The Transgender Dictionary
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Vaginectomy

Table of Contents

Introduction

Originally developed as a treatment for vaginal cancer for those who can't be treated with radiation or chemotherapy; a vaginectomy is a surgery that removes all or part of the vagina. This page will be discussing vaginectomies in the context of gender-affirming care.

Many transgender men, some transmasculine nonbinary people, and some nullos experience gender dysphoria around having a vagina. Having his vagina removed can cause gender euphoria for many transgender men. Some additional reasons why someone may want a vaginectomy include, but are not limited to; a desire for a male perineum and no vagina, to get rid of secretions produced by vaginal mucosa, to be free of pain from a gynecological condition, to eliminate the need for speculum exams or pap smear tests, or to reduce the potential for complications related to urethral lenthening (urethroplasty).

A hysterectomy is typically required prior to a vaginectomy, due to the vaginal opening being sewn shut at the end of the procedure (which leaves no exit for vaginal discharge or bleeding). It is advised for the hysterectomy to be performed months prior to the vaginectomy (rather than immediately prior) to allow the body more time to heal. There is also a risk of prolapse without a hysterectomy.

If the patient desires a phallus (as opposed to a smooth perineum) surgeries such as metoidioplasty, scrotoplasty, urethroplasty, and phalloplasty can be performed alongside or after a vaginectomy. It is important to keep the surgeon informed regarding all other desired surgeries, as tissues that may normally be removed during a vaginectomy may be utilized for the other desired surgeries.

Note that while a vaginectomy is typically not required for other transmasculine bottom surgeries, most surgeons typically require it be performed if the patient desires urethroplasty. This surgery can be performed on anyone who wants one.

General Information

A vaginectomy is performed by a gynecological surgeon while the patient is under general anesthesia. The amount of the vagina that is removed is based on the needs of the patient. The approximate duration of a vaginectomy is 2-3 hours. Prior to the operation, patients will have a consultation with the surgeon to discuss medical history, surgical goals, and what to expect from the general anesthesia.

Preoperative bowel preperation is required before a vaginectomy. This is because the rectum is near the vagina, and the voiding of the bowels during surgery would result in contamination of the surgical site. A surgeon will suggest that the patient consume a low-residue diet (eat low-fibre food) and take mild laxatives for a few days prior to the procedure. A phosphate enema will be administered the morning of the procedure to help clean out the rectum.

A vaginectomy for transgender men typically includes both colpocleisis and colpectomy. Penetrative vaginal sex is no longer possible after this procedure.

Note that when performed on its own, the patient may be able to choose whether or not they would like to keep sensitive nerves there under the skin, even if having external genitalia removed.

During a vaginectomy, incisions are made on the interior of the vagina and the vaginal mucosa is carefully removed, either with excision (stripping it piece by piece - a lengthy and bloody process) or ablation (burning & cauterizing the tissue). This allows the vaginal canal to adhere to itself and heal. The vaginal walls are sutured together and the vaginal opening is closed. Depending on the technique, the opening may be left open, however it is typically closed for transmasculine patients.

The vulvar tissue (labia majora and labia minora) may also be removed if the patient does not plan on having additional surgeries that resuire the usage of these tissues. When they are not removed, patients typically report a high satisfaction rate regarding regarding aesthetics, clitoral erection and sensation.

Typically, transgender men will not have the labia or the clitoris removed (so that they can be utilized for metoidioplasty, scrotoplasty, or phalloplasty). Nullos are more likely to have everything removed, so that there is no genitalia of any kind (other than the urethra).

After surgery, there is typically a "dip" where the vaginal opening used to be. The tissue of the labia minora/small ridges (if left intact) typically meet up in the center, but is not always symmetrical. For example, one side may appear normal (as it did pre-surgery) while the other side is fused to the center. Hair may grow over this region over time.

This is typically an inpatient procedure, though it can sometimes be outpatient. Patients will typically spend a 3-7 days in the hospital afterward. During this time, the patient will be given medication to reduce pain, reduce inflammation, and prevent infection. Full recovery is roughly 4 to 6 weeks, though the total length of recovery will vary based on how much is removed. The patient will likely have a urinary catheter (or two with one plugged up if urethroplasty was performed) for one to two weeks. At least one follow-up doctor's appointment is required to have the catheter removed.

Complications associated with vaginectomies are uncommon and easy to manage when they do arise. Potential risks associated with vaginectomies include excessive bleeding, poor healing, drainage issues, problems with defecating (pooping) or leaking stool, urinary retention, and vaginal fistula (a hole between the vaginal area and other internal organs, such as the bladder). There is a high risk of infection. The amount of potential bleeding is directly related to the length of the vagina. Some pain is normal with a vaginectomy, though it normally diminishes significantly after about two weeks.

There is always a risk of the surgeon missing a part of the mucosa walls, and for that part to continue secreting fluids, causing a risk to the patient's health and requiring follow-up surgery. There is a risk of damge to the rectum.

Restrictions for activities the patient may do post-op (such as sitting, cycling, swimming, hot tubbing, heavy lifting, and sexual activities) are typically set by the surgeon and can vary based on the exact nature of the procedures performed. These activities can be limited for a minimum of 6 months during the healing process. The recovery is generally easier than some other bottom surgeries.

If you have had a vaginectomy, contact your gynecological surgeon if you experience any of the following; severe abdominal pain, urinary incontinence or fecal incontinence, fever, bleeding or swelling in the abdominal area, or redness and swelling near the incision (these are signs of infection).

Any activity that involves movement of the belly (such as sneezing, laughing, and lifting things) will be painful for a while post-surgery.

Glossary