Vaginectomy

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Surgeries and procedures

Colpectomy, colpocleisis, and vaginectomy are all roughly synonymous terms meaning the closure or removal of all or part of the vagina. This means the orifice, and not necessarily the external parts of the vulva. Sometimes a vaginectomy is done as a treatment for vaginal cancer, in which case it can be followed with a reconstruction of the vagina (vaginoplasty), if that is what the patient wants.[1][2] Some transgender men and nonbinary people who were assigned female at birth have chosen to have a vaginectomy as part of their transition, because they do not want to have a vagina. Trans people can choose to have surgical changes made to their clitoris to make it more penis-like (metoidioplasty), or have a full-size penis constructed (phalloplasty) in addition to the vaginectomy. They can also choose not to do so, in order to create a relatively smooth, featureless genital area (genital nullification).[3]

In a partial vaginectomy, they leave a small canal open, unsuitable for sexual penetration but able to drain menses if the uterus and ovaries are still intact. This makes it possible to keep the uterus. In the "radical" or "total" version, the uterus and cervix must be removed as well, because menstruating into a closed body cavity is very dangerous.[4] (Not sure if removing both ovaries instead would do the trick, though!) This can be done at the same time, but may require a different surgeon, such as an OB-GYN to assist a urologist.

At least for total vaginectomy, the doctor will also remove the vaginal mucosa walls, since they would continue to secrete into the closed body cavity. Different doctors have different methods for this, from excising the tissue (lengthy and bloody) to burning and cauterizing it (which requires special training). There is always a risk of missing a section which will continue to secrete and cause health risks, requiring follow-up surgery.

It is extremely rare for a trans man to get vaginal cancer after hormone therapy and hysterectomy. However, there are documented cases of that happening.[5] Anyone who has a vagina needs preventive screening for vaginal cancer.

For definitions of anatomical terms used in this article, a diagram of a vulva, as seen in an adult who was assigned female at birth, and who has not had hormone therapy or surgery.

Urethral Lengthening Option[edit | edit source]

Different doctors have different policies here: some may require urethral lengthening for vaginectomy, some require vaginectomy for urethral lengthening (eg Meltzer, to provide greater tissue/blood vessel support), and some let the patient do one or the other by itself.

Dr. Garcia at UCSF highly recommends urethral lengthening when getting a vaginectomy, because otherwise the urethral opening remains in a now-recessed cavity where the vagina has been sutured shut, and there is increased risk of urinary infection and difficulty of cleaning.

This can be performed at the same time as the vaginectomy, and possibly could be performed later. Usually the new location is just underneath the clitoris/micropenis, and some people like to stand to pee by pulling up there and angling their stream. If you sit to pee, you may have to adjust how you sit -- farther back on the toilet, with legs wider apart, for example.

Other Surgeries[edit | edit source]

Vaginectomy does not preclude either metoidioplasty or phalloplasty, so you could do those later or even at the same time, depending on how long that makes the surgery. Scrotoplasty should also be possible. However, vaginectomy does remove tissue, so make sure to check if having less genital tissue will affect future surgery.

Physical Results and Scars[edit | edit source]

Some of the scarring depends on whether you get an abdominal, vaginal, or laparoscopic hysterectomy (this link has a lot of info). Be aware that an abdominal hysto resembles the scar of a C-section and may be viewed as a scar from giving birth. Laparoscopic scars (usually to remove ovaries and the upper part of the uterus) are more like two dime-sized-or-smaller dots on each side of your belly and one in your belly-button.

As for the vaginectomy itself, the tissue of the labia minora/small ridges are rolled over into the center where the vaginal opening used to be. This is not always perfectly symmetrical; some people end up with one side fused into the middle but the other side still being much like pre-surgery. This can also result in tissue that can grow hair being in the midline (which can be weird, especially if unexpected!). There is usually still a small cavity/dip where the vaginal opening used to be. Scars are likely not super visible. If you had urethral lengthening, your new opening is probably not very visible at all.

Complications and aftercare[edit | edit source]

Complications can include, blood loss; scarring; damage to bladder, urethra or colon; and post-op depression typically associated with prolonged anesthesia. After surgery, use of a neck pillow or inflatable doughnut is recommended to not place pressure on the perineum area for 3 weeks.

Recovery[edit | edit source]

Expect not to ride a bike or go swimming for a good six months or more. Short-term, you will likely be weak for at least one to two months. It's a good idea to have a hospital-like bed that can raise at an incline, or an easy-chair, or lots of pillows to prop up on, as lying flat will probably stretch the lower abdomen and hurt a great deal and make sleeping difficult. Sneezing, laughing, even lifting things, anything that moves your belly can really hurt for a while.

You'll probably have one catheter, or even two with one plugged up (especially if you had urethral lengthening done), for at least one to two weeks. The bags will need to be emptied every few hours, and they do affect travel; one nifty technique is to keep them in a shopping bag for ease of carrying, leak prevention, and privacy. Plan on at least one doctor follow-up visit to remove the catheter(s), if not another one to check them without removing them yet; and even if you don't have catheters, there should be at least one follow-up to check for infection, sinus leakage indicating missed mucosa tissue, etc.

Bowel movements are also a problem. Expect to be prescribed multiple stool softeners and laxatives for when you go home, since pain meds often cause constipation and the hospital will have given you meds to prevent bowel movements for the first day or so. You definitely don't want to be straining to pass stool, as that's both painful and bad for the stitches, and there is some risk of the rectum prolapsing into the cavity left by removing the vagina. Make sure you've stocked up on toilet paper in advance!

General Hospital Logistics[edit | edit source]

As with all surgeries and hospital stays, brace yourself for misgendering by nurses and staff who aren't up-to-speed, and be wary of them forwarding phone calls from family through without checking your "no-call" list. Unfortunately, an advance directive doesn't seem to get noticed much. It's an extremely good idea to have an advocate/friend with you, as you will be exhausted and in pain and probably a little blurry.

Be sure to take out all piercings pre-surgery, even plastic stoppers. Although the hospital should provide all your prescription meds including psychiatric meds, be aware that they might only have generic or non-extended release or some other inexact match. They also might not give them to you at your designated med time; they often have a very "8am is Medication Time" mentality, and if you got out of surgery in the evening (as is likely), they may want to wait until the anesthesia wears off before giving you your medication, and they may push that off until morning. So if you have evening meds, even if you've told the hospital what they are and when you take them, it might be a good idea to ask the anesthesiologists about their plan, and to explain any withdrawal side effects you anticipate.

Hospital rooms are also usually lit by fluorescent lights, which doctors walking in will flip on without asking, so if you're sensitive to fluorescents it's great to have a nurse flat-out tape down the switch. Doctors will also be very in-your-space and inspect you physically, and while they will probably ask permission/consent both before looking and before touching, it can be extremely hard to feel like you have a choice at all. This includes orderlies and "learning" doctors, too, and while you may have met them all before surgery, it's very different afterwards. This is where it can really help to have an advocate/friend.

Hospitals can be a serious site of trauma, no matter how prepared you are or how many times you've been through surgery before. Please take good, good care of yourselves!

See also[edit | edit source]

External links[edit | edit source]

References[edit | edit source]

  1. Taber's cyclopedic medical dictionary. Venes, Donald, 1952-, Taber, Clarence Wilbur, 1870-1968. (Ed. 22, illustrated in full color ed.). Philadelphia: F.A. Davis. 2013. ISBN 9780803629776. OCLC 808316462.
  2. "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America". www.cdc.gov. Retrieved 2017-12-15.
  3. "Non-Binary Options For Metoidioplasty". Metoidioplasty.net. 8 April 2020. Retrieved 28 June 2020.
  4. Surgical Treatment of Vaginal Cancer: eMedicine Obstetrics and Gynecology
  5. CASE REPORTS: Vaginal Carcinoma in a Female-to-Male Transsexual by Schenck TL, Holzbach T, Zantl N, Schuhmacher C, Vogel M, Seidl S, Machens H-G, and Giunta RE (Journal of Sexual Medicine: Volume 7, Issue 8, pages 2899–2902, August 2010)