What is the process of creating a vagina in a transgender woman?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: July 19, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Creation of a Vagina in Transgender Women: Surgical Techniques and Outcomes

Penile inversion vaginoplasty is the gold standard surgical technique for creating a functional and aesthetic vagina in transgender women, with documented improvements in quality of life and reduction in gender dysphoria. 1

Surgical Techniques for Vaginoplasty

Penile Inversion Vaginoplasty (PIV)

  • Primary technique: Single surgical procedure involving anatomical rearrangement of penis and scrotum 1
  • Components:
    • Creation of vaginal canal using inverted penile skin
    • Formation of vulva with labia minora and majora from scrotal skin
    • Creation of sensate clitoris from glans penis
    • Repositioning of urethra for downward urinary stream

Alternative Techniques

  • Minimal-depth vaginoplasty: For patients who don't desire receptive intercourse
  • Peritoneal pull-through vaginoplasty:
    • Used when penile skin is insufficient (due to radical circumcision, puberty blockers, or lichen sclerosis)
    • Involves harvesting peritoneal flaps from posterior bladder wall and anterior rectosigmoid peritoneum
    • Creates self-lubricating neovagina with depth of approximately 14.7 ± 0.5 cm 2
  • Intestinal vaginoplasty: Uses sections of intestine to create vaginal canal

Surgical Procedure Details

  1. Pre-operative preparation:

    • Hormone therapy optimization (typically continued through surgery)
    • Hair removal from penile shaft if required

  2. Surgical steps:

    • Orchiectomy (removal of testes)
    • Creation of neovaginal space between rectum and prostate/bladder
    • Preservation of neurovascular bundle to maintain sensation
    • Inversion of penile skin to create vaginal canal
    • Formation of clitoris from glans penis with preserved innervation
    • Creation of labia from scrotal skin
    • Urethral repositioning

  3. Post-operative care:

    • Vaginal packing for approximately 7 days 2
    • Regular dilation schedule for 12 months to maintain vaginal depth and width

Outcomes and Complications

Positive Outcomes

  • Quality of life: Significant improvements in quality of life and decreased gender dysphoria 3, 1
  • Satisfaction rates: High satisfaction with genital appearance and function (approximately 96% in peritoneal vaginoplasty) 2
  • Functional outcomes:
    • Sensate clitoris allowing for sexual pleasure
    • Vaginal depth sufficient for intercourse (14.7 ± 0.5 cm in peritoneal technique) 2
    • Self-lubrication (particularly with peritoneal techniques)

Complications

  • Overall complication rate: Up to 70%, though most are minor and manageable without surgical intervention 1
  • Major complications:
    • Rectal injury
    • Rectovaginal fistula
    • Urethral or introital stenosis
  • Minor complications:
    • Hematoma
    • Wound dehiscence
    • Superficial necrosis

Long-term Considerations

  • Dilation: Regular dilation required to maintain vaginal depth and width
  • Microbiome: The neovaginal microbiome differs from that of a natal vagina 4
  • Follow-up care: Regular gynecological examinations recommended
  • Psychological support: Important during recovery period, with 61% of patients appreciating chaplain visits and 58% requesting follow-up support 3

Clinical Significance

  • Low regret rates: Only approximately 1% of transgender patients experience regret following gender-affirming surgery 3
  • Mental health benefits: Gender-affirming surgeries are associated with improved mental health outcomes and quality of life 3
  • Surgical innovations: Continuing advancements aim to reduce complications and improve outcomes 1

The creation of a neovagina through vaginoplasty represents a significant advancement in gender-affirming care for transgender women, providing both functional and psychological benefits that align with their gender identity.

References

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

Do male-to-female (MtF) transgender individuals retain a clitoris after vaginoplasty?
Do male-to-female (MTF) transgender individuals who have undergone vaginoplasty experience vaginal candidiasis (yeast infection)?
Do transgender women have labia minora?
What are the indications for vaginoplasty?
What are the most common complications after vaginoplasty?
What is Edathamil (possibly Edetate disodium)?
What is the antibiotic of choice for a urine culture growing a gram-negative lactose fermenting rod, such as Escherichia coli (E. coli)?
Is an intercostal nerve block with steroid contraindicated for postherpetic neuralgia?
What is the treatment for optic neuritis?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question