Transgender vaginoplasty

This medical procedure involves the creation or reshaping of the vagina. Vaginoplasty is sometimes performed to revise vaginal anomalies and congenital conditions such as absence of a vagina at birth, as well as to repair the area following disease or injury.

As with other procedures, like plastic surgery of the nose (rhinoplasty), vaginoplasty may be undertaken for functional reasons, aesthetic reasons, or a combination of the two.

Vaginoplasty evokes very strong emotional responses (both pro and con) far more often than more common procedures like rhinoplasty. There is considerable controversy regarding surgery on some patients, notably children with “ambiguous genitalia” who have no pressing medical or functional need.

In some jurisdictions, vaginoplasty is currently required by law in order for trans people to change the sex marker on government documents.

Some women in our community choose bilateral orchiectomy prior to or instead of vaginoplasty.

The most common vaginoplasty technique performed on women in our community uses tissue from the existing genitalia to create the vagina (the penile inversion technique), although in some cases the lack of tissue may require additional skin grafts taken from the buttocks or near the hip bones. Some surgeons use a two-stage procedure which includes a labiaplasty at a later time. A more complicated procedure using a segment of colon (colovaginoplasty) may be performed if there is very little existing tissue to use, although the complexity of the procedure and higher complication rates make it a less preferable option in most cases.

Terminology

When performed on women in our community, the procedure has been given many suggested names over the years:

  • sex reassignment surgery (SRS)
  • sexual reassignment surgery
  • sex change operation
  • “the operation”
  • genital reassignment surgery
  • genital modification
  • genital plastic surgery
  • gender reassignment surgery (GRS)
  • genital reconstruction surgery
  • genital repurposing surgery
  • gender reinforcement surgery
  • gender affirmation surgery
  • gender confirmation surgery

These terms each have nuances in meaning that are simultaneously useful and problematic (to be discussed at length in the future). To avoid these semantic and political issues, this section uses the medical term for this procedure except when citing the works of others.

Dedication
This section of Transgender Map is dedicated to the fond memory of Fran Kern. Fran was a personal assistant for Dr. Meltzer’s recovering patients, who passed away on December 24, 1998. Those whose lives she touched with her caring and compassion will not forget the kindness that emanated from her.