Vaginoplasty Documentation Project

The purpose of this project and documentation of this surgery is to demystify the procedure that is vaginoplasty by answering the following questions: What do the results look like? What is the healing process? How functional is the vagina after surgery and what does that timeline look like? More questions will be answered than just these and I will do my best to answer your questions as they come. Please see my contact me at aliceferox@gmail.com with questions*.

*Please keep in mind that my personal experience is not reflective of everyone's experience as you or your loved one, friend, family members, etc, undoubtedly have varied experience. This is okay. I am not an authority on anything beyond my own experience.

Every surgeon carefully curates their gallery of vaginoplasty results so they are not the complete picture of what to expect when going under the knife for vaginoplasty. Additionally, very few recent and quality photographs are available online that chronicle the healing process and surgical results. I hope to combat this by posting regular photographic documentation as much as I can and also writing about the process in the capacity that is available to me at the time.

I have provided an FAQ below (which includes some optional NSFW medical images). I also have a 100 days of Vaginoplasty Recovery Gallery (Also NSFW, lots of images so please give it time to load.)

If you found this project helpful consider leaving me a tip in my Tip Jar.


FAQ*


*I reserve the right to withhold various information as necessary and I will update and add various questions as I am able.

What is Vaginoplasty?
In the penile inversion vaginoplasty the testicles are removed (orchiectomy) and the scrotal skin is used to make labia majora (labiaplasty). The nerves to the the sensitive glans penis and the corresponding skin is preserved and used to make a clitoris. The skin of the penis and, in most cases, skin grafts from the scrotum are used to make a vaginal vault. The urethra is shortened and placed in the female position. Sensitive urethral mucosa is placed in between the labia minora. (source: Brownstein & Crane)

What surgeon performed your surgery?
Dr. Marci Bowers

Where is your surgeon taking place?
Burlingame, California - Mills Peninsula Hospital

What does function look like for you? Climax? Depth? Sensation?
I am able to achieve clitoral orgasm. For quite some time I was not able to achieve vaginal orgasm, but that has since changed. It took around eight months. This is because things become pretty tender after too much activity in these areas early after surgery. I thought I may never be able to achieve vaginal orgasm but this changed as more nerves reconnected over time. As you probably know some vaginas never orgasm vaginally, so it is very possible that you or someone you know may never be able to orgasm vaginally, and that’s okay. Penetration wasn’t super pleasurable early on, but that has since changed. I think that was mainly due to my rigorous dilation schedule and sticking things in my vagina just seems really annoying and unappealing at the time. Since, I have had receptive intercourse with my partner via dildos and fingers and it felt good, but it felt much better in combination with clitoral stimulation which ultimately helps me reach climax more reliably.

My clitoris is very sensitive and is growing sensitivity over time. I got little "daggers of pain" and "electric shocks" every now and then as nerves reconnected, but after about 6 - 8 months that largely went away. All my numbness has gone away as of a few weeks after surgery. Early into recovery psychological dysphoria really dampened my desire for stimulation and my penis had lots of little cuts and bruises on it over time from my need to tuck nearly 24/7. Not to mention I was in a lot of pain, so that will kill just about anyone’s mood.

Depth is 6 inches. Originally, I was only able to achieve 5 1/2 inches, but with rigorous dilation, I’ve seen six reliably now.

What does scarring look like?
Looks very good so far. Scarring isn't a major concern for me unless it impacts the health of my vagina, but I do know it is a concern for others. Here are my scarring results at day 26 (1) (2). Here are scarring at six months & 1 year. My scars have and will get better with time. I treated my scars with neosporin in the early days of my recovery and they will fade as time goes on just like any other scar. Like most scars they may never completely go away, but I do have the liberty of growing out my pubic hair if I want to cover my scars up.

What does the urethra and clitoris look like?
Looks very good so far. Here is a look at both my clitoris and urethra a couple weeks in recovery. Here is my clitoris at around ~75 days in recovery with minor redness at the time that was resolved using an intravaginal estrogen cream to treat it. 

Are you still transgender?
Yes. Surgery does not change anything about me besides the fact that my genitals have changed shape. Surgery does not make me a full/true/complete woman or whatever you want to call it, I was always a full, true, complete woman before surgery and after it. I'm not suddenly cisgender nor am I suddenly transsexual. Some folks who get various surgeries may tell you different and that is problematic in many ways that I am not going to get into at the moment. However, they are allowed their experiences, I just don't share these sentiments.

Is your transition complete/over?
There is no such thing as "completion" and there is no such thing as "over" for me. Transition doesn't follow a linear step by step path of hormones and surgeries and name/gender marker changes. That said, I have no future surgeries planned or wanted as this time. I'm allowed to change my mind on that, but I am pretty firm on that as it is now.

How often do you have to dilate? How long? 
I have three dilators each all the same length but all with differing widths. Once my catheter was removed I was allowed to dilate for the first time starting with the smallest width dilator. One week later I moved onto the second widest dilator and another week later I moved onto the widest dilator. I dilate three times a day for the first 3 months post op, then I go to two times a day for 9 months. After 1 year post op, I move onto once a day dilation for the rest of my life. Although, you can potentially replace dilation with regular receptive intercourse, this is not something I plan on doing. Each dilation must be 10 - 15 minutes in length. I opt for 15 mins each time.

How did you pay for surgery?
It was covered under my insurance plan including hospital stay, medicine required before and after surgery, dilators, etc. The expenses that were my responsibility were flight, hotel, food (except the food I ate in the hospital), rental car, and any other miscellaneous expenses. Many of my own expenses were covered generously by my parents family who came together to make this surgery successful.

Does circumcision impact vaginoplasty in any way?
Depends on who you ask. For my surgeon she was not at all concerned that I was circumcised, it never even came up as a potential issue. Many surgeons to my understanding have adapted their techniques as many folks (especially in the U.S.) are circumcised. I have seen many folks say circumcision will require you to have a skin graft of some kind, this is not true in all cases. I did not require any type of leg or stomach graft for my surgery and I know others who have different and similar experiences to mine. Don't take my experience as law, talk to your surgeon.

Does penile length impact vaginoplasty in any way?
Again, depends on the person and who you ask. Some folks to my understanding are worried about the effects hormones have in penile tissue, but keep in mind the surgeon can stretch penile tissue much further than one might think. So penile length isn't necessarily tied to the vaginal depth you can expect. I was on hormones for nearly 4 years and I wasn't "well endowed" by any means and I was able to achieve 6 inches in depth immediately post surgery.

What is that white stuff coming out your vagina in some of your photos?
It is an intravaginal estrogen cream that I apply intravaginally to speed up the healing process. My vagina produces its own vaginal fluid, but some photos are extra fluid in them that is leftover lubricant from dilation.

What is it that the estrogen cream is supposed to do?
It promotes healthy tissue. I am not a doctor so I don't know much more than that. It is a intravaginal medication. I can only repeat my experience and what it has done for me personally. My hormone provider has been taking over my care in my home state as she has done aftercare for vaginoplasty recipients for years and she is the one that prescribe it. I asked my surgeon and she said that my provider's prescription was appropriate.

Are you able to self lubricate?
Yes. I am able to self lubricate. Some people can self lubricate a lot, some just a little, and some not at all. I would say I am able to self lubricate moderately and will make use of lubricate for additional assistance on a case by case basis.

Did you need a graft?
I did not require a graft although I did have to sign off on an "extra expense" in case a graft was needed during surgery. Some surgeons take it from the leg, some take it from the belly.

How is your depth?
My depth is good. I had 6 inches of depth immediately post operative and I have been able to increase that to 6 1/2 inches through rigorous dilation.

How old were you when you had surgery?
27.

What was the duration of your recovery (e.g., how long bed ridden, how long did it take to go back to work, etc.)?
It depends greatly on the person, providing everything goes smoothly you can probably expect the following:

I arrived in Burlingame, CA on a flight from Minneapolis, MN 3 -4 days before my surgery. I had 1 day to fool around in San Francisco and then the following day I had to go in for a pre-op appointment with my surgeon and an appointment at the hospital I was to stay at where they did some blood tests, etc. I then had to drink a "cleansing" fluid (4000ml) that basically cleans you out completely (colon). I couldn't eat anything for 2 days which was really hard since my partner and mother were eating all sorts of great food in SF and at the hotel's provided breakfast. You will want to stay close to your hotel room as you will be on the toilet constantly. After 24 hours you should have finished the fluid and you can no longer have food or even water. No liquids. (pro tip: mix the fluid with country time lemonade powder to get it down, it's a bit thick. After 3 glasses you'll be a pro at it.)

Then you should be completely cleaned out my surgery day. I arrived early in the morning for my surgery and they did some basic tests (weight, height,etc.) and the surgeon, nurses, and anesthesiologist meet with you and give you a run down on how it all is going to go. Soon you walk into the operating room and you lay down and you're out. This is when recovery begins.

I was in the hospital for 3 days total. After 2 days the bandages come off. After 2 -3 days it is recommended you start trying to walk, even if it is a little bit to prevent blood clots. They do put a compressing machine that alternates on your legs to help prevent this. Then after 3 days I was discharged to my hotel. At this point my blood draining tube (seen in the photos) was taken out before I left the hospital but I still had my catheter in. On day 5/6 I went in for a post op check up with my surgeon and she took out the catheter and gave me my dilators and dilation schedule. I started dilating on day 6. Moving up a dilator size each week until I hit the largest one. You can see what the dilators look like here.

I stayed in the hotel until day 10 from my surgery day and I flew home on a plane. At the airport I was wheeled in a wheelchair because I was walking super slow and for short distances still. You will walk like a penguin basically.

A couple weeks (3 to 4) and I was ~80% back to my normal self. Lots of sleep, dilation, eating healthy if you can, and general rest and taking it easy. Let people do things for you if you can.

Since I am permanently disabled from schizoaffective disorder there is no "back to work" for me. Having worked a 9-5 job that was physically demanding I would say I would have returned to work after a month with one little caveat being that you would have to find some time in the middle of the day to dilate! Being that dilation is a three time a day event (and it is best to spread them out evenly as possible IMHO) I could imagine it would be difficult to take time off in the middle of the day and depending on your job to dilate so it could be 3 months before you return to work. That said, not all surgeon recommend the dilation schedule I am on. Some have you do it 4 times a day some only 2 times a day. My dilation schedule is like this: 3 times a day for 15 mins each. Morning, midday, before bed. Then after 3 months go down to 2 times a day for 15 mins each, then after 1 year go down to 1 time a day for the rest of your life. You can replace the 1 time a day after a year with regular receptive intercourse, but you may have to still dilate periodically even with receptive intercourse. Keep in mind dilation takes longer than just 15 mins. There is "prep" and there is clean up afterwards.

How painful was the dilation process? Did it ever improve or is it still uncomfortable?
Dilation isn't extraordinarily painful at first or really at all. During the first few weeks I dilated I was on painkillers and so you really don't feel too much in terms of pain when it comes to dilating. Numbness also sets in during those first few weeks so that helps assist in dilating IMO. Dilation is somewhat uncomfortable though. Some folks find the dilation schedule I am on to be "too aggressive" and while it was anxiety inducing to move up a dilator each week until I hit the widest one I was always able to manage to get it in and get it to the appropriate maximum depth each time.

I did use a vegan lube during the early days of my dilation and quickly discovered it to be too acidic and it was bad for the PH balance of my vagina. I thought that my organic and vegan lubricant would be better for dilation than my surgeon's recommended lube of KY jelly or surgilube, I was wrong and the vegan lube I was using (Sliquids) produced a horrible burning sensation. I haven't switched from KY or a generic and Surgilube back to my organic lube since then.

Dilating is a chore, especially since I am still doing it 3 times a day, but the morning and before bed dilation isn't bad at all, it's the middle of the day one that kind of disrupts everything that is most annoying. Dilation has improved and it is much more comfortable than it was early on, it's just annoying now.

The scarring inside by your legs and at the base of your vagina, is this expected to disappear later? If not what can you do to help it?
The scarring at the base of my labia and the scars where my vulva starts by my legs will dissipate and lessen over time like any other scar. Keep in mind these are significant scars, they may never disappear completely. Metronidazole was used to treat the area for the first 30 days along side neosporin. I have since discontinued both and only silver nitrate applied during two different visits (to treat my granulation tissue) and currently an estrogen cream to treat some redness around my clitoris and intravaginal areas. You also want to keep these areas as dry as possible so they heal nicely, which admittedly is hard to do when you are required to put on all these gels or creams and the area is generally damp in general.

Here's some tips to help with scarring though. I was told after a month I could start taking daily epsom salt baths and soaking in them while "opening" myself up and soaking for no more than 15 mins per day. How much affect on the scars this has had I am not sure, but it does bring blood to the entire area to promote healing.

Here's something you can do prior to surgery. If you surgeon requires laser hair removal in the genital area you can get the hair removal done in an upside down triangular pattern over your crotch. My surgeon did not require laser hair removal as she does some scraping during the procedure to prevent hair growing inside of the vagina, but I did go through 2 sessions of laser hair removal on my genitalia prior to surgery. I decided it wasn't worth the expense though and discontinued as I was told hair growth inside the vagina post op is quite rare. That said, I am shaving my vulva and crotch so that people can get an unobstructed view, but one can choose not to shave and that will hide the scars quite nicely.

How does the inside of your vagina feel compared to a natal vagina? Like texture, etc? Can you feel things going in and out?
I've asked my partner (who is a cisgender woman) and we both haven't noticed any significant difference. Early on you could feel stitches inside my vagina, but they have since dissolved. The smoothness and texture. All roughly the same. Of course every vagina is different anyway. I can feel “things” going in an out of my vagina. That area is not numb whatsoever. When things are in, there is a feeling of fullness and pleasure when applied correctly. I do not receive pleasure from dilation as I mostly see that as a massive chore. So it is quite boring to me.

How long were you on painkillers for?
I was on morphine and percocet for awhile and eventually just percocet and then switched to oxy and eventually just ibuprofen and eventually nothing most days. I would say morphine and percocet for the first 24 to 48 hours and percocet for 2 more days and Oxy for 3 weeks and eventually oxy for a week more but only at night. From there it was just ice packs to reduce swelling and soothe the area and ibuprofen as needed (but not overdosing.)

What physical restrictions did you have immediately post operative?
For the first few days I was bed ridden but I started walking a little bit at a time on day 3. The first three weeks my walking was quite slowed and hindered although each week my walking improved. Bending down was difficult for about 4/5 weeks. I wasn't able to run until about week 5. For the first three months I got tired much faster than usual especially after more physical activities. At about day 70 everything was back to "normal."

What was the pain like?
Waking up in the hospital I was quite groggy and things were pretty foggy especially the first 24 hours. The pain wasn't too bad since I was on such heavy painkillers around the clock. I didn't sleep very much in the hospital. So much so that my nurses told me I was the only one out of three patients at the hospital recovering from vaginoplasty that were awake and they really were hoping I would sleep soon. It was difficult for me to sleep due to a alternating compression type wrap that was around my legs for awhile to help prevent blood clots. Understandably, I was uncomfortable a lot and I constantly was trying to find a comfortable position. Ultimately, there wasn't a comfortable position just one I was willing to tolerate for 20-30 mins at a time.

During my stay at the hospital the pain wasn't too bad at all. Once I got to my hotel room to recover is when my pain increase quite a bit. My painkillers were reduced of course so I imagine that had something to do with it, but also the swelling was at its maximum point at the time that contributed to my pain. That said, pain was kind of like a roller coaster. There were times when the pain started to diminish and then would return temporarily to a higher level and then subside a bit more again. Eventually all pain disappeared. Pain returned every now and then over the first 3 months if I over-exerted myself. All pain has subsided and my life is back to “normal.”

How is your urination functionality? Was it a problem at first? Did you have to... "re-learn how to pee?" in terms of having to relax differently, or tilt your pelvis differently, etc.
Urination is different due to the shorter urethra. I noticed that when I have the urge to go I can't hold it nearly as long as I used to be able to so I have to take care of business sooner rather than later. At first, I had a catheter in for about a week which was annoying but not painful. Eventually they took that out when I started dilating and initially I had a lot of "spraying" due to the swelling. I also periodically had accidents due to the numbness of the area and the muscles in the area just had experienced trauma from the surgery. I had to wear pads for about 3 weeks due to all the discharge and a bit of blood so that helped catch urine a bit too when I didn't make it all the way to the toilet in time.

Since I have been sitting down preop for years peeing sitting down wasn't unusual to me so there was no relearning although to get a steady stream took a bit to get but improved as swelling disappeared. I can get a steady stream just fine now and I no longer have accidents. There is no difference from knowing how to pee the muscles movement is the exact same. Although sometimes you can benefit from closing your legs all the way or opening them up wide to get a steady stream. It depends on the person.

Protip: Don't buy cheap toilet paper if you can help it, especially right after surgery. Buy the nicest stuff you can find. You'll thank yourself. If you're in a hotel room recovering swap out the 1 ply toilet paper for some softer toilet paper.

Did you have any complications?
I popped a stitch on day 6 due to walking too much. This wasn't too bad of a complication, but it was painful and delayed my healing slightly near the base of my vagina. I also had two pencil tip sized bits of granulation that were treated with silver nitrate. My surgery went quite smoothly and I had very little complications. Not everyone has this experience and I consider myself very fortunate.

Are there any issues with "leakage?"
There is bloody discharge during the early days of recovery but that is to be expected. I also had some accidents (urine) that eventually resolved itself that was also to be expected due to the shorter urethra and trauma that happens to the muscles in that area. But it's been a long time since I had an accident now. I have some healthy discharge daily which is to be expected of a vagina. Other than that no leaking of any kind.

Do you have a "G spot?"
Yes! Certainly takes time to find so early after surgery, but it is definitely there. You will know it when you find it most likely.

Did you have to go off hormones prior to surgery? What was that like?
Yes. I had to reduce my estrogen by half by 3 weeks from my surgery day, then half again 2 weeks out. At 2 weeks out I had to stop taking progesterone and spironolactone. Going off hormones was more anxiety inducing prior to going off of them. Once I actually did it I didn't feel much change right away as I had been taking hormones for so many years already. I did have a lot of emotional swings leading up to and directly after surgery, but it is really hard to say if that was hormone related or just because I was going through a life altering major surgery.