Some women may have functional or anatomical variations of their genitalia that require surgical treatment. Trauma from childbirth, aging, or inherited anatomical variations can affect the appearance and/or the normal function of the vagina. These changes can create sexual dysfunction, problems with intimacy and emotional angst. For example, tearing of the vaginal and perineal muscles during childbirth can result in a loss of muscle tone and stretching of the vaginal opening. An overstretched or “loose” vagina may contribute to reduced friction during intercourse and diminished sexual pleasure. Aging can also have the same effect.
Using a surgical technique known as vaginoplasty, or vaginal rejuvenation surgery, a board certified gynecological surgeon can tighten lax muscles and the supporting tissues in the vagina. This achieves a narrower and tighter vaginal canal and a smaller vaginal opening. The procedure can often be performed with the use of a laser that creates very precise and minimally traumatic incisions in the vagina. The procedure takes about an hour to perform, and the patient can usually return to work in 3-4 days. Sexual activity and exercise can usually be resumed in 6-8 weeks.
Vaginoplasty is also the term used to describe a major surgical procedure used to create a vagina where either one didn’t exist before, such as in the case of male-to-female sexual reassignment patients, or when there is a congenital absence of a vagina in an otherwise normal female or as presents with other congenital abnormalities.
In male-to-female sex reassignment surgery (MTF SRS), some trans-gender women undergo vaginoplasty as part of their physical transition. There are essentially two main ways in which vaginoplasty is carried out: using a split-thickness skin-graft (the McIndoe technique), and recto-sigmoid colon vaginoplasty. Subsequent care following both procedures is essentially the same and involves the use of vaginal dilation using a set of high quality vaginal dilators.
A few days after surgery, the surgeon removes the stent that was put into the neo-vagina during the operation, and a long regimen of vaginal dilation begins. A set of dilators is used for every dilation, each one with an increasingly larger width. For the first week or two, and up to a month post-surgery, dilation is performed several times a day.
Over time, dilations can be reduced to once daily, then every other day, and then once per week, all while working up to the larger dilators. Eventually, once per month using one of the larger dilators is the goal for a maintenance schedule. Some trans women find they require dilation even less frequently depending on experience and individual physiology. It is important to note that waiting too long between dilations can lead to increased difficulty starting up the dilations again. It should also be noted that vaginal dilation is required for life, and sexual activity (including intercourse) in place of dilation may not be sufficient to prevent shrinkage in vaginal length and diameter.
In the initial stages, dilation can be quite uncomfortable and disruptive to one’s lifestyle. Dilations may need to be repeated four to six times a day for 45 minutes at a time. After a while, however, dilations become less frequent and less uncomfortable. With patience and persistence, a trans woman can enjoy a healthy, fully-functional vagina that allows coherence between her innate gender and her new physical body.