Our Summary

The visible result of a gender-affirming vaginoplasty or vulvoplasty procedure is the vulva, the external part of the female genitals. The aesthetics, or the appearance of the vulva, can have a significant impact on how individuals feel about their surgery results. Therefore, creating a visually pleasing vulva is a critical part of these surgeries. There is no single “ideal” look for a vulva, but it’s considered aesthetically best when all the main parts of the vulva are proportionate to each other. This article reviews existing literature and discusses ways to improve patient satisfaction with the appearance of their vulva, such as educating patients, redefining what an “ideal” vulva looks like, and applying aesthetic surgical principles and techniques. This review is based on the authors’ experience with over 630 gender-affirming vulva surgeries.

In the review process, the authors found 1,042 articles, but many were excluded for various reasons, such as not being related to gender-affirming surgery, not being in English, or not discussing the aesthetics of the vulva. Ultimately, only 25 articles were included in the review.

The authors conclude that to create the best-looking vulva for each patient, surgeons need to make flexible decisions based on the individual’s anatomy and available tissues. This review offers an overview of current approaches to creating aesthetically pleasing vulvas during gender-affirming surgeries.

FAQs

  1. What is the goal of a gender-affirming vaginoplasty or vulvoplasty procedure?
  2. How is the “ideal” look of a vulva defined in the context of these surgeries?
  3. How did the authors of the review determine which articles to include in their research?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about vaginoplasty is to have realistic expectations about the outcome of the surgery. It’s important to understand that the goal of the surgery is to create a functional and aesthetically pleasing vulva, but perfection may not always be attainable. It’s also important to communicate openly with your surgeon about your goals and concerns, so they can work with you to achieve the best possible results. Additionally, following post-operative care instructions and attending follow-up appointments are crucial for a successful recovery and optimal outcome.

Suitable For

Patients who are typically recommended for vaginoplasty include transgender women who desire to have female genitalia that align with their gender identity. These individuals may experience gender dysphoria related to their assigned sex at birth and seek surgery to alleviate this distress. Additionally, individuals who have undergone hormone therapy and meet certain criteria for surgery may be considered candidates for vaginoplasty. It is important for patients to undergo thorough evaluation and counseling before undergoing this procedure to ensure they fully understand the risks, benefits, and potential outcomes.

Timeline

Before vaginoplasty:

  1. Patient consults with a gender-affirming surgeon to discuss the procedure, risks, and expected outcomes.
  2. Patient undergoes pre-operative assessments and tests to ensure they are a suitable candidate for surgery.
  3. Patient may need to undergo hormone therapy and hair removal in the genital area prior to surgery.
  4. Patient receives pre-operative instructions and prepares for surgery, including fasting and discontinuing certain medications.

After vaginoplasty:

  1. Patient is monitored in the hospital or surgical facility for a period of time following the procedure.
  2. Patient experiences post-operative pain, swelling, and discomfort, which is managed with medications.
  3. Patient is discharged from the hospital and instructed on wound care, hygiene, and activity restrictions.
  4. Patient attends follow-up appointments with the surgeon to monitor healing and address any concerns.
  5. Patient may undergo post-operative treatments, such as vaginal dilation, to maintain the results of the surgery.
  6. Patient experiences physical and emotional changes as they adjust to their new genital anatomy and identity.

What to Ask Your Doctor

Some questions a patient should ask their doctor about vaginoplasty include:

  1. What are the potential risks and complications associated with vaginoplasty surgery?
  2. What type of anesthesia will be used during the procedure?
  3. How long is the recovery period after vaginoplasty surgery?
  4. Will I need to follow any specific post-operative care instructions?
  5. What are the expected results of the surgery in terms of appearance and function?
  6. Will I need to undergo additional surgeries or procedures in the future?
  7. What are the factors that can affect the aesthetic outcome of the surgery?
  8. Can you show me before and after photos of previous patients who have undergone vaginoplasty?
  9. How experienced are you in performing gender-affirming surgeries, specifically vaginoplasty?
  10. What is the cost of the procedure and will it be covered by insurance?

Reference

Authors: Peters BR, Carboy JA, Richards H, Dy GW, Dugi D 3rd. Journal: Transl Androl Urol. 2024 Feb 29;13(2):274-292. doi: 10.21037/tau-22-681. Epub 2024 Feb 21. PMID: 38481864