The goals of vaginoplasty will be discussed during your consultation. Typically, people undergoing this procedure have the following goals:

Feminine appearing vulvas (exterior of genitals)
Penetrative sexual intercourse, except for vulvoplasty
Clitoral sensation
Urination while seated

How long is the surgery and hospitalization stay?

Vaginoplasty surgery takes approximately 5-7 hours. Vulvoplasty will be slightly shorter.

You will be hospitalized for about 5 days after your surgery.

If you are traveling from another state or more than 8 hours from the Twin Cities metro area, you will be required to stay in the area for 6 weeks after surgery.

What do I need to do to prepare for vaginoplasty or vulvoplasty?

During your consultation, your surgeon will give you a treatment plan and goals. The treatment plan includes the necessary steps you need to take to be medically ready for surgery. We encourage you to partner with your primary care physician to achieve these goals. These steps typically include:

Letters of referral or support – You will need to provide two mental health letters of support that follow with WPATH standards of care. These letters need to be less than 12 months old. The care team needs these letters before surgery can be scheduled and submitted to your insurance for prior authorization.
Hair removal – hair follicles are not removed during the surgery. Electrolysis or laser hair removal is required. This is not a requirement for vulvoplasty.
Pelvic Floor Therapy – you will be given a referral to go see a physical therapist who specializes in Pelvic floor therapy prior to surgery. They will let you know if you need additional visits prior to surgery.
Nicotine use – You will need to stop smoking, vaping or using any type of nicotine at least 3 months prior to surgery. The sooner you quit using nicotine the easier your body will heal from surgery. You may be required to take a urine test months and days prior to surgery.
Weight loss - We want to affirm everyone, including all body sizes and shapes. We hope to have a respectful discussion regarding weight and Body Mass Index (BMI). Body physique or build will impact healing, post-surgical wounds, surgical complications, aesthetic outcomes (how good you look) and the need for future revision surgeries. The preferred BMI for vaginoplasty is 30. Your surgeon will discuss this with you throughout the surgical consultation and pre-surgical process. Referrals to weight management are available to help you with healthy weight loss.
Diabetes - People with diabetes will need to have an A1C blood test that is 7 or less within 3 months prior to surgery.
Hormones – Your hormones will need to be stopped 2 weeks before and 2 weeks after vaginoplasty or vulvoplasty.
Bowel Prep – You will need to perform a bowel prep, cleaning out your colon, 1-2 days prior to surgery. The care team will provide you with the instructions.

When do I start to dilate after surgery?

Vaginal dilation is a life-long process after vaginoplasty. Our surgeons will instruct you on when and how to dilate. You will also have the opportunity to work with pelvic floor therapists before and after surgery to help with the dilation process.

Dilators will be provided during your hospital stay.

Self-lubrication after this surgery is not a goal or expected. However, some patients have reported self-lubrication was achieved. You will need to purchase high quality water based lubricant for the dilation process.

At rest, the vaginal walls of all women both cisgender and transgender, lie exposed to one another. Dilation is a necessary process for transwomen who lack the constant sloughing and lubrication from a natal vagina and keeps it flexible. There is also a tendency for the new vaginal graft to contract. Dilation allows the depth and diameter of the new vagina to remain adequate.

What do I need to do to recover from vaginoplasty?

After care assistance

Social support is crucial to the post-operative healing process. You will be limited in your mobility for varying amounts of time. You will need someone to stay with you for at least 2 weeks after you are discharged from the hospital.

This support person will need to help you with bandage changes on your genitals, going up and down stairs, going to the bathroom, washing yourself, and making you food. If you have children or pets, additional help will be needed.

Therefore, social support will be assessed during your consult appointment and we encourage you to discuss this with your therapist.

Vaginal rinses

During your post-operative period (until the sutures in your new vagina have healed), the vaginal irrigations will need to be performed with a water and Iodine solution.

Mix 1 part Iodine and 10 parts water (should look like a light tea color) and place in applicator (see example below). To mix the solution remove 1 cup of water from 1 gallon of water and replace with 1 cup of Iodine. Sit on toilet and gently insert into the vagina at a 45 degree angle. Let mixture run out into the toilet.

This should be done after each dilation.

Purchases to consider:

Buy a Doughnut pillow, the center is open to take pressure off the surgical site when you sit.

Test different types of water based lube, like Slippery Stuff or Sutil Lubricant, prior to surgery to ensure you don’t have a negative reaction. This will help you be prepared when it’s time to dilate. Avoid silicone based lubricants.
Purchase a douching bulb for future vaginal rinses

Buy Iodine for the vaginal rinse solution; we suggest buying in bulk as you will be doing this frequently, for the first three weeks after surgery.
ABD pads to collect surgical site drainage. We will give you a few at post-op, but you may need additional ones.
Mesh panties/underwear. We will give you a pair, but you may need additional ones.

When can I start regular activities after surgery?

Returning to work can vary, but you should take 6-8 weeks off from work, depending on what job activities you perform. If you have complications, you may need to take additional time off from work.

In general, we recommend waiting 6-8 weeks before resuming any strenuous activities such as running or weight lifting. Once you do begin these activities you need to start slow and slowly increase. For example, runners can begin with walking, jogging, short distances of running and so forth. You should avoid bike riding and swimming for 3 months total. If there are any wound healing issues after surgery, you may need to wait longer before exercising.

Sexual activity can resume after 3 months or when your surgeon allows.

You should discuss these activities with your surgeon before resuming work or any new strenuous activity.