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What is vaginoplasty? Read our guide to bottom surgery.
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Surgeries are an option for anyone who wants to align their body with their gender, including non-binary people. There’s no one way to be trans, and you can choose whatever journey feels authentic to you.
This might include hormone therapy and transition-related surgeries, or it might include surgeries without hormones. It might not include medical treatments at all. Not every trans, non-binary or gender diverse person has surgery – it’s a decision that’s yours to make.
What is vaginoplasty?
Vaginoplasty is often known as “bottom surgery”. Other names include “gender-affirming surgery (GAS)”, “gender-confirmation surgery (GRS)” and “sex-reassignment surgery (SRS)”. SRS is an outdated term and it is used less often.
Vaginoplasty is a surgery to remove penile tissue, the scrotum and testicles and create a vagina and vulva (including labia, clitoris and a new urethral opening). You can also choose if you would like a vaginal cavity, which allows for penetrative sex. Surgery with external parts only – i.e. no vaginal cavity – is known as vulvoplasty.
There are a few surgical techniques to choose from, depending on your surgeon, insurance coverage or personal preference. Not all techniques are offered in Canada.
Why do people get vaginoplasty?
There’s many reasons someone might get vaginoplasty. The most common is that it can help ease feelings of dysphoria, which improves your wellbeing. It lets you stop or significantly reduce androgen blockers, and can also help you lower your dose of estrogen.
Vaginoplasty means you can have vaginal sex (if you choose a cavity surgery option), and it can also give you more options for clothes to wear, since it removes the need for tucking. Some people might also choose surgery to feel more comfortable in environments like the pool, gym or beach.
Alternative treatment options
If you’re not ready for surgery or are still exploring your options, tucking is a way to change the shape of your genitals. There’s some safety tips to bear in mind though, and this guide from Trans Care BC has a helpful summary.
There are also other surgical options if you would like to reduce or eliminate your need for androgen blockers. Orchiectomy is a surgical procedure that removes the testicles (which produce testosterone) while leaving the penis intact.
You have three main options when it comes to vaginoplasty. The first two options below are offered in Canada and covered by OHIP and Alberta Health, if you have received a funding approval letter. In some cases, OHIP will fund surgeries performed in other countries (e.g. colovaginoplasty in the United States).
OHIP and Alberta Health require that you have been on hormone therapy for at least 12 months before applying for coverage. The method you choose will come down to your surgeon, your current anatomy and your goals. In your pre-surgery consultation you’ll have a chance to discuss all of your options and find what works best for you.
Penile inversion vaginoplasty
This is the most common type of vaginoplasty performed in Canada.
Testicles and penile tissue are removed, and the surgeon makes a space between the bladder and the rectum for a vaginal canal.
The penis is inverted and penile skin is used to line the new vagina.
A clitoris is made from a small part of the head of the penis.
A clitoral hood is made with penile tissue.
Labia minora is made from tissue in the urethra and penile skin.
Labia majora is made from scrotal skin.
This is a less common, less invasive type of vaginoplasty performed in Canada.
The surgeon follows the same steps as penile inversion but does not create a vaginal canal and makes a shallow dimple instead.
Creates a vulva with the same external parts (clitoris, labia minora, labia majora) as vaginoplasty.
This does not allow for receptive vaginal sex.
A type of vaginoplasty that is not performed in Canada, but is sometimes covered by OHIP in other countries.
The surgeon takes part of the large intestine and uses this to create a self-lubricating vaginal lining.
External parts (clitoris, labia minora, labia majora) are created the same way as other methods.
This technique is more invasive and has a higher risk of bowel complications.
Other surgical techniques exist but they are not usually covered by public insurance or offered in Canada at this time. If you have decided to pursue one of these options through private payment and you need a pre-surgical assessment, contact Foria to see if we can provide this. Please email firstname.lastname@example.org before booking an appointment.
Before and after surgery
Vaginoplasty is a major surgery, so you’ll need a plan for how you’ll prepare and recover. You’ll need to take time off work afterwards and will also need someone you trust to help out in the days and weeks after surgery. Your pre-surgery assessments will give you a chance to discuss this.
Each surgeon or clinic will also have their own guidance for preparation and recovery – for example, some surgeons require permanent hair removal before surgery. They’ll also stay in touch with you throughout the recovery process to ensure you’re healing well. After surgery you may have regular check-ups and aftercare appointments, like pelvic floor physiotherapy.
If you have penile inversion vaginoplasty your vagina will also need lifelong maintenance through dilation. You do this by using dilators, which are medical objects you insert into the vagina to maintain depth and function. How often you do this and how long you leave them in for will depend on where you are in your healing process. Your dilation schedule will start at multiple times a day after surgery, getting less frequent as you recover. From one year after surgery most people will only need to dilate once a week.
For more information about dilating, see this guide from Women’s College Hospital.
Side effects and risks
As with all surgery, vaginoplasty comes with side effects and risks. A major side effect is infertility, which is permanent and irreversible. This is because the testicles are removed during surgery. If you would like to have biological children in the future then you can bank sperm before your vaginoplasty. You will likely need to pause your hormones to do this – speak to a fertility specialist for more information. Other risks include:
Side effects of low testosterone (higher risk of osteoporosis, less energy, lower mood)*
Loss of sensation, sexual function and/or ability to orgasm
Compartment syndrome (swelling of the muscles, nerves and blood vessels) or nerve damage in the legs (both due to position in surgery)
Vaginal stricture or stenosis (the vagina becomes narrowed or blocked)
Vaginal prolapse (the vagina falls outward)
Clitoral necrosis (the clitoris partially or completely loses blood flow and falls off)
Hair growth inside the vagina (causes irritation, inflammation or infection)
Urethral stricture (the urethra becomes narrowed, making urinating difficult)
Urethral stenosis (the urethra becomes blocked, preventing urination – requires a catheter and/or surgery)
Urinary incontinence (losing control of urination)
A fistula (connection) between the vagina and urethra
UTIs (urinary tract infections)
Rectal injury during surgery
A fistula (connection) between the vagina and rectum
Some aesthetic problems can be addressed with revision surgery or other treatments, like laser for scarring. Your surgeon should walk you through all of the potential complications with vaginoplasty, and some will include revisions free of charge. You can ask them about this in your consultation appointment.
General surgery risks
There are some general risks that come with most surgeries. They are:
Blood clots in your legs or lungs
Injury to surrounding organs, nerves or blood vessels
Hematoma (a collection of blood) or seroma (a collection of fluid)
Infection or abscess
Wound opening or delayed healing
Feeling dissatisfied with the outcome
Feelings of regret about surgery
These risks can be higher with certain medications and health conditions, like immune or clotting disorders, or if you smoke. Tell your doctor about any medications and supplements you take, along with any health conditions you have (even if they don’t seem relevant!).
Bottom surgery requires going under general anesthetic. General anesthetic has the following risks (most of which are very rare):
Aspiration pneumonia (pneumonia from inhaling liquid like saliva or vomit)
Respiratory failure (i.e. stopping breathing)
Ready for surgery?
If you'd like to get vaginoplasty, your surgeon will require two assessments to confirm you're ready for surgery.
If you're in Ontario and would like to apply for OHIP funding to cover your surgery then you also need to submit an application to the Ministry of Health. Foria can provide your assessments, and we can also submit and track your funding application for you. See our Surgical Referrals in Ontario article for more information.
If you're in Alberta and would like to apply for Alberta Health funding to cover your surgery then you also need to submit an application to the Ministry of Health. One of your two assessments must be done by a psychiatrist. See our Surgical Referrals in Alberta article for more information. Foria does not currently offer assessments in Alberta, but these services will be available soon.
This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Rainbow Health Ontario’s TRS Surgical Summary Sheets.