In recent years, a surgical procedure called Vaginoplasty has gained attention, especially for adolescents and young adults who are transitioning from male to female. However, this operation, performed by certain plastic surgeons and urologists, has raised concerns. Many believe these young individuals are being given false hope when they are told that this procedure will provide them with a new vagina. The reality, however, is far from what is marketed.
A UK based Emergency Medicine senior doctor who is also a fellow of the Royal College of Surgeons of Edinburgh, and a member of Our Duty, has researched the Vaginoplasty procedure extensively. What is often presented as a surgical creation of a vagina is, in fact, a deep surgical wound lined by a flap of skin. This procedure creates a wound in the perineum (the area between the anus and the genitals), which the body naturally treats as a wound—leading to granulation and scarring. As the healing process continues, the hole created in the perineum shrinks, and the individual is required to perform painful dilatations for the rest of their life to maintain its size.
The following table compares the true anatomy of a female vagina with the results of the Vaginoplasty procedure:
Comparison: Normal Female Vagina vs. Vaginoplasty (Post-Surgery)
| Feature | Normal Female Vagina | Vaginoplasty (Post-Surgery in Biological Male) |
|---|---|---|
| Structure | Highly distensible fibromuscular elastic tube. | A non-distensible surgical wound that tends to contract. |
| Development | Provided by nature to biological females. | Surgically created by human intervention. |
| Inner Lining | Non-keratinized stratified squamous epithelium. | Keratinized stratified squamous epithelium (skin). |
| Lining Purpose | Designed for a moist surface. | Designed for a dry surface, prone to maceration. |
| Underlying Layer (Lamina Propria) | Highly vascular with elastic fibers, providing distensibility. | No lamina propria and no elasticity. |
| Glands | Contains natural glands (e.g., mucous-producing glands). | Contains sweat glands, apocrine glands, sebaceous glands, and hair follicles, leading to potential infection. |
| Glycogen | Glycogen present, supporting Lactobacillus bacteria, which maintains healthy pH. | No glycogen, leading to bacterial and fungal growth. |
| Cervical Secretion | Cervix produces mucus for lubrication and cleansing. | No cervix or cervical mucus to provide natural lubrication. |
| Muscle Layer | Circular and longitudinal muscles provide function during intercourse and childbirth. | No muscular layer. |
| Surrounding Tissue (Adventitia) | Dense connective tissue with extensive vascular and elastic supply. | No adventitial layer, just a deep surgical wound. |
| Vestibular Bulbs | Present on both sides of the vaginal orifice. | Absent in the surgical wound. |
| Bartholin’s Glands | Present at the vaginal introitus, secreting lubrication. | Absent in the surgical wound. |
| Bulbospongiosus Muscle | Surrounds the vaginal opening, contributing to function during sexual activity. | Absent in the surgical wound. |
The Reality of Vaginoplasty
From the table above, it is evident that the surgical result of Vaginoplasty does not produce an anatomical and physiological vagina. Instead, the procedure creates a deep surgical wound that is lined with skin grafts, and this wound does not replicate the natural structure or function of a female vagina. The terminology “Vaginoplasty” is a misnomer that misleads adolescents and adults into thinking they are receiving a real, functional vagina.
Complications of Vaginoplasty
There are several serious risks associated with this surgery, including:
- Post-operative infections and sepsis
- Necrotizing fasciitis
- Pulmonary embolism
- Inadvertent bowel and bladder injury
- Urethral and Recto-neovaginal fistulas (uncontrolled leakage of feces and/or urine)
- Urinary strictures
- Neovaginal stricture requiring painful dilatations for life
- Numbness in the perineum
- Fungal and pyogenic infections in the neovagina
- Failure of reproduction/sterility
- Unpredictable effects on the prostatic tissue
One of the most severe complications, urethral and recto-neovaginal fistulas, can lead to uncontrolled leakage of feces and urine, which is a serious medical issue that may result in sepsis or death. In such cases, colostomy and other extensive surgeries may be required, often with high peri-operative mortality risks.
Conclusion
In conclusion, while Vaginoplasty is marketed as a procedure to provide a new vagina, the reality is that it creates a surgical wound with serious risks and lifelong complications. The procedure cannot replicate the function or anatomy of a natural female vagina. The use of the term Vaginoplasty is misleading, and it is essential that individuals considering this surgery are fully informed of the risks and the realities of what the procedure entails.