor blood could carry an infectious disease. Steps to avoid this: stop all drugs that affect clotting at the time recommended by your surgeon. Some surgeons recommend banking your own blood prior to surgery.
Blood clots
- These can lead to heart attack, stroke. Steps to avoid this: stop all drugs and hormones at the time recommended by the surgeon. Stop smoking and vaping.
Infection
- This can result from the surgical procedure or from improper postoperative care. This could affect your recovery time, your surgical outcome, and in extreme cases could possibly kill you. Steps to avoid this: be very diligent out hygiene postoperatively, especially regarding bowel movements and dilation.
Pneumonia
- Fluid in the lungs is sometimes contracted after surgery. Steps to avoid this: Stop smoking and vaping. Get in shape. Use an incentive respirator after surgery or do breathing exercises. Walk or at least sit up as much as possible after surgery.
Necrosis
- Death of tissue. This can be caused by infection, tissue rejection, or loss of blood supply to tissue.
Vaginal collapse
- In severe cases of stenosis, the entire new vagina can cave in, which may lead to reconstruction and in severe cases removal.
Paralysis
- Caused by stroke from a blood clot, or a severed nerve. Extremely rare.
Allergic reaction
- Severe allergic reactions can cause your air passage to close or send you into shock. Reactions can be from anesthesia, certain drugs such as penicillin. Non-fatal reactions include rashes and hives.
Excretory
Bowel problems
- You could have permanent problems, especially if you experience a fistula or get a rare type of vaginoplasty involving a bowel segment (sigmoid vaginoplasty).
Urinary problems
- You could have permanent urinary problems, from urine stream direction and spraying to problems with incontinence or painful urination. Your urethra can be very wide, which may cause problems in intimate situations, or it may stick out or have unremoved spongy penile tissue around it, which can cause irritation when sitting or walking.
Sexual function
Inorgasmic
- You may have difficulty reaching climax for weeks or months after surgery. Some patients never have an orgasm again.
Depth problems
- You may end up with a vagina too shallow for standard sexual function.
Stenosis (width problems)
- You may have a vagina too narrow for standard sexual function
Lubrication
- You will probably need some sort of lubrication for any penetrative sexual activity. Some people achieve moderate amounts of prostatic lubrication, but usually must supplement it. Conversely, those who have the unusual sigmoid vaginoplasty procedure sometimes secrete so much mucus from the bowel segment in their vagina that they must wear maxi pads at all times.
Numbness
- You may have numbness in some or all parts of your genitals, which limits your pleasure and increases the chance of injury from your lack of sensation during vigorous activity.
Pain
- You may have permanent pain in some areas from a severed nerve, etc.
Hypersensitivity
- You may find some areas too sensitive to be touched. Hypersensitive areas can also cause discomfort from just walking or sitting.
Cosmetic
Scarring
- Some people have noticeable scarring that is discolored or raised.
Graft
- Some patients require a skin graft, which can mean additional scars.
Keloids
- Some (notably African-American patients) get this unusual type of raised red scars
Hair
- Some patients have reported hair growth inside the vagina and around the opening. This is difficult to remove after vaginoplasty, and is the reason many advise getting electrolysis prior to vaginoplasty.
Clitoris size
- Some women end up with a clitoris that is much larger than most. Others end up with one that is much smaller than most.
Shape
- Asymmetrical outcomes are not uncommon, especially in one-stage procedures.
Labia
- Sometimes labia are different shapes or positioned differently.
Urethra
- Some have a urine stream that points in an unusual direction. Others have had a urethra opening that was big enough that partner mistook it for her vaginal opening.
Positioning
- Some have reported the entire vulva is too high or too low, or that there is too much or too little space between the clitoris and the vaginal opening.
Yeast infection/douching
- Some have temporary, and in some cases, chronic problems with yeast infections or unpleasant smell following surgery.
Psychological
Fatigue
- Vaginoplasty takes a lot out of you, and many find that they tire easily in the months following surgery.
Depression
- Many find that completion of vaginoplasty leaves them feeling a bit lost, especially if they had expectations that vaginoplasty would make a major difference in their day-to-day existence. It won’t.
Regret (didn’t put in proper thought)
- In rare cases, patients have decided that vaginoplasty wasn’t the solution to their unhappiness.
- Some people with regret may also modify their gender identity and/or gender expression after vaginoplasty. This may be due to pressures from work, school, faith, family, etc.
Temporary
Evacuation
- Many have problems going to the bathroom for a while after surgery, from constipation and hemorrhoids, to inability to control their bladder, sometimes requiring incontinence pads. This usually resolves itself in a few months.
Mild bleeding
- Many have mild bleeding, especially around sutures or after dilation, which requires the use of a sanitary pad for a few months.
Bed sores
- Those who do not move around enough sometimes get bed sores, which can take a while to heal.
Ripped suture
- Occasionally someone might tear a suture from certain types of movement. While usually not a serious problem, it can cause a small scar.
Clitoral scab
- Many report they have a scab over their clitoris following surgery. In some cases, when this falls off, there is very little protruding clitoral tissue remaining. This can be corrected during labiaplasty if desired.
Shocks
- Many report a sensation of electrical “shocks” as nerves in the surgical site regenerate. This is especially common in the legs near the pelvis.
Bruising
- You can expect bruising ranging from mild to significant, which can take many weeks to resolve.
Nausea
- Following anesthesia, many get nauseated. This can also be caused by the antibiotics, or the hospital food! ;
Allergic reaction (drugs, leg things, etc)
- Some patients get contact dermatitis from the leg compression stockings, the catheter, or from other vaginoplasty related items.
References
Cecile A Ferrando (2018). Vaginoplasty Complications. Clin Plast Surg
. 2018 Jul;45(3):361-368. doi: 10.1016/j.cps.2018.03.007.
Nail Omarov and Sedat Tatar (2021). The Repairing of the Recto-Neovaginal Fistula in a Male-to-Female Transgender Through Perineal Graciloplasty. Cureus 2021 Jun; 13(6): e15784.doi: 10.7759/cureus.15784
-http://www.avitale.com/Rectovaginal_Fistula.html
Wouter B van der Sluis 1, Mark-Bram Bouman, Marlon E Buncamper, Garry L S Pigot, Margriet G Mullender, Wilhelmus J H J Meijerink (2016). Clinical Characteristics and Management of Neovaginal Fistulas After Vaginoplasty in Transgender Women Obstet Gynecol. 2016 Jun;127(6):1118-1126. doi: 10.1097/AOG.0000000000001421.
Christian X. Lava et al (2023). Rectovaginal Fistula Repair Following Vaginoplasty in Transgender Females: A Systematic Review of Surgical Techniques. Plastic Surgery https://doi.org/10.1177/22925503231190923
Disclaimer: This is medical talk, not medical advice. Some of this may not apply to you. It is presented without warranty. It may contain errors or omissions. You must do your own research.