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Vaginoplasty is a surgical procedure that’s used to either construct a new vagina or repair an existing vaginal canal. The same term is used for different procedures, even though gender-affirming vaginoplasty and vaginoplasty performed on women with existing female anatomy involve different surgical goals, techniques, and areas of specialization.
Vaginoplasty is a surgical procedure used to construct or repair a vagina/vaginal canal, and the surgical approach depends largely on a patient’s existing anatomy and the goal of reconstruction.
For gender-affirming care, vaginoplasty is performed to create a vulva and, when desired, a vaginal canal using existing genital or other tissue. For women who already have a vaginal canal, vaginoplasty is used to repair structural changes, such as vaginal laxity or pelvic floor muscle separation following childbirth, trauma, or other changes to the vaginal anatomy.
Although both procedures are called vaginoplasty, they involve different surgical techniques and require different areas of surgical expertise.
Gender-Affirming Vaginoplasty
Gender-affirming vaginoplasty is a reconstructive procedure that creates a vulva and, for patients who desire receptive vaginal intercourse, a vaginal canal. The procedure uses existing male genital tissue and, depending on the surgical technique and available tissue, might also use tissue from elsewhere in the body.
Because gender-affirming vaginoplasty involves creating new vaginal and vulvar anatomy, it requires specialized surgical training in gender-affirming genital reconstruction and is very different from the vaginoplasty performed by a cosmetic gynecologist to repair or reconstruct an existing vagina. Vaginoplasty services specifically designed for women with existing female anatomy focus on reinforcing the structures that support the vaginal canal.
Vaginoplasty for Existing Female Anatomy
Because vaginoplasty for existing female anatomy works with the vaginal canal and pelvic structures that are already present, the procedure is fundamentally different from vaginoplasty that constructs new vaginal and vulvar anatomy. For women who already have a vaginal canal, vaginoplasty is generally a reconstructive procedure that’s primarily used to treat moderate to severe vaginal laxity associated with vaginal childbirth, pelvic trauma, or changes that occur with aging. Overstretched or separated pelvic muscles and/or a widened vaginal canal can affect sensation, sexual function, or the ability to retain tampons or vaginal pessaries.
“When vaginal laxity is severe, the pelvic muscles may have actually separated or torn, leaving the vaginal opening and canal quite wide. These patients often don’t feel much friction or sensation during sex – sometimes it feels like nothing – and they may worry that their partners feel the same way.” – Dr. Shaya Taghechian
Unlike non-surgical vaginal rejuvenation, which primarily targets the surface layer of epithelial tissue or stimulates collagen production with radiofrequency or electrical stimulation, surgical vaginoplasty addresses the deep, underlying muscular structures. Areas of stretched or separated tissue are repaired with sutures to restore muscles to their original anatomical position and narrow the vaginal canal.
Not every woman with vaginal laxity needs surgery. Mild changes in tissue elasticity may respond well to pelvic floor physical therapy or other nonsurgical approaches. Women who are still early in postpartum recovery or who plan to have additional vaginal deliveries may also be advised to postpone surgery. A thorough evaluation can help determine whether the symptoms are related to muscular separation, tissue changes, pelvic floor dysfunction, or another condition and whether vaginoplasty is an appropriate option.
Swelling and soreness after the procedure are common initially, and strenuous activity, heavy lifting, and sexual intercourse generally need to be avoided during the early healing period. Your surgeon will provide specific instructions based on the procedure performed and your recovery.
Dr. Shaya Taghechian is an Atlanta-based urologic surgeon specializing in intimate aesthetics and female sexual wellness, including surgical and nonsurgical labiaplasty, vaginal rejuvenation, hormone replacement therapy (HRT), and vaginoplasty. At Aayla, we emphasize patient education, transparency, and individualized care, with treatment recommendations based on each patient’s anatomy, symptoms, and goals.
