Vaginoplasty
Vaginoplasty is a surgical procedure in which the penis and testes are removed, and from the remaining skin tissue a neovagina, labia and clitoral structure are constructed. The result is not a functional vagina in a biological sense: there is no uterus, no ovaries, no vaginal lubrication and no self-cleansing mucosa. It is the cosmetic and functional construction of a body part that superficially resembles a vagina, with permanent medical consequences.
Techniques
The standard technique is penile inversion vaginoplasty: the skin of the amputated penis is turned inside out to line the wall of the newly created cavity. When there is insufficient skin (for instance after puberty blockers, because the penis has then remained underdeveloped), additional scrotal skin or a bowel segment is used (sigmoid or colon vaginoplasty). A bowel segment provides its own mucus production but brings risks: abdominal surgery, risk of bowel leakage, and in rare cases diversion colitis in the used bowel segment.
Complications: concrete and partly permanent
Complication figures are often kept flat in public information ('rare with experienced surgeons'). The medical literature shows a different picture:
- Necrosis of the neoclitoris or parts of the skin flap occurs and can lead to lasting loss of sensation and cosmetic damage.
- Strictures and stenosis (narrowing of the neovaginal opening or the whole canal) are a common complication. Treatment requires further surgery or aggressive dilation.
- Fistula formation, particularly rectovaginal fistulas (connections with the rectum), is a serious complication. Repair is difficult and not always fully successful.
- Urinary tract problems: meatal stenosis, incontinence, spraying during urination and chronic infections.
- Loss of sensation: partial or complete reduction of sensation in the genital area. Orgasmic capacity is variable; total loss occurs.
- Granulation tissue, prolapse phenomena, poor cosmetic results, chronic pain and lasting dissatisfaction belong to the possible outcomes.
Lifelong dilation duty
The neovagina is a wound that the body wants to close. To keep the canal open, the patient must dilate for life — inserting a dilator, first several times a day, tapering down to weekly. If dilation is skipped, the canal can narrow strongly or close within weeks, with surgery as the only option. This lifelong obligation is regularly insufficiently emphasised in pre-operative information. For people with physical limitations, psychological complaints or ageing bodies, dilation can become a serious burden.
Fertility and sexuality
Vaginoplasty makes the patient permanently sterile: no sperm cells are produced after orchidectomy. Any future wish to have children requires prior cryopreservation of sperm — which may already be reduced or impossible due to earlier hormone use. Sexual function changes radically. Penetrative sex from the neovagina is possible but not comparable to cis female sex: there is no natural lubrication, lubricant is always needed, and sensitivity strongly depends on the surgical outcome.
Irreversible
The procedure is fully irreversible. Reconstruction of male genitalia after vaginoplasty is barely possible; detransitioners who underwent this procedure live with the consequences. Together with phalloplasty, it is one of the most definitive medical interventions known to modern medicine.
Conditions in the Netherlands
The procedure is performed in the Netherlands at Amsterdam UMC. Conditions are usually a diagnosis, at least a year of hormonal treatment and a stable situation. Reimbursement is via the basic insurance. Waiting times are long. See also Waiting times and care pathway, Detransition and Cass Review.