Feminizing Surgery -Vaginoplasty

The purpose of vaginoplasty is to provide the patient with a female genital apparatus that complies with anatomical, aesthetic and sensory functional characteristics in a Gender Affirmation or Gender Reassignment surgery. Vaginal reconstruction as a gender reassignment surgery presents variable dimensions, determined by three characteristics of the patient: penis size, skin elasticity and height. However, the final size of the vagina does not depend exclusively on penile size or structure; if the initial dimension is not adequate, additional techniques are used to achieve the desired depth. On average, the length achieved in the operating room is 17 cm, which can be extended by exercises in the postoperative period. It is a one-stage, irreversible procedure.

The techniques in this type of common Transgender Surgery include the removal of the testicles and the internal structures of the penis, as well as the creation of a space between the rectum, the bladder and the prostate where the neovaginal cavity will be housed. In addition, a clitoris is created, ensuring sensitivity through the use of a segment of the glans retaining its vascular and nervous bundle.

Different tissues can be used to construct the neovagina. Options include the use of penile skin in the form of an inverted tube, an anterior penile flap combined with a posterior preanal flap that are joined and inverted, or the thinned scrotal tissue as a graft, forming the vaginal cavity over a tutor that is then placed in the cavity created.

The urethra is reduced and placed in a female position, while major labiaplasty is performed using skin from the penis or scrotum, and minor labiaplasty is performed using the foreskin or a urethral flap. Due to the variability of the structures used in the surgery according to each patient, the technique is individually adjusted to maximize the chances of satisfaction.

The surgery has an average duration of 4 to 6 hours. The vaginal tutor and urinary catheter remain in place for 5 days, while hospitalization usually lasts 4 to 6 days. Once the tutor is removed, a self-tutoring schedule begins with four sessions a day, then reduced to two, and finally once a day. Sexual relations are recommended between 45 and 60 days, depending on postoperative evolution.

In our experience, the rate of preservation of postoperative sensitivity is 100%, and 82% of patients report having experienced orgasm after the procedure.

Dr. Javier Belinky has performed more than 1,300 surgeries with resounding success.