Vulvoplasty 101: Your Low-Risk Alternative to Vaginoplasty

Did you know there's a less invasive alternative to vaginoplasty with a 93% patient satisfaction rate? Enter vulvoplasty, a gender-affirming procedure that creates external female genitalia without a vaginal canal, presenting a lower-risk option for trans people. This article explains how vulvoplasty differs from traditional vaginoplasty and covers topics like costs, preparation, recovery, as well as its transformative impact.

Table of Contents

1. What is Vulvoplasty?
2. Vulvoplasty vs Vaginoplasty
3. Who is a Good Candidate for Shallow-Depth Vaginoplasty?
4. Vulvoplasty Cost
5. How to Prepare for Zero-Depth Vaginoplasty
6. Vulvoplasty Procedure
7. Vulvoplasty Recovery
8. Vulvoplasty Risks and Complications
9. Vulvoplasty Results
10. Takeaways

What is Vulvoplasty as a Gender Affirming Surgery?

Vulvoplasty, or zero-depth vaginoplasty, is a type of bottom surgery that creates a vulva (external genitalia) for transgender women and non-binary people. A vulvoplasty constructs a mons pubis, clitoris, and inner and outer labia using the patient’s penis, scrotal skin, and other genital tissue.

Vulvoplasty’s defining feature is that it does not involve creating a vaginal canal. Nevertheless, in most cases, surgeons can still construct a vaginal dimple (i.e., shallow-depth vaginoplasty). It does not lead to an internal vaginal canal but provides the appearance of a vaginal opening.

So, what exactly sets vulvoplasty apart from vaginoplasty, and what are the reasons behind the growing preference for it?

Vulvoplasty vs. Vaginoplasty

Unlike vaginoplasty, vulvoplasty does not involve the creation of a vaginal canal. This difference has several implications for patients:

• Less invasive. Vulvoplasty includes creating a vulva, clitoris, labia minora, and labia majora using tissue from the penis and scrotum but skips the vaginal canal, making it a less invasive procedure.
• Reduced recovery time. Without the need for the creation of a vaginal canal, patients often experience quicker recovery.
• No need for dilation. Unlike vaginoplasty, which requires regular dilation to maintain the new vaginal canal, vulvoplasty patients do not need to undergo this process.
• Less risks. Vulvoplasty has a lower risk of complications, such as rectal injuries and infections, which are common concerns with vaginoplasty.
• No vaginal penetration. The patient will not be able to engage in penetrative vaginal sex since there is no vaginal canal.
• Potential for vaginoplasty. Although most patients are satisfied with the final results of vulvoplasty, surgeons will be able to create a vaginal canal using skin grafts, if desired later.

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🤔Learn more about different types of male-to-female bottom surgery.

Who is a Good Candidate for Shallow-Depth Vaginoplasty?

Vulvoplasty can be an excellent choice for trans individuals looking to affirm their gender identity without undergoing a full-depth vaginoplasty. You might be a good candidate for this type of bottom surgery if you:

• Do not desire penetrative vaginal sex.

Vulvoplasty presents a less complex and less invasive alternative since it only creates external genital anatomy without a functional vaginal canal.

• Have concerns about your age and recovery.

Older patients may find the recovery process from vulvoplasty to be more manageable than that from vaginoplasty. The less invasive nature of zero-depth vaginoplasty often results in a quicker and smoother recovery period.

• Prefer to avoid lifelong dilation.

Since vulvoplasty doesn't create a vaginal canal, this means you won't need to commit to regular dilation to maintain the surgical results.

• Identify as non-binary.

Some non-binary patients may find zero-depth vaginoplasty more affirming because it creates genital anatomy that's less associated with binary female bodies.

• Have higher risk factors due to medical conditions.

Certain medical conditions can increase the risks associated with major surgeries. Patients with a history of radical prostatectomy, pelvic radiation, or major rectal injuries are at higher risk during complex surgery procedures. Additionally, those with congestive heart failure, multiple mental health conditions, or limited ability for self-care may find vulvoplasty to be a safer option. Its comparatively simpler nature can mitigate some of these heightened risks.

• Have timing and practical concerns.

If you are facing a loss of health insurance, you may opt for vulvoplasty due to its quicker scheduling. Additionally, vulvoplasty does not require pre-operative hair removal, which can expedite the preparation process.

• Have financial concerns and are paying out-of-pocket.

Vulvoplasty tends to be less expensive than vaginoplasty.

Vulvoplasty Cost

On average, zero-depth vaginoplasty costs from $10,000 to $22,000. Vulvoplasty is typically around 12% cheaper than a classic penile inversion vaginoplasty. However, the final price can vary significantly depending on several factors, such as the surgeon's expertise, the clinic's location, and the specific procedure details.

💰Compare costs for different male-to-female bottom surgery options here.

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How to Prepare for Zero-Depth Vaginoplasty

During the preparation phase, you'll have the support of a dedicated care team who will guide you through the necessary medical evaluations and practical steps to ensure a smooth recovery. You're not alone in this journey.

Health evaluations

A vulvoplasty is a serious and irreversible procedure, so it’s crucial to have a reliable and experienced care team. Experts in gender-affirming care will evaluate your physical and mental health to determine if vulvoplasty is for you.

1. Physical health evaluation

• Your medical team will review your medical history, conduct a physical exam, and order lab tests to check hormone levels and organ health.
• They’ll address any infections or prior conditions and ensure you’re not using tobacco or certain drugs.
• Discussions will include the impact of vulvoplasty on future health and family planning. If you wish to conceive biologically in the future, consider sperm banking before undergoing surgery.

2. Mental health evaluation

• You’ll meet with two behavioral health specialists who will evaluate your psychological well-being and ensure that vulvoplasty is a healthy choice for you.
• Following WPATH standards, both specialists must provide letters of support.
• You’ll need to understand the risks, benefits, and costs of vulvoplasty.

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Preparations for a smooth recovery

Planning for your recovery ahead can significantly ease the transition post-surgery. Here are some practical steps to take.

1. Work

• Plan for 8-12 weeks off work. Ensure your leave of absence is approved. 
• If your job is physically demanding, negotiate for a lighter workload upon return.

2. Self-care 

• Eat nutritious foods and stay active to support healing. Discuss a suitable exercise routine with your surgeon.
• If you smoke, now is the time to quit, as it can complicate surgery and slow healing. 
• Stop taking hormones 6 weeks before the date of your surgical procedure.
• Continue with mental health counseling to process your emotions and address any concerns.

3. Home preparation

• Complete chores and errands, plan meals, and buy groceries.
• Choose loose, comfortable clothes and nonslip shoes for recovery.
• Arrange your living space for easy access to necessities.

4. Support network

• Don't underestimate the importance of a strong support system. Ask friends and family to help with daily tasks, especially during the first 2 weeks after surgery.
• Consider making an extra house key for helpers to come and go easily.
• Surround yourself with supportive people to boost your spirits.

Vulvoplasty Procedure

During vulvoplasty, your surgeon will skillfully rearrange the tissue in your genital area to create a vulva. Here’s a step-by-step guide to what you can expect:

1. The surgeon removes the penis, scrotum, and testes.
2. The surgical team uses tissue from the head of the penis to form your clitoris, preserving sensation.
3. The surgeon shortens the tube that carries urine out of your body (urethra).
4. Tissue from the scrotum, penis, and urethra is used to form the rest of your vulva.
5. The surgeon creates a shallow vaginal canal, a small dip in the tissue to mimic female anatomy.
6. You may get a urinary catheter inserted into your bladder to help you urinate after surgery. Your surgeon will remove it in a couple of days.

Vulvoplasty Recovery

Recovering from bottom surgery requires time, patience, and careful adherence to your doctor’s instructions. The following timeline will help you understand what to expect:

🗓️Days 1-3. Bed rest in the hospital.

🗓️Days 4-5. Gradual increase in movement under medical supervision.

🗓️Weeks 1-2. You’ll be housebound, so ensure you have sufficient support arranged.

🗓️Weeks 3-4. You should start feeling better. Avoid driving and strenuous activities.

🗓️Weeks 8-12. Most patients can return to work. Continue to avoid strenuous activities.

🗓️Month 4. Swelling should significantly reduce, giving you a clearer view of the final appearance of your vulva.

🗓️Year 1. Complete healing may take up to a year. Follow your doctor’s advice on physical activities and sexual intercourse and attend all scheduled checkups to ensure proper recovery.

Potential Vulvoplasty Risks and Complications

When an experienced, board-certified plastic surgeon performs vulvoplasty, the chance of complications is low. However, like any surgery, it comes with some manageable risks. Here are some to be aware of:

• Urinary tract infection is the most common complication, occurring in approximately 14.3% of patients. Good wound care is essential to minimize this risk.
• Hypergranulation is the second most common condition (9.5%). Although fairly benign and treatable, it can lead to fluid or blood loss and may have an odor.

Other possible risks include:

• bleeding;
• blood suffusion (hematoma);
• fluid retention (seroma);
• poorly healing wound edges;
• numbness in legs;
• abscess;
• blood clots;
• loss of sensation;
• scarring (can be corrected 1 year post-surgery).

Vulvoplasty Results

The outcomes of zero-depth vaginoplasty are overwhelmingly positive, with a remarkable 93% satisfaction rate among those who undergo the procedure. From daily routines to intimate experiences, the effects of vulvoplasty touch many aspects of a person's existence.

Benefits

A vulvoplasty can make you feel more comfortable and happier with your body. After the zero-depth vaginoplasty procedure, patients can:

• have genitals that more closely match their desired appearance;
• reduce or stop their hormone therapy;
• experience clitoral pleasure and orgasm;
• perform everyday activities available to people with vulvas, like peeing while sitting down.

Sexual function and sensation

While zero-depth vaginoplasty does not allow for vaginal penetrative sex, it can still enable a fulfilling sexual life. It's important to take time to explore your new anatomy and discover which areas are erogenous and pleasurable. 

Doctors generally recommend postponing sexual activity for 3 months post-surgery. During this time, gentle massage can help desensitize overstimulated nerves. Vibrators are particularly useful in preventing injury during the healing process.

Fertility

Vulvoplasty involves the removal of testicles, eliminating the ability to produce sperm. It's vital to discuss preservation options with your healthcare provider before proceeding with gender confirmation surgery. If you think you may want to have children, you can consider freezing your sperm in a sperm bank.

Revision surgery

In some cases, patients may seek revision plastic surgery to enhance the appearance or function of their vulva. Common corrections include:

• reducing labia minora; 
• adjusting the clitoral hood;
• addressing scarring;
• modifying the urethra. 

Surgeons recommend waiting at least 6 months, preferably a year, before considering revision surgeries. This allows for complete healing and a clear assessment of the initial results.

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Takeaways

✦ Vulvoplasty, or zero-depth vaginoplasty, is a gender-affirming surgery that creates a vulva using the patient's genital tissue without making a vaginal canal.

✦ Compared to traditional vaginoplasty surgery, zero-depth vaginoplasty is less invasive, has a quicker recovery, requires no dilation, and has a lower risk of complications but does not allow for vaginal penetration.

✦ Zero-depth vaginoplasty ranges from $10,000 to $22,000, 12% cheaper than vaginoplasty.

✦ The recovery timeline includes a hospital stay (days 1-5), housebound period (weeks 1-2), improvement in feeling (weeks 3-4), return to work (weeks 8-12), significant swelling reduction (month 4), and complete healing (up to 1 year).

✦ Complications are rare but can include urinary tract infections, hypergranulation, bleeding, hematoma, seroma, poorly healing wounds, numbness, abscess, blood clots, loss of sensation, and scarring.

✦ The results of vulvoplasty show a high satisfaction rate (93%), with benefits such as improved self-confidence, potential reduction in HRT, ability to experience orgasm, and comfort in everyday activities.

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