Vaginoplasty

Vaginoplasty is a surgical procedure that addresses various concerns related to the vagina, such as vaginal laxity, loss of tone and elasticity, childbirth-related changes, and aesthetic dissatisfaction. It can be performed for both cosmetic and reconstructive purposes, depending on the individual's needs and goals.

Types of Vaginoplasty

A vaginoplasty is performed when individual needs are met according to the reason for surgery, indicating that there are different types of vaginoplasty procedures: 

• Penile inversion vaginoplasty: A very popular method in penile skin transplantation, usually used for intended transgender women who develop vaginal canals but retain good sensation.
• Sigmoid colon vaginoplasty: It is because of a minimum available penile skin or for medical reasons, and the length of the vagina is increased. 
• Peritoneal Vaginoplasty: Laparoscopic construction of the vaginal canal is performed using the lining of the abdominal cavity.
• Skin Graft Vaginoplasty: Engrafts skin either from thighs or abdomen to line the vaginal canal, very common in conditions like Mayer-Rokitansky-Küster-Hauser syndrome or post-cancer.
• Vulvovaginoplasty: Provides an area in the perineum when vaginal establishment is required.
• Vecchietti procedure: Laparoscopic method for treating Müllerian agenesis (underdeveloped vagina).

Purpose of Vaginoplasty

The purposes of vaginoplasty differ from one individual to another. Here are some definitions: 

1. Gender Affirmation: For transgender women, vaginoplasty is like a physical anatomy with the gender identity of the individual in terms of gender transformation, thereby decreasing the level of dysphoria and enhancing quality of life.

2. Congenital Conditions: To create a vagina in individuals with syndromes like MRKH, meaning they have absent or underdeveloped vagina.

3. Trauma or Cancer: To reconstruct the vagina from an injury caused to the vagina or removal of cancer tissue through surgery. 

4. Vaginal Relaxation: Improvement in sexual function through tightening made after such childbirth or due to age-related changes. Vaginal laxity is usually due to many births, and the laxity is also attributed to advancing ages and the loss of elasticity of tissues.   

5. Cancer Treatment: Vaginoplasty is one of the procedures that may need to be performed alongside surgery to remove a tumor in the vaginal or pelvic area in treatment of cancer.

6. Other medical reasons: Rare abnormal conditions might warrant vaginoplasty.

Recovering After Vaginoplasty

The Postoperative recovery stage after vaginoplasty becomes significant for effective healing and attaining the best result. Various important aspects of this: 

• A pain reliever medication given for pain control and antibiotics may also be prescribed. 
• The surgical site will be monitored for infection. Vaginal packing controls bleeding and supports the healing process.
• A urinary catheter is put in place during the initial healing period, allowing for urinating. Close monitoring of vital signs and recovery.
• Gentle cleaning of the surgical area is essential in preventing later infection. Sitz baths may be recommended. 
• Regular use of vaginal dilators following surgery is imperative for vaginal health; follow the instructions of the surgeon.
• Lifting heavy objects, sexual intercourse, and vigorous activity should be avoided for several weeks; gradually resume normal activities.
• Regular visits with the surgeon are necessary for healing progress.
• During the recovery period, emotional help would be great. 

Risk & Complication

Like any surgical procedure, there may be potential risks and complications associated with vaginoplasty. It is important to know about these before the surgery. Here is a list of potential risks: 

• Infection: A risk accompanying every surgery. 
• Bleeding: Excessive bleeding may occur during or after the surgery. 
• Anesthesia Reaction: The degree of reaction may vary from mild to severe. 
• Scar formation: Scar tissue is part of the body's normal healing process, however, complications may arise in cases of excessive scar formation. 
• Vaginal stenosis: Intercourse might be difficult because of narrowing of the vaginal canal. 
• Fistulas: Abnormal connections form between the vagina and other organs such as the rectum or bladder. 
• Urethral injury: Damage to the urethra may lead to problems in urination. 
• Rectal injury: Damage to the rectum; this is very infrequent but has the worst complications. 
• Loss of Sensation: The nerve damage may change sensation in the vagina. 
• Wound Dehiscence: Failure of the surgical wound to heal properly. 
• Neovaginal Prolapse: In rare instances, the new vagina may prolapse. 
• Hair growth in neovagina: Possible due to penile or scrotal skin without appropriate hair removal. 
• Dissatisfaction with the aesthetic result: The vulva may differ from what was expected.

Benefits and Considerations

Vaginoplasty can have significant benefits for individuals seeking vaginal rejuvenation. These include:

1. Improved Sexual Function: Vaginal tightening can enhance sexual satisfaction by increasing friction and tightness during intercourse, resulting in improved sensation for both partners.

2. Boosted Self-Confidence: Restoring the appearance and function of the vaginal area can enhance self-esteem and body image, leading to increased confidence in intimate relationships.

3. Correcting Anatomical Irregularities: Vaginoplasty can address congenital abnormalities or reconstruct the vaginal area after traumatic injuries or surgeries, allowing for a more normal and comfortable anatomy.

It is important to note that vaginoplasty, like any surgical procedure, carries potential risks and complications. It is crucial to choose a skilled and experienced surgeon, follow proper preoperative and postoperative care instructions, and have realistic expectations regarding the outcome of the procedure.

1. Preoperative Evaluation: Before undergoing vaginoplasty, a thorough consultation with a qualified surgeon is necessary. The surgeon will assess the individual's concerns, medical history, and expectations to determine if they are a suitable candidate for the procedure. They may also perform a physical examination and discuss the potential risks and benefits.

2. Anaesthesia: Vaginoplasty can be performed under general anaesthesia or local anaesthesia with sedation, depending on the complexity of the procedure and the individual's preference.

3. Surgical Techniques: Vaginoplasty techniques may vary based on the specific goals of the procedure. Common techniques include:
   a. Vaginal Tightening: The surgeon removes excess vaginal lining and tightens the underlying muscles and tissues. This may involve excising excess skin, suturing the muscles together, and reducing the diameter of the vaginal opening.
   b. Perineoplasty: Perineoplasty involves reconstructing the perineum, the area between the vagina and anus. It can address concerns such as perineal tears, scarring, or asymmetry.
   c. Clitoral Hood Reduction: In some cases, clitoral hood reduction may be performed to enhance the aesthetic appearance and accessibility of the clitoral area.

4. Recovery and Postoperative Care: After vaginoplasty, the individual may experience temporary discomfort, swelling, and bruising in the treated area. Pain medication, antibiotics, and specific postoperative instructions will be provided by the surgeon. It is essential to avoid sexual activity, tampon use, and strenuous physical activities during the initial healing phase. Follow-up appointments will be scheduled to monitor the healing process.