Vaginoplasty is a type of cosmetic surgical procedure performed on female genitalia, such as labiaplasty and vaginoplasty. The surgery is performed either to construct or reconstruct the vagina. Vaginoplasty also termed as posterior colporrhaphy is a procedure that helps tighten up the vagina that has become saggy or loose from vaginal childbirth or aging.
The aim of vaginoplasty is to remove the extra mucosal skin from the back of the vagina and bring the separated muscles together to tighten up the vagina. Sometimes, to create a more aesthetic appearance the external skin of the vagina is also removed. Vaginoplasty is most often performed to repair the damaged parts of the vagina and its attached structures due to trauma or injury.
Why do women choose to undergo vaginoplasty?
● After childbirth, women may undergo a lot of changes in her vagina; the vagina loses its laxity and becomes loose, wide and softer than what it was before childbirth. This can also happen after a woman had undergone vaginectomy for vaginal cancer. Loosening of the vagina can, in turn, lead to urinary incontinence, separation of muscles and tissue stretching which can make your tampon fall and can contribute to sexual dysfunction. In this case, a woman needs to undergo vaginoplasty.
● Vaginoplasty can also help women who have undergone treatment for malignant tumors or abscess that can help them restore a normal vaginal structure and function.
● Some women or girl child suffer from certain congenital disorders related to vagina, urethra, and rectum. In such cases, a vaginoplasty can correct the protrusion and help those women to get an aesthetic looking vagina.
● Congenital disorders such as adrenal hyperplasia can cause an absence of vagina in some women. Most of the transgender is known to suffer from the absence of the vagina. These women or transgender can undergo vaginoplasty to create or reconstruct their vagina.
● A vaginoplasty is a surgical option that can be considered for the babies born with Microphallus/ micropenis (stretched penile length), people with Missing uterus or underdeveloped vagina (Vaginal hypoplasia).
What are the different types of vaginoplasty?
● There are various types of vaginoplasty surgery procedures available, and the most appropriate method is selected based on a number of factors of an individual. For instance, surgery appropriate for an adult transgender woman would be different for women who suffered from trauma, injury or malignant growth. However, the most important factor which is considered for vaginoplasty is woman’s age and the reason for vaginoplasty.
Intestinal or Sigmoid Vaginoplasty
Due to the advancement of anesthesiology, reduced risks and availability of anti-biotic the sigmoid vaginoplasty has become the first line treatment option in both women and children. Reconstructing of the vagina through sigmoid vaginoplasty creates an aesthetically pleasing vagina with an adequate length, natural lubrication, early intercourse and low rate of shrinkage. The procedure involves cutting out a small piece of the colon and attaching it to the vagina by rotating it downwards. This becomes the lining of the vagina after which the surrounding colon is stitched to restore its function.
It is a laparoscopic surgery with minimally technique to produce a neovagina. It is considered best suited for transsexual surgery after penile inversion surgery. Post-operative care is easy and the mucus production gradually decreases after 6 months.
Peritoneal vaginoplasty is also a laparoscopic procedure in which the lining of the abdominal cavity called the peritoneum is used to create the vagina. Peritoneal vaginoplasty does not necessarily need to use dilatation if they are having regular sexual intercourse. However, there is a risk of the rectovaginal fistula with this type of vaginoplasty which can be treatable with the surgery.
The McIndoe technique utilizes a skin graft taken from buttocks which are then placed on the top of the vagina to give it a form. The McIndoe vaginoplasty is different from the peritoneal and intestinal vaginoplasty procedures in which the skin is taken from the lower abdominal portion to create the lining.
The McIndoe procedure requires Postoperative dilation and maintenance because it does not self –lubricate. Some other risks include hematoma; graft failure, and fistula.
Buccal Mucosa Vaginoplasty
Buccal mucosa vaginoplasty is an ideal and simple method. This technique provides excellent results in patients suffering from vaginal agenesis and improves the vaginal length of the patient. The buccal mucosa is the tissue lining present in the mouth which is similar to the lining of the vagina. It has replaced other tissues of skin and bladder mucosa because it is a non‐hair‐bearing material, easily accessible, provides adequate blood supply.
However, the buccal mucosa vaginoplasty needs maintenance of vaginal dilation via a vaginal mold which is suggested until normal sexual intercourse is resumed. Buccal mucosa vaginoplasty may be an ideal method but a relatively small area of tissue is available for vaginoplasty surgery. Also, most of the gynecologists may not prefer the procedure because buccal mucosa lining is something they are not the expertise of.
Penile Inversion Vaginoplasty
For transgender women, penile inversion vaginoplasty is only the best option. The procedure involves disassembling of the penile components where the skin from the groin, scrotum or lower abdomen is removed and grafted to form the lining of the vagina, corpora cavernosa are completely dissected from the urethra glans and the head of the penis is removed and inverted to form the lining of the vagina and reshape the clitoris.
The procedure involves lifetime maintenance for vaginal dilation and lubrication.
Dilation after Vaginoplasty
Vaginoplasty is a procedure that improves vaginal laxity and to improve the laxity doctor or may not indicate dilation in some women depending on the technique used on them. However, Dilation of the vagina is done to maintain the depth of the neo-vagina and help prevent contraction of the skin which is grafted inside the vagina. Dilation improves the depth and elasticity of the vagina by promoting gentle stretching. Your gynecologist may provide or recommend a silicone dilator which is to be kept inside the vagina for around 10-15 minutes
In procedures such as McIndoe and penile inversion, dilation is necessary to maintain the vaginal opening. Also, it provides relief to women who face difficulty during sexual intercourse.