A.Griguolo vaginoplasty

Generality

Vaginoplasty is the surgical procedure for building, reconstructing or rejuvenating the vagina.

An example of genitoplasty, vaginoplasty can be used in various areas of surgery, from therapeutic surgery to cosmetic surgery, through surgery aimed at changing sex.

Vaginoplasty requires special preparation, which includes a series of pre-operative examinations and some precautions such as, for example, the fasting presentation for at least 8 hours on the day intended for the intervention.

There are various surgical techniques for performing vaginoplasty; the choice of surgical technique depends on the purpose of the intervention, so it is not the result of chance.

Vaginoplasty is a substantially safe procedure, which is only associated in rare cases with adverse effects or complications.

Currently, thanks to the progress of surgery, vaginoplasty ensures good results.

Short review of the Vagina

The vagina is the fibro-muscular channel that connects the uterus with the outside. To be precise, it is in connection with the cervix, which represents the lower portion of the uterus.

From the functional point of view, the vagina is the anatomical area responsible for housing the male sperm after ejaculation, on the occasion of a sexual relationship .

What is vaginoplasty?

Vaginoplasty is the surgical procedure which, depending on the circumstances, can be used for the construction, reconstruction or rejuvenation of the vagina.

Vaginoplasty is an example of genitoplasty, where by genitoplasty we mean any genital surgery, remodeling or rejuvenation of the genitals.

uses

Vaginoplasty can be used in therapeutic surgery (to treat a medical condition involving the vagina), in cosmetic surgery (to improve the appearance of the vagina) or in sex-change surgery (for men who want to be women also in the 'anatomy).

Vaginoplasty is a surgical operation that men can also use.

More specifically, vaginoplasty can serve to:

Restore normal vaginal anatomy, after radiotherapy treatment or surgical removal of tumor growths or abscesses formed on the vagina;
Correct the vaginal birth defects . Correction of congenital vaginal defects may include homologous tissue transplantation or prosthetic material grafting ;

Remedy the so - called postpartum laxity of the vagina, a condition that affects the tonicity of the vaginal muscles and can have repercussions on a woman's sexual life;
Repair the vagina after severe trauma or injury to it. The repair of the vagina that has suffered trauma or injury can include, as in the case of the correction of congenital defects, the homologous tissue transplant or graft of prosthetic material;
Build a vagina, when it is absent due to agenesis . Agenesia is the medical term that describes the complete absence of an organ, following an error during embryonic development;
Correct the vaginal hypoplasia following Müllerian agenesis . With the expression "Mülleriana agenesia", doctors mean a congenital condition characterized by the absence of the uterus and the more or less severe malformation of the vagina;
Treating cystocele or rectocele episodes. Cystocele and rectocele are two medical conditions that involve the vagina. In fact, the first corresponds to the sliding of the bladder from its natural location in the direction of the vagina, while the second corresponds to the sliding of the intestine held by its natural position towards the vagina.
Vaginoplasty performed during a cystocele or rectocele can include homologous tissue transplantation or graft of prosthetic material;
Building a vagina in men who want to become women and in subjects who have some kind of intersex condition. Individuals with intersex are people whose sex is impossible to define and who, depending on the therapy adopted, could become male or female.
The most classic example of intersex condition is the so-called Morris syndrome (or androgen insensitivity syndrome ).

Did you know that ...

In vaginoplasty operations in which homologous tissue transplantation is expected, the latter may come from another part of the body of the same patient ( autologous transplant ) or from another person ( allogeneic transplant ).

Preparation

Vaginoplasty requires special preparation, which consists of:

Blood and urine tests . They are used to assess the general state of health of the possible patient, as well as his suitability for surgical procedures.
Electrocardiogram . It has the same purpose as blood and urine tests.
General practitioner meeting - patient . On this occasion, the doctor who should perform vaginoplasty personally assesses the patient's suitability for surgery; more in detail, investigate:
- Current drug therapies. During an operation such as vaginoplasty, all those pharmacological therapies that alter the normal coagulation process (aspirin, warfarin, etc.) should be suspended, because they could cause serious blood loss;
- Drug allergies, sedatives and anesthetics. For the doctor who will carry out the operation, being aware of these disorders is fundamental information for the success of vaginoplasty, since the execution of the latter requires the use of drugs for sedation, anesthesia, etc. ;
- Presence of chronic diseases or heart diseases. Any presence of these conditions represents the sign of a precarious state of health, for which any surgical intervention of a certain invasiveness is contraindicated;
Medical presentation of all the details related to vaginoplasty, from pre-operative instructions (see details) to recovery times, through the procedure and possible risks . As a rule, the patient receives all this information if he is suitable for vaginoplasty surgery.

In general, if the patient is suitable for vaginoplasty, the doctor will fix the latter after 1 or 2 weeks .

Pre-Operative Instructions

Pre-operative instructions are those set of indications that a patient must have the foresight to follow in the days before a certain surgical procedure.

Pre-operative instructions are a very important part of preparing a surgical procedure; that's why they deserve further study.

In the case of vaginoplasty, the pre-operative instructions for future patients are:

Stop smoking (this makes sense, of course, if the patient is a smoker). Cigarette smoking increases the risk of infections arising from surgical incisions made during vaginoplasty; moreover, it alters the flow of blood to the skin and this slows down the healing of the aforementioned incisions.
According to industry experts, smoking patients should initiate smoking cessation at least 2 weeks before surgery and implement it at least 2 weeks after the operation-
Temporarily stop, starting from a few days of vaginoplasty, any drug therapy that alters the normal process of blood coagulation (therefore, suspend any treatments based on aspirin, warfarin, heparin etc.).
On the day of the procedure, appear at full fast for at least 8 hours . This means that, if vaginoplasty is scheduled for the morning, the last meal the patient can take is the dinner the day before the operation.
Fasting is part of the pre-operative instructions of any surgical procedure that includes general anesthesia or that, in particular circumstances, could include general anesthesia (this is the case with vaginoplasty).
Ask a close relative or friend for support on the day of the procedure, especially with regards to returning home, once the operation is completed.

Procedure

In temporal order, a classic vaginoplasty intervention involves:

The preparation of the patient with a coat, instead of his clothes;
The accommodation of the patient in an operating table specially prepared for him;
Anesthesia and the expectation of its effects;
The actual operations on the vagina .

There are various surgical techniques to perform the vaginoplasty operation.

The choice of surgical technique is not random at all, but depends, first of all, on the purpose of vaginoplasty and, secondarily, on the preparation of the attending physician.

Anesthesia

During vaginoplasty, anesthesia can be local or general .

The choice between general anesthesia and local anesthesia is left to the surgeon who will carry out the operation; factors such as the complexity of vaginoplasty intervention, the age of the patient, the surgeon's experience in operating under local anesthesia or general anesthesia affect this choice.

To take care of the practical execution of anesthesia - general or local - is an anesthesiologist .

Did you know that ...

Vaginoplasty with reconstructive or rejuvenation purposes is very often associated with labioplasty, that is surgery for the reconstruction / remodeling of small and / or labia majora (of the vagina).

GENERAL ANESTHESIA

General anesthesia induces the patient to fall asleep; therefore, during vaginoplasty procedures performed under general anesthesia, patients are completely unconscious.

LOCAL ANESTHESIA

During vaginoplasty operations performed under local anesthesia, patients are fully conscious, however they do not experience any pain where the surgeon will work.

As a rule, drugs are administered for local anesthesia by means of an injection near the pubic area.

Surgical techniques for vaginoplasty: what are they?

The technique of reconstructive surgery . It is indicated after surgical removal or radiotherapy treatment of a tumor growth or an abscess on the vagina;
The Mclndoe surgical technique . It is useful when there is a need to carry out a homologous tissue transplant;
The surgical technique using a foley catheter (balloon vaginoplasty). It is one of the surgical techniques used to create a vagina from scratch (neovagina);
The surgical technique of Vecchietti . It is indicated for the treatment of Mülleriana agenesis.

How long does a vaginoplasty last?

The vaginoplasty procedures can last from 1 to over 2 hours, depending on the complexity of the intervention (the more the purpose of vaginoplasty is complex to achieve, operationally speaking, and the longer the entire procedure will be).

Which medical professional performs frenuloplasty?

The professional figures prepared in performing vaginoplasty are plastic surgeons with a particular preparation in the construction, reconstruction and remodeling of the genitals .

After the Procedure

At the end of vaginoplasty operations, hospitalization is expected; the duration of this hospitalization depends on the complexity of the surgical operation: the more the operation was complex and the longer the period of stay in the hospital becomes longer.

In general, the duration of hospitalization after a vaginoplasty can fluctuate from a few hours, for less complicated operations (eg: post-natal laxity cure), to a few days, for more invasive procedures (eg: construction of a neovagina).

Hospitalization and general anesthesia

Regardless of the purpose of vaginoplasty, the use of general anesthesia always requires hospitalization of at least one day.

This is a purely precautionary choice, as general anesthesia is a medical practice that can have unpleasant repercussions even after several hours of its implementation.

Post-operative sensations

As a rule, the first few hours after vaginoplasty coincide are characterized by a painful sensation in the vagina . Due to surgical practice and to the disappearance of the effects of anesthesia, this pain is temporary (1-2 days, for less complex operations; a few more days, for more invasive operations) and is largely manageable with the more traditional painkillers (ex: ibuprofen or paracetamol).

Pain aside, other sensations typical of the post-vaginoplasty phase are those connected to general anesthesia (if this was the anesthetic practice adopted); underway for a few hours, these feelings usually consist of: tiredness, confusion, lack of balance, slowness in reflexes and headaches.

Post-Operative Signs

After a few hours from a vaginoplasty, the anatomical area on which the surgeon acted could be swollen and show signs of a variable-sized hematoma . Both the swelling and the hematoma are temporary; their residence times vary according to the invasiveness of the surgery.

What to do and what not to do after a vaginoplasty

After a vaginoplasty operation, the patient must refrain from sexual activity for at least 4-6 weeks ; the precise duration of abstention from sexual activity depends (again) on the complexity of surgery.

Respect for abstention from sexual activity is essential for the correct healing of surgical wounds and complete recovery by the patient.

In the specific case of women performing vaginoplasty due to the postpartum laxity of the vagina, the post-operative phase also includes performing Kegel exercises to strengthen the pelvic floor muscles.

For more complex vaginoplasty operations, abstention from sexual activity could take several months .

Total recovery: how long does it take?

Total recovery from a not particularly complex vaginoplasty operation takes about 3 months .

In general, the more the complexity of the operation increases, the more complete healing times become longer.

Risks and Complications

Vaginoplasty can give rise to some adverse effects or real complications ; however, the risk of this happening is very low . So, ultimately, vaginoplasty can be considered a more than safe surgical operation.

Risks of vaginoplasty: what are the details?

Vaginoplasty presents the classic risks associated with any surgical procedure - which could be defined as generic - plus some specific risks (where by specific is meant typical of vaginoplasty).

Generic risks include:

Excessive bleeding during surgery;
Infection of a surgical incision;
Deep venous thrombosis;
Adverse reaction to anesthetics;
Formation of obvious scars;
Formations of dangerous blood clots.

Specific risks include:

Damage to some nerves located near the vagina;
Vaginal collapse;
Swelling of the clitoris, which can even result in its necrosis;
Vaginal prolapse;
Rectovaginal fistula;
Urinary incontinence;
Predisposition to urinary infections.

Contraindications

Vaginoplasty has some contraindications; to be precise, its implementation is not indicated in:

Women who are pregnant or are planning to become pregnant. Vaginoplasty involves changes in the vagina, such that giving birth would be even more painful and difficult than it already is.

All people with a chronic illness or heart disease . In such subjects, whose health is not optimal, a surgical operation such as vaginoplasty could be fatal.

Did you know that ...

For women with postpartum vagina laxity, there is a conservative alternative to vaginoplasty, which doctors recommend before the latter: these are the already mentioned Kegel exercises and intimate gymnastics for strengthening the pelvic floor muscles.