Vaginoplasty

Vaginoplasty reconstructs or reshapes the vaginal canal. The name covers operations of very different size, and the one you are having is the one to ask about specifically.

At the smaller end are repairs of walls that have been stretched or torn, and repairs of scarring from a difficult delivery or a previous operation. At the larger end are reconstructions where the canal is absent from birth, has been narrowed by scarring or radiotherapy, or is being created as part of gender-affirming surgery. These larger operations use tissue brought from elsewhere, take much longer, and are planned in their own way with a longer stay and a much longer aftercare programme.

What every version shares is that the result depends heavily on what happens after the operation as well as during it. Where a canal has been created or widened, the tissue will contract as it heals unless it is kept open, so a schedule of dilatation becomes part of the treatment and usually continues for months. Your surgeon will go through that schedule before you agree to anything, because someone who cannot commit to it will not keep the result.

The operation is done under general anaesthetic, so you are asleep throughout. You will be asked not to eat for about six hours beforehand and will see the anaesthetist on the morning of surgery.

For the commoner repairs the operation takes one to two hours. Your surgeon works through the vagina with no cut on the abdomen, removes or repositions tissue, brings the deeper muscle layer together, and closes with dissolvable stitches. A pack is often placed in the vagina for a few hours and a catheter is used so that the bladder can be emptied without disturbing the repair; both are usually removed before you leave or the following morning.

A repair of this kind is planned as a Day Care attendance, and you go home once the anaesthetic has fully worn off, you have passed urine and the bleeding is settled. Arrange for someone to take you home and stay overnight. A larger reconstruction is planned differently, with several nights in hospital, and your surgeon will tell you which of these your operation is.

Expect six weeks before you are properly healed and about three months before the tissue has finished settling. Soreness and swelling are worst in the first week; ice, loose clothing and regular pain relief cover most of it, and warm salt baths from the second day keep the area clean and comfortable.

Stitches dissolve over two to four weeks and light bleeding or discharge through that time is expected. Nothing goes into the vagina for six to eight weeks apart from dilators, if you have been given them, and those are used exactly on the schedule you are given, which typically starts a few weeks after surgery, runs several times a day at first, and reduces slowly over months. Skipping them is the commonest reason a good operation ends in a narrowed canal.

Most women are back at desk work in two to three weeks and avoid lifting, cycling and the gym for six. Sex is usually possible after six to eight weeks with your surgeon's agreement, and the first few times are often best approached slowly and with lubricant.