Vaginoplasty 101

What is a Vaginoplasty?

A vaginoplasty is a surgical procedure that results in the construction or reconstruction of the vagina. In this blog, we will be exploring the ‘penile inversion vaginoplasty’, which is a procedure that uses the tissues from the penis and scrotum to create a vagina. An individual may elect to have this procedure if they experience gender dysphoria¬†(not being aligned with the gender they were born with).

Who, what, when, where?

Up until 2019, the only hospital in Canada performing these procedures was GRS Montreal. However, Women’s College Hospital is now performing penile inversion vaginoplasties as well. To date, they have conducted 3 surgeries since June 2019. To be a potential candidate for this procedure at WCH, an individual must be living in Ontario, taking hormones for at least 12 months and must be experiencing significant gender dysphoria.

How does the anatomy change?

A new space is created between the bladder and the rectum. This cavity is lined with the skin of the scrotum. Part of the urethral tissue is used to create the labia minora and the inner lining of the vulva (vestibule). The tip of the penis becomes the clitoris and the penile/perineal skin become the labia majora, vaginal entrance, and the clitoral hood.

Pre-surgical Preparation:

  • Laser hair removal is suggested to avoid the growth of hair inside the new vaginal cavity
  • Approximately 6-8weeks off work to recover; however, it depends on the type of work the client does
  • No estrogen or progesterone for two weeks before the procedure
  • Pelvic floor assessment prior to surgery
  • Organizing a support team at home


Post-Surgical Care:

  • For the first week, a foley catheter and packing will be in place
  • After the removal of the catheter and packing, pelvic physiotherapy will begin. The physiotherapist will teach you how to use vaginal dilators
  • Hormones restarted two weeks post-surgery
  • Pain/bruising/swelling are all normal symptoms and should be treated with rest, ice, compression and pain medication as needed. The vagina should be approaching it’s expected appearance by about six months
  • Light walking for 15-20 minutes several times per day is encouraged for the first two months, and avoid lifting anything greater than 15 lbs
  • Penetration of fingers, toy and/or vaginal penile intercourse will be possible by three months post surgery. Other types of non-penetrative sex are encouraged prior to the three month mark


The Role of Pelvic Physiotherapy

There is an important role of pelvic physiotherapy both prior to and after surgery. It is recommended that the patient see a pelvic physiotherapist before surgery to learn how to connect with their pelvic floor. More specifically, it is really helpful to learn how to fully relax and lengthen the pelvic floor to help with pain management after surgery.

After surgery, the client will be taught how to use dilators by a pelvic physiotherapist. This begins one week after surgery. The protocol begins with dilation 3x/day for 15-20 minutes. Throughout the first year, dilation will continue to be part of the rehab program, but the frequency of dilation needed will decrease (eg. 1x/day at 12 months post-operatively). It is extremely important to maintain dilation throughout recovery because the depth of the vaginal canal can be lost if dilation is not maintained.

In addition to dilation, patients may find that they need more manual therapy from a pelvic physiotherapist if they notice pain or discomfort with penetration even though they are using dilators diligently. The focus of treatment may include connective tissue mobilization, desensitization, pelvic floor muscle relaxation and/or biofeedback.

Should you be experiencing adverse symptoms after a vaginoplasty surgery and need some assistance with your care, see one of our pelvic physiotherapists today.



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