Vaginectomy is a surgical procedure that removes the vagina and closes the vaginal opening. Many transgender men have a Vaginectomy combined with other FTM surgeries as part of their gender confirmation. Vaginectomy has had a reputation for being a very risky procedure but surgeons specializing in it believe that Vaginectomy reduces complications associated with urethral lengthening, and report high rates of satisfaction among patients.
In the context of FTM surgery, Vaginectomy is a Colpectomy plus a Colpocleisis. Colpectomy involves removal of the vaginal lining, or epithelium, and Colpocleisis is the fusion of the vaginal walls, which creates support for pelvic organs. Most commonly, the general term Vaginectomy is used instead of Colpectomy and Colpocleisis. Finally, some surgeons offer partial closure of the vaginal opening in combination with Simple Release and Ring Metoidioplasty but this is not to be confused with Vaginectomy; it is just partial closure.
Is Vaginectomy Really That Risky?
For many years, Vaginectomy endured a reputation for being a very risky procedure—so risky, that many surgeons refused to perform it and even discouraged trans men from seeking it out, citing major intraoperative bleeding and bladder perforation as high risks. While there is very little published data regarding the safety of FTM Vaginectomy, recent reports from surgeons experienced with the procedure indicate that with modern techniques Vaginectomy may not be as risky as previously thought, and may even reduce complications associated with urethral extension.
4 Reasons Why Trans Men Have Vaginectomy
- The desire to have the vagina removed and have a male-looking perineum.
- To eliminate the secretions produced by vaginal mucosa.
- To eliminate the need for speculum exams or Pap tests.
- To reduce complications with Urethroplasty.
How Vaginectomy Is Performed
- Incisions are made inside the vagina and the vaginal mucosa is carefully removed, either with cautery or laser.
- The vaginal walls are sutured together and the vaginal opened is closed.
- Operative time is 2-3 hours.
- Laparoscopic and robot-assisted laparoscopic Vaginectomy are emerging methods.
Vaginectomy is usually combined with other procedures, either Hysterectomy or a genital surgery. There are many benefits to combining Vaginectomy with other FTM surgeries, such as lowering the risk of complications with Urethroplasty, as well as reducing costs and time off work, and no additional recovery time.
Some surgeons require a Vaginectomy for patients undergoing Metoidioplasty or Phalloplasty, especially if Urethroplasty is performed, because of the theory that Vaginectomy reduces complications associated with the neourethra.
Vaginectomy and Recovery
Length of hospital stay, recovery time and time off work all depend on if Vaginectomy was combined with other procedures or not. Similarly, restrictions on prolonged sitting, cycling, swimming, hot tubbing, heavy lifting, and sexual activities will vary based on the procedures done.
Patients will experience some pain but this typically diminishes significantly within two weeks. Longer term discomfort is not uncommon with prolonged sitting and activities such as cycling and horseback riding.