Opinions on Vaginoplasty

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Vaginoplasty is a reconstructive plastic surgery and cosmetic procedure for the vaginal canal and its mucous membrane, and of vulvo-vaginal structures that might be absent or damaged because of congenital disease (e.g., vaginal hypoplasia) or because of an acquired cause (e.g., childbirth physical trauma, cancer). As such, the term vaginoplasty generally describes any such cosmetic reconstructive and corrective vaginal surgery, whilst the term neovaginoplasty specifically describes the procedures of either partial or total construction or reconstruction of the vulvo-vaginal complex. Sometimes referred to as "vaginal rejuvenation”, “aesthetic vaginal surgery”, or “cosmetic vaginal surgery”, various results aim to strengthen the function of the vulvo-vaginal area, firm up and reshape tissue for youthful appearances. In regular terms, the procedure is essentially a “face lift” for the vulva and vagina. Vaginal rejuvenation is often two combined distinct surgeries of labiaplasty and vaginoplasty, to restore or enhance the vagina's cosmetic appearance or function. Labiaplasty is a labia reduction and cosmetic enhancement genital surgical procedure to reduce or change the shape of the labia minora (small lips) on the outside of the vagina. Some surgeries are needed for discomfort occurring from chronic labial irritation that develops from tight clothing, sex, sports, or other physical activities. Vaginoplasty surgery is done by removing excess vaginal lining and tightening the surrounding soft tissues and muscles. The post-operative outcome of vaginoplasty is variable; it usually allows coitus (sexual intercourse) after a week, although sensation might not always be present. In fertile women, menstruation and fertilization are assured when the uterus and the ovaries have preserved their normal functions; in a few cases, vaginal childbirth is possible.

In male-to-female sex reassignment surgery, some trans women patients undergo vaginoplasty as part of their physical (sex) transition. In Berlin in 1931, Dora R, born as Rudolph R, became the first known transgender woman to undergo vaginoplasty. Post-operative sexual intercourse is possible after such surgery, although with a much longer delay (usually around six weeks). Sensation is usually very good. One important difference regarding vaginoplasty on trans women is the need to dilate the vagina. A few days after surgery, the vaginal stent is removed and a long regimen of vaginal dilation begins. A set of dilators is used during each dilation, each one with an increasingly large width. For roughly the first week or two, and sometimes up to a month, dilation is performed several times a day using the smaller dilators. It can then be tapered off gradually, becoming once per day, then every other day, and then once per week, all while working up to the larger dilators. Eventually, it can be slowed down to once per month, and use of only one dilator (of the larger widths from the set) is the goal. Some trans women find they require dilation even less, even once every couple of months, depending on experience and individual physiology. However, it is important to note that waiting too long between dilations (the exact time depending on post-operative time and individual physiology) leads to increased difficulty restarting dilation. Vaginal dilation is also required for life, and sexual activity (including intercourse) in place of dilation may not be sufficient. The physical factors that limit vaginal dimensions are the rectoprostatic Denonvilliers’ Fascia (depth) and the Levator ani muscle (diameter); thus, in trans women patients, the narrowness of the male pelvis can reduce the available area to use for vaginoplasty.


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