Gender Affirming Surgery - Vaginoplasty
Dr. Shih

According to the domestic medical practice of gender affirming surgery, the certifications from two different psychiatrist are required before the operation. Since the operation is irreversible, the sperm is suggested to be preserved. Since the operation involves the reconstruction of multiple soft tissues and the urethra, inadequate blood supply might easily lead to stenosis and fistula formation. No smoking will be recommended before and after operation.

Structure changes from male to female gender affirming surgery
Masculine Feminine
Pineal glans Clitoris, part of labia minora
Corpus cavernosum, Albuginea X
Urethra Urethra (1/3~1/4 of original length)
Testis X
Preputial Part of labia minora, vagina canal
Scortum Vagina, labia majora

“X” means total removal

Indications for vaginoplasty
Length of penis Indications
X Zero-depth vaginoplasty#1
≦7 cm Colonic vaginoplasty#2
7~15cm Inverted skin flap + Skin graft#3
≧15 cm Inverted skin flap
  • #1
    Patients receiving vaginoplasty will need postoperative vaginal dilation for a long time. For patients who do not want long-term dilation treatment or who do not expect for vaginal intercourse, zero-depth vaginoplasty could be an option.
  • #2
    For the penis length less than 7 cm, the outer skin of the penis is completely inadequate for vagina canal formation. Therefore, the colonic vaginoplasty wound be a better option. The lumen supporting force may be adequate, but the use of dilators after surgery is still necessary.
  • #3
    For the penis length greater than 7 cm, part of the external skin of the penis can be used for neo-vagina lengthening, but it is still not enough to achieve the ideal vaginal depth (6 inches). Part of the scrotum skin can be used to achieve this goal.
Pre-OP Note

Penile length measurements, colon preparation before surgery, hormone therapy suspended for 2 weeks.

  • Locationperineal area.
  • Anesthesiageneral anesthesia.
  • Duration8-10 hours.
  • Targetvaginoplasty.
Post-OP care
  • Drainage tube remove on postoperative day 2.
  • Remove scalp stitch on postoperative day 14.
  • Hair clearance with normal saline in 1st week after operation.
  • No smoking.
Possible complications
  • Drainage tube remove on postoperative day 3.
  • Low residue diet for 5 days.
  • Vaginal dilation 3 times a day for 2 months (30mins/each time).
  • No smoking.
Last updated2023.10.10