Vaginoplasty

Full-depth vaginoplasty is a surgery that creates a vaginal canal, usually by using tissue from the phallus, scrotum, and the peritoneum of the abdomen. Vaginoplasty creates a vaginal canal that can be penetrated during sex. Regular dilation is needed to maintain vaginal depth after vaginoplasty.

Your surgeon will answer your questions about surgery and provide you more information about the risks associated with vaginoplasty during your consultation.

How do I prepare for vaginoplasty while I am waiting for a consultation?

While you wait for your consultation, there are several things you might need to do to prepare for vaginoplasty.

Hair removal

Hair removal is an important aspect of preparing for full-depth vaginoplasty, and is required if you want to have a vaginal canal created. Body hair needs to be permanently removed from the penis shaft, the scrotum, beneath the base of the penis, between the thigh creases, and the perineum (the space between the scrotum and the anus).

Hair removal can take more than a year for some people. Hair removal needs to be completed before you can schedule vaginoplasty. It is important to start laser hair removal or electrolysis to remove the hair from your genitals as soon as possible.

Orchiectomy

Orchiectory is a surgery that removes both testes. An orchiectomy is necessary to perform vaginoplasty. You can undergo an orchiectomy while you are waiting for vaginoplasty, or undergo an orchiectomy at the same time as vaginoplasty.

Nicotine cessation

We require you to abstain from nicotine consumption, including tobacco and e-nicotine products, for at least 6 weeks prior to surgery and 6 weeks after surgery. This is because nicotine constricts the blood vessels and decreases blood flow to body tissues. Nicotine users may have a higher risk of complications, including delayed healing of wounds and skin graft failure.

Some patients may choose to work with their primary care provider and the Koop Tobacco Treatment Center at Dartmouth Hitchcock Medical Center to receive support in quitting nicotine products to help them prepare for surgery.

Diabetes management

For individuals who are diabetic or are at-risk for diabetes, it is important to have A1C levels checked and confirmed before you have surgery. We ask that you have an A1C of 7% or lower prior to surgery. Having uncontrolled blood glucose levels can lead to higher rates of infection and there are risks associated with poor healing of the surgical site.

Body mass index (BMI)

We recognize that bodies come in all sorts of shapes and sizes and that weight is not the ultimate deciding factor for overall health. Generally speaking, a BMI of 35 or less is desirable for optimal surgical recovery. Having a BMI above 35 can lead to higher rates of complications, specifically with regard to blood clotting and tissue healing.

Some patients may choose to work with their primary care provider and the Weight and Wellness Program to address weight and related conditions to help them prepare for surgery. However, each person is unique and BMI is not always a reliable indicator of overall health.

Mental health letters of support

Patients will need two letters of support from two separate mental health providers. In 2022, the World Professional Association for Transgender Health (WPATH) released the 8th version of their Standards of Care document, which recommends only one mental health letter is needed before gender-affirming genital surgery. However, many insurance companies still use the older SOC-7 guidelines and require two letters before they will cover surgery for the treatment of gender dysphoria.

Letters must meet the requirements of the specific insurance carrier as well as the criteria listed below. It is important for patients to contact their insurance provider to confirm what their requirements are for coverage.

• One of the letters needs to come from a mental health provider who the patient has an established and ongoing relationship with. This provider is usually a therapist or psychiatrist who the patient has regular appointments with.
• The second letter can come from a mental health provider who has screened the patient for eligibility and surgical readiness but that the patient does not continue to see on a regular basis.

Please note: One of the letters needs to come from a mental health provider who holds an MD, PhD, or PsyD degree. The other letter needs to come from a mental health provider who holds a Master's degree or higher.