What is a Vaginectomy?
A vaginectomy is the surgical removal of all or part of the vagina, typically performed for vaginal cancer, severe vaginal intraepithelial neoplasia (VAIN), or as part of gender-affirming surgery, and in rare cases for severe vaginal vault prolapse in elderly patients who are sexually inactive.
Primary Indications
Oncologic Indications
- Upper vaginectomy is performed for grade 3 vaginal intraepithelial neoplasia (VAIN 3), particularly in patients with prior hysterectomy for cervical neoplasia 1
- This procedure serves dual purposes: diagnosing occult invasive vaginal carcinoma (found in 28% of cases) and treating in situ or superficially invasive disease 1
- In cervical cancer treatment, vaginectomy may be incorporated as part of radical surgical approaches when there is vaginal extension 2
Non-Oncologic Indications
- Complete vaginectomy with pelvic floor closure can be performed for severe vaginal vault prolapse or procidentia in elderly, sexually inactive women who have failed pessary management or previous surgical repairs 3
- This approach eliminates the vaginal space entirely, preventing recurrent prolapse in patients who do not require vaginal function 3
Gender-Affirming Surgery
- Vaginectomy is performed as part of masculinizing genital surgery for transgender men, involving removal of vaginal tissue 4
- This is distinct from vaginoplasty (creation of a vagina), which is performed for transfeminine patients 4
Surgical Context and Your History
Given your history of hysterectomy and colostomy, if vaginectomy is being discussed, the most likely scenarios are:
- Oncologic indication: Treatment or prevention of vaginal cancer, particularly if your hysterectomy was performed for gynecologic malignancy 1
- Prolapse management: If you have severe vaginal vault prolapse following hysterectomy and are not sexually active 3
- Complication prevention: Your colostomy suggests prior pelvic surgery or disease that may have altered pelvic anatomy, potentially increasing risk for vaginal vault complications 5
Important Considerations
Functional Impact
- Complete vaginectomy eliminates the possibility of vaginal intercourse 3
- The procedure is only appropriate for patients who do not desire to maintain vaginal sexual function 3
- Urinary function is typically preserved, though careful surgical technique is required to avoid urethral injury 3
Surgical Outcomes
- For oncologic indications, upper vaginectomy shows good efficacy with 83% of patients remaining disease-free at mean follow-up of 152 weeks 1
- For prolapse, vaginectomy with pelvic floor closure provides definitive treatment, though operative time averages 100 minutes with mean blood loss of 278mL 3
- Postoperative care is relatively straightforward due to minimal body cavity invasion 3
Rare Complications
- After hysterectomy and vaginectomy, there is a rare risk (0.032-1.2%) of vaginal evisceration, where bowel herniates through the vaginal defect 5
- This risk may be relevant given your colostomy, suggesting prior abdominal surgery that could affect tissue integrity 5
Clinical Pitfall to Avoid
Do not confuse vaginectomy (removal) with vaginoplasty (creation/reconstruction) - these are opposite procedures with entirely different indications 4, 1. If you're uncertain why this procedure is being recommended, request explicit clarification from your surgeon about the specific indication, expected functional outcomes, and whether this relates to your prior hysterectomy or colostomy.