The Cosmetic Vaginoplasty

[Guest KerryUK]

With there being so little information about this procedure, I thought I would compile my own description in the hope it helps others.

For all sorts of reasons, some transwomen choose not to have the vagina complete with vaginal canal created. Rather, they opt for the Cosmetic Vaginoplasty which gives the look of a vagina but there is no vaginal canal. For some, the decision may be based around age or other medical reasons but in my case, I could see no reason to put myself at additional risk and have the need to dilate for the rest of my life - I don't see myself being together with a man and nor do I see myself giving birth at any point.

I think the simplest way to describe the procedure is that instead of creating the tube from the penile skin for creation of the vaginal canal, the skin is left flat and pulled down and stitched in place just in front of the rectum. The sides are attached to scrotal skin which forms the labia. The urethra is shortened and positioned in the correct female place through an incision in the penile skin. The clitoris is created using a diamond shaped piece of the glans (if you look down on to the top of the penis - it's the bit on the top just in front of the neck of the penis and back from the urethra). There is a bundle of nerves which runs centrally along the top of the penis back from the glans and it is this bundle which is carefully separated away from the erectile tissue and left connected to the 'diamond' shaped piece of glans (the new clitoris). Once the nerve bundle and urethra have been separated from the erectile tissue, the erectile tissue is removed as close as possible to the pubic bone so as not to become construct post op.

In my case, some of my clitoris remains uncovered and rubs which I find too sensitive but that is improving (I wasn't circumcised so it was pretty sensitive). I brought this up with the surgeon who said that the hood is there and that the part which is exposed will de-sensitise - there is quite a lot of the new clitoris which is buried out of sight which will continue to be sensitive.

I have another appointment with him at the end of November and I think he will be removing a few skin tags - they can't be removed earlier because everything down there needs to settle down.

After the op, the swelling made having a pee feel quite restrictive and it can still feel like that now, it is improving though. I've managed to have some orgasms but it is like people here say - it takes a lot longer, oh I mean quite a lot longer and so I guess it's a case of relearning what works best. The thing is that there are areas down there which remain numb after the op and can take a year to become sensate again. The skin which is now inside the labia (that which can be seen if the labia are pulled apart) has now become much more like inner vaginal skin and is no longer external skin.

Oh, how it feels. Well, I refer to the op (to people who aren't trans) as not 'chopping it off' but rather as recycling what's there. It does feel a little like you are still tucked. After the op I had twinges which felt like they were on a part of my penis but that was no longer there - so I had to remind myself where that is now located.

I hope this makes sense and if any questions arise, I might even edit this post to directly answer the questions to save readers the bother of reading through an entire thread.

[Jani]

Kerry,

Congratulations and thank you for the information. I know this subject came up recently and many are curious. Obviously the surgery must have taken less time and there is less risk afterwards of infection, etc. Were you in recovery long? When were you able to go home? Your comment of feeling like its tucked reminded me of those who lose a limb but still can "feel" it, apparently due to some nerve memory. Is that correct? It's interesting that you can orgasm since I wouldn't have thought it was possible without the vaginal canal. Thanks again.

Hugs,

Jani

[Guest KerryUK]

Hi Jani,

Thanks very much for your reply to my blog (to be honest I'd hoped for a few more bearing in mind how little information there is out there around the Cosmetic Version but hey-ho).

I'll answer your questions because I do feel it's important for others who follow to know. Please bear in mind though, that I am relatively young, I don't smoke and I don't drink very much (anymore) plus I am not overweight - so my recovery was relatively quick and as the saying goes 'Your Mileage May Vary' (YMMV).

The surgery lasted for around 3 1/2 hours. On my way in to Theatre, I was administered an Epidural directly into my spine (actually, that wasn't as bad as I expected and was a bit of a non-event really). The Epidural was 'topped up' again as I left Theatre to give me an extra boost of pain relief and then removed but I don't remember that. I didn't get any feeling back in my legs for a good few hours but it slowly but surely came back and by evening I could move my legs and feet again.

I was on IV antibiotics for 2 days followed by a 5 day course of oral antibiotics and for pain relief I was on Ibuprofen and Paracetamol. I didn't find that I needed anything more though if I had needed it, I could have had stronger.

I was in recovery at hospital for 7 nights and could slowly start to sit up within several days but this was only where the bed back was raised a little and by about day 4, I could get out of bed and 'sit' in a special chair (albeit a little carefully and somewhat uncomfortably). It was on day 4 that (the most awful) compression knickers were also removed to allow me to have a careful bath. Those knickers have to be the worst part of the procedure for me as they were SOOOOOO tight. To reduce the risk of DVT, I had compression stockings which I needed to wear for around 2 weeks and for the first 4 days I was also connected to this special machine which kept 'squeezing' my legs every few seconds.

I had a catheter fitted during surgery and this remained in situ for 14 days. This meant that I needed to go back in to the hospital for a visit a week after discharge to have that removed. The surgeon felt that leaving the catheter in for longer (rather than taking it out prior to discharge from hospital), helps the new Urethral opening to heal better. Once the catheter was removed, I wasn't permitted to go home until I had emptied my bladder at least twice. If I couldn't do that, the nurses would have inserted another catheter and left it in for longer I guess but I went four times and so we were all happy with that.

There is no way I could have driven my car for around 7 weeks because everything was too tender and so my partner took over all driving duties.

Well, the feeling of still being 'tucked' is not a phantom feeling but rather the skin used is in very similar places. The penile skin is pulled down and stitched into place - kind of like 'tucking'. The labia are basically scrotal skin which is in a similar place still. The thing is that you soon realise (once the swelling goes down) that there is nothing there that gets in the way anymore. Even now, I sometimes forget when I'm in the shower or sit down on the toilet and go to move something out of the way - only to find there is nothing there anymore (that amuses me).

In my case, the 'phantom' limb feeling came from twinges. I would get a twinge (sometimes really painful for a second or two) which would come from something that was no longer there (for example, a part of the foreskin or penile skin which is now in a different place). So, I'd have to think about where that nerve is now and try to remember that it is in a different place now.

I was surprised by your remark about needing a vaginal canal to orgasm Jani but all the same - it was a good point to make. Many ciswomen can't orgasm on penetration alone - they need clitoral stimulation. Also, many ciswomen stimulate themselves by clitoral stimulation alone if they are in need of a 'quickie'. So yes, it is possible to orgasm without penetration and I have done that - but I've found now that I have to be in the right mood, relaxed AND not let my mind wander. It takes a very long time compared to before too. I am, to all intents and purposes a complete and utter beginner and so I'm having to learn all over again what works best. Of course, let's not forget - an awful lot of nerves etc are still numb at the moment and so I hope as time passes, things may become more fun down there and I can appreciate it much more.

My partner says that it looks incredible and on Monday, I showed my new vagina to a nurse at my local GP surgery (she has known about me since I started transition and has been absolutely wonderful). Well, I offered to show her and of course she was really keen to see (so long as I was comfortable in showing her - which I was). She was simply amazed and exclaimed that it looks better than hers.

So, I hope this has helped to answer some more questions around the procedure.

Kerry x.

[Guest Raya]

Kerry, thank you for the information. I'm a bit new to transition, and only recently found out about this option, partly from your posts.

I consider it an option for me in the future, due to less invasive surgery and reduced need for care post op.

Im glad your surgery has gone well

[Guest KerryUK]

You are more than welcome Raya. I know what it's like trying to find information and finding none. So if my thread here helps, then it makes it all worthwhile.

Kerry x

[Guest KerryUK]

Just a quick update, I had my review consultation with the Surgeon yesterday and will be having a 'revision' operation. I have a few 'dog ear' tags on my labia which need tidying, my clitoris remains exposed and so rubs (it can be quite uncomfortable at times and way too sensitive) and my urethra needs a little 'stretch' as I sometimes feel a little restriction if I've been holding it in.

So, he will be moving the clitoris down more towards the urethral opening and drawing the two sides (labia) closer together as when I stand, they are apart. He will be tidying the 'dog ears' and will stretch my urethra. It should be a roughly 40 minute procedure and will be a day visit so no overnight stay. Then he said I should have no more than a week off to recover.

I know this sounds like a lot but in actual fact, he is pleased with the overall results and especially with the fact that there is no vaginal opening there - he had to remind himself that I didn't have one so it must look pretty good.

[Jani]

Hi Kerry,

Thanks for the update. Sorry about the need for revision but it sounds as if your doctor is working to make it right for you. I guess it's a plus that he had to remind himself about the type of surgery you had. I'm sure you do look good!

Hugs,

Jani

[Charlize]

Thank you for sharing this information Kerry. I considered this surgery but due to my heart problems and the anti coagulants which i must continuously use i was unable to do it. I had an orchiectomy instead which doesn't do it aesthetically but at least does allow an easy tuck and a way to stop taking blockers. I also find some solace when i'm working on the farm, well away from a powder room. Your description helps me to better understand how that option would have worked for me.

Hugs,

Charlize

[Guest KerryUK]

You're both very welcome. I'm glad it helps and of course it's the reason I started this thread. I remember how frustrating it was to find so little information out there about the procedure. So this is my way of giving something back.

Kerry x

[Guest KerryUK]

Just a little post here to say that I am in for surgery tomorrow for the revision procedure mentioned previously.

I will post again when I am recovered enough to let you know how the procedure goes.

Kerry

[Guest]

Much success Kiddo! Hug. JodyAnn

[Jani]

Our thoughts are with you Kerry, for a successful operation and a smooth recovery.

Cheers,

Jani

[Guest KerryUK]

Hello Jody and Jani,

Thanks very much for your kind wishes.

I've just arrived back home after the revision surgery. I'm not feeling too bad apart from being tired and a little sore.

I'm not going to go over the day now as I'm a bit tired and so I'm going to rest.

I'll catch up soon.

Kerry

[Jani]

Great to hear you're back safe at home. Rest up. The weekend is here. Have a cup of tea and relax.

Hugs,

Jani

[Guest KerryUK]

Aw Bless You Jani and thank you,

Well, because I was going to be under General A aesthetic, I had to fast from tea time on Wednesday so I had a pizza and then it was water only until 08:30 on Thursday morning. I woke up with a pounding headache which progressively got worse through the morning. We set of in plenty of time to allow for the inevitable traffic jams along the M62 between Halifax and Leeds. Well, we arrived early but relieved to be there in time and not late. We were shown to my room to go through all of the usual procedures. I was expected to go in to theatre for 12:00 but that became more like 13:15ish. By then, my headache was really awful and was making me feel somewhat nauseous. I think it might have been no fluids and perhaps withdrawing from caffeine too.

In the prep room, I met many of those who had been there for my main op some 9 months ago - they were wonderful and we had a few laughs while the preparations were done.

The next thing was I was waking up in recovery (that was the bit I couldn't remember from last time). I didn't feel nauseous, just really tired. Once they were happy that I was suitably recovered, I was wheeled back to my room. Due to the pain killers, the headache was thankfully history. Back at my room, I was encouraged to start drinking and eventually those wonderful egg mayo sandwiches which I remembered so well from last time, arrived and were duly devoured.

Mr Fenton popped his head round the door to see how I was getting on and later came by to tell me what had been done. He said that all had gone well and that he had reduced and tightened the labia. My clitoris had been buried deeper inside so that it is now less exposed with a few temporary stitches to try to stop it 'popping' out again - also he had moved it further down towards my urethra into a more natural and less exposed position. Finally, he did something to my urethra to relieve some of the restriction while peeing - he didn't stretch it because he said that it could cause scarring there which could increase the risk of stricture. So he made an impression of nicking something with his scalpel - so I think he cut something but I can't remember the word he used for it. I wasn't catheterised - thankfully.

I think it was around 17:30 when I was discharged (once I'd had something to drink, eat and that all important pee) and then it was the slightly uncomfortable ride home - my partner drove and bless her, she tried so hard to avoid potholes and bumps. As soon as we arrived home, it was off to bed for me.

Although it is sore, it's bearable and the painkillers are helping. There are seepages of blood but they aren't too bad and I hope they should get less and less over the next few days. Oh yes, there is swelling too especially on the left labia where the most skin was removed.

Anyway, that's the account of my latest visit. I'll need to go back to see Mr Fenton in about 6 weeks for a post-op check up.

All for now and hope this is a useful addition to the blog.

Kerry

[Guest KerryUK]

Hi Vivianmichelle,

Thanks very much, oh yes - that headache was certainly a belter.

Well, I don't know why, but I've woken up feeling better than I have for a very long time. I had a pretty good night sleep and I'm still sore and swollen but without a headache or aching jaw/teeth (I grind my teeth in my sleep). It makes you think doesn't it? I guess I must have been worrying about the surgery more than I realised.

My partner had a look at my revised veejay yesterday and said that although it looked good before, it now looks very natural (hopefully it will continue to look as good once all of the swelling has gone down).

Kerry

[Guest]

Happy blooming flower girlfriend! Giggle. Love JodyAnn

[Guest KerryUK]

Heehee, thank you Jody, you always cheer me up.

Kerry x

[Guest Lizzie McTrucker]

This has been an incredibly interesting read because I have never heard of this procedure before.

[Guest KerryUK]

Wow, just reading your reply here has made my efforts here worthwhile Lizzie. If I managed to help just one person by coming here and writing about my experiences then I feel that I've given something back to this wonderful Site. Before I had my surgery, there seemed so little information out there regarding the Cosmetic Vaginoplasty - this is why I wrote about it. I wanted others out there to know that there is an alternative to the full Vaginoplasty.

So thank you very much Lizzie.

Kerry

[Guest Lizzie McTrucker]

So thank you very much Lizzie.

You're quite welcome! I'll admit, after reading about your experience and reason behind your decision, it caused me to think if this would be something I would consider for myself. This morning, I even lingered in bed a little longer than I should have because I was thinking about this procedure in regards to myself and was weighing the pros and cons. I believe I've come to the conclusion that if, due to health reasons, I'm unable to have the complete gender reassignment surgery, then I would seriously consider cosmetic vaginoplasty. In my opinion, it would be better than having nothing at all. The male bits would still be gone, even if I didn't have the complete female bits.

I started doing a little bit of online research to find out who does this procedure and what the related costs are but I wasn't able to find out much information about that. Also, are there any unique requirements leading up to this? Did you have to follow something similar to the Harry Benjamin SOC or is it not as strict because it's only considered a partial GRS?

Thanks for your help!

[Guest KerryUK]

I'm so glad it's given you food for thought Lizzie - everybody seems to think that there is only one solution/outcome but just as there are those who choose not to have surgery, there are alternatives to the full vaginoplasty too.

Considering that this alternative surgery is available, it astonished me how little information there is out there about it - hence my reason for this thread. I was very lucky in that there was a person who is an infrequent visitor to this site, who kindly gave me information through PMs. She was obviously shy about doing anything openly on the forum and I respect that. I, however wanted to provide information for anybody to see and be able to make more informed decisions about their surgery choices.

As with everything, there are pros and cons. The reduction in risk, shorter recovery period and reduced maintenance are the obvious pros. The equally obvious con is that I can't have penetrative vaginal sex - there are occasions when I see a sex scene on TV and feel a little envy for her experiencing that. I knew that this could happen and weighed this up as part of my decision process. I think that the overall aesthetic results are somewhat better than if I'd had a full vaginoplasty too though I have to wait a little longer to confirm that following my revision surgery last Thursday.

Regarding preparation, here in the UK and on the NHS, I had to follow exactly the same process as somebody who wanted the full vaginoplasty - in fact I guess that I could have changed my mind very late in my assessment period to then request the full vaginoplasty. When I visited the surgeon for my pre-op assessment, he was concerned that for someone so 'young' I might be making a mistake. He satisfied himself that I had made my decision based on sound reasoning and judgment - after all, it's a very difficult mistake to correct.

So, I still have no regrets Lizzie. I hope this helps and please feel free to ask any more questions you may have.

Kerry

[Guest]

And the up side is that you can't get addicted to your dilator. And to think I started out painfully scared and hating to do that...

"Will you get back in your drawer and let me get some sleep!"

You did good Kiddo! That and we have appointed you our "go to girl". Giggle.

[Guest KerryUK]

Whoops, there goes Jody again hee hee - you always make me smile, you 'daft ha'peth' (pronounced aypeth and is a nice Yorkshire saying).

Probably just as well I can't use a dilator Jody - if I did, I'd probably need to go to DA (Dilators Anonymous) to wean me off the darned thing.

Kerry

[Guest]

Why yes, I'm going to go to those meetings, the closest meeting hall to me though is just across a river in Egypt, you know the one. De Nile!

I forewarn you, before my last breath I want to come to see you, even if I have to swim the gap. I want a hot cup of tea, a warm hug and the maximum laughs that Parliament allows!

If a handsome uniformed gentleman lifts me by my scruff, I will afford you plausible deniability, that and my innocent mischief will only give me a few days in the clinker. Barring that, only our sides will hurt! Hug me and keep a straight face, I dare ya! Giggle. JodyAnn