Bridget Coley, PT, MSc PT, BKin

Vaginoplasty

A vaginoplasty is a procedure whereby a vagina is surgically constructed or reconstructed. In this blog we will be focusing on Penile Inversion Vaginoplasty which involves rearranging tissue (penis, testicles and scrotum) in the genital area to create a vaginal canal and vulva. We will also discuss the importance of proper post-operative care. 

During penile inversion surgery, the surgeon makes a new space between the rectum and the urethra, becoming the new vagina. This space is lined with skin from the scrotum and penis. The labia majora are created using the penile and perineal skin and the clitoris is created from the tip of the penis (glans). The blood and nerve supply to this are preserved to keep sensation. At the end of the surgery, packing will be inserted into the vagina and a urinary catheter is put into the bladder. Both of these will remain for at least 7 days. Seven days after surgery, the catheter and vaginal packing will be removed. At this stage, the patient will begin working with pelvic physiotherapists who will show the patient how to use vaginal dilators.

Dilation

Vaginal dilation is important post-surgery as the repurposed tissues will want to return to its original position. Dilation is critical to keep the width and depth of the neovagina. Vaginal dilation involves slowly stretching the neovagina to maintain as much width and depth as possible. The client will begin dilating as soon as their vaginal packing is removed (one week post-surgery). The dilation protocol begins with 15 minutes of dilation done 3 times per day for the first 3 months, slowly tapering down to 15 minutes of dilation 1 time per day at the 12 month mark. Dilation will be something that the client needs to maintain for the rest of their life, but at a reduced frequency (about 1 x per week for 15 minutes). During the earlier stages of dilation it can be normal to see blood, drainage or pieces of stitches.

The Role of Pelvic Floor Physiotherapy

Pelvic physiotherapy plays an important role both pre and post surgery. Prior to surgery, clients will meet with a physiotherapist too screen for any pelvic symptoms such as urinary or bowel problems, or pelvic pain and pressure so that the pelvic physiotherapist can prescribe exercises and strategies to help improve those symptoms. Clients will learn to connect to their pelvic floor and learn how to relax their pelvic floor muscles to help with dilation and pain management post-surgery. 

Patients will be taught how to properly dilate by a pelvic physiotherapist one week following surgery. A pelvic floor physiotherapist will assist clients by teaching them to relax their pelvic floor muscles during dilation, teaching them how to progress to different dilator sizes, helping with any bowel or bladder concerns and provide therapeutic exercise recommendations for a gradual return to daily activities.

If you are struggling with any symptoms post-operatively or need any dilation support book an appointment with one of our pelvic physiotherapists today.