VAGINOPLASTY
GENDER-AFFIRMING VAGINOPLASTY SURGERY
Vaginoplasty is a gender-affirming surgery that creates a vagina and vulva for transgender women, nonbinary individuals, or anyone assigned male at birth who wants to align their body with their gender identity. It is sometimes referred to as transfeminine bottom surgery.
This procedure can help reduce gender dysphoria and improve quality of life. Many people who choose vaginoplasty report better self-confidence, improved mental health, and more comfort in their gender expression.
If you’re considering vaginoplasty, it’s important to choose a clinic that offers experienced surgeons, compassionate care, and support throughout the process, from your first consultation to post-op recovery.
Editor’s note: In our article, we may use terms that are culturally outdated, as many of our patients still rely on them when searching for information. We want to ensure we remain visible to this audience as well.
PATIENT STORIES
Choosing Align Surgical for your gender-affirming care means entrusting your health and identity to a skilled, compassionate team. Hear firsthand from patients who’ve experienced expert care from our renowned doctors.
BENEFITS OF VAGINOPLASTY
How Vaginoplasty Can Support Your Wellbeing and Gender Identity
Vaginoplasty offers many benefits for people who want their body to align with their gender identity. These changes can support emotional, mental, and physical well-being.
Gender Euphoria and Alignment with Gender Identity
For many transgender women and nonbinary people, vaginoplasty helps relieve gender dysphoria. After surgery, many people experience gender euphoria, or a deep sense of peace and happiness.
Improved Mental Health and Self-Confidence
Studies have shown that people who undergo gender-affirming surgery like vaginoplasty often experience better mental health, including reduced depression and anxiety. Many also feel more confident in themselves and their appearance.
Potential for Sexual Function and Sensation
Vaginoplasty can also create a vagina that allows for sexual function and sensitivity. Many people are able to experience pleasure and orgasm after healing. Sensation depends on individual healing and surgical technique, and your surgeon can help set realistic expectations.
Ability to Urinate Sitting Down and Aesthetic Alignment with Personal Goals
After vaginoplasty, most people are able to urinate while sitting, which can feel more natural and affirming for many transgender women.
TYPES OF VAGINOPLASTY
Understanding the different surgical options: there are different types of vaginoplasty, and each method is tailored to meet your personal goals, anatomy, and medical needs. Your surgical team will help you choose the option that’s right for you.
PENILE INVERSION
PERITONEAL GRAFT
ROBOTIC VAGINOPLASTY
COLOVAGINOPLASTY
PENILE INVERSION
PENILE INVERSION VAGINOPLASTY
This is the most common type of vaginoplasty. In this procedure, the skin of the penis is used to create a vaginal canal and the external vulva (including the labia and clitoris). The clitoris is created using sensitive tissue from the penis to allow for erotic sensation.
This method is usually recommended for people who want both internal vaginal depth and external feminine appearance.
PERITONEAL GRAFT
PERITONEAL GRAFT / TUNICA VAGINALIS
This method involves using tissue from the peritoneum (the lining of the abdominal cavity) to form the vaginal canal.
ROBOTIC VAGINOPLASTY
ROBOTIC / PERITONEAL PULLTHROUGH (PPT)
Robotic Vaginoplasty, also known as robotic peritoneal pull-through, is an excellent option for individuals who desire a vaginoplasty or patient-tailored genital procedure but either lack the genital tissue necessary to form a vaginal canal (sometimes as a result of using puberty blockers) or for whom a traditional vaginoplasty has not yielded satisfactory results (such as stenosis or fistula). In these cases, robotic vaginoplasty can be a great alternative.
COLOVAGINOPLASTY
COLOVAGINOPLASTY (SIGMOID COLON, INTESTINAL)
Colovaginoplasty involves using tissue from the colon (large intestine) to construct a neovagina. This technique is often chosen when there is insufficient genital tissue for penile inversion, and it is also commonly used in cisgender women with congenital absence of the vagina.
THE SURGICAL PROCESS: WHAT TO EXPECT
STEPS TO HELP YOU PREPARE FOR VAGINOPLASTY
STEP 1 | PRE-SURGICAL CONSULTATION AND EVALUATIONS
Before surgery, you’ll have one or more consultations with your surgeon and care team. They will talk to you about your goals, medical history, and readiness for surgery.
You may also need letters of support from licensed mental health professionals as part of following the WPATH Standards of Care.
Your team might also check for any medical conditions that could affect your recovery, like diabetes or heart issues, and may request lab work or imaging.
STEP 2 | HAIR REMOVAL REQUIREMENTS (IF ANY)
For most vaginoplasty procedures, genital hair removal is requested before surgery. This is done to prevent hair from growing inside the new vaginal canal, which can cause discomfort or infection.
Hair is usually removed with laser hair removal or electrolysis several months before the procedure.
STEP 3 | PRE-OP INSTRUCTIONS AND TIMELINE
A few weeks before your surgery, your clinic will give you detailed pre-op instructions, which may include:
1). Stopping certain medications
2). Changing hormone therapy temporarily
3). Fasting before surgery
4). Cleaning the surgical site
Following these steps helps lower your risk of complications and prepares your body for safe healing.
STEP 4 | HOSPITAL STAY AND SURGICAL DURATION
Vaginoplasty is done under general anesthesia and typically takes 4 to 6 hours, depending on the surgical method and individual anatomy.
After surgery, you will usually stay in the hospital for 3 to 5 days so your team can monitor your healing and manage pain or swelling.
RECOVERY AND AFTERCARE
What to expect after vaginoplasty surgery: healing after vaginoplasty is a gradual process that involves rest, care, and regular follow-ups. Knowing what to expect can help you feel more prepared and confident during recovery.
HEALING TIME: HOSPITAL STAY, HOME REST, TIME OFF WORK
After surgery, most people stay in the hospital for 2-3 days so your care team can monitor your healing and manage any early discomfort or swelling.
Once home, you’ll need about 6 to 8 weeks of rest, avoiding strenuous activities. Most people take 4 to 6 weeks off work depending on how physically demanding their job is.
DILATION REQUIREMENTS AND SCHEDULE (IF APPLICABLE)
If you had a full-depth vaginoplasty, you’ll need to start vaginal dilation soon after surgery. Dilation helps keep the vaginal canal open and prevents it from narrowing.
In the first few months, you may need to dilate multiple times a day, eventually reducing frequency as healing continues. Your surgeon will give you a personalized dilation schedule and guidance. If you choose zero-depth vaginoplasty, dilation is usually not required, since there’s no internal canal.
PAIN MANAGEMENT AND MOBILITY TIPS
It’s normal to feel sore and tired after surgery. You’ll be given pain medication and tips on how to rest comfortably. Gentle walking is encouraged soon after surgery to help with blood flow and reduce the risk of blood clots.
Keeping your surgical area clean and following your care team’s hygiene instructions are also important for avoiding infection.
ONGOING FOLLOW-UP AND SUPPORT
Your surgeon will schedule regular follow-up visits to check your healing and answer any questions. These appointments are important to catch any issues early and support your recovery.
Many clinics also offer emotional support services or can connect you with mental health professionals who understand gender-affirming care.
ELIGIBILITY AND REQUIREMENTS - Who Can Get Vaginoplasty Surgery?
Before getting vaginoplasty, there are a few important steps and requirements to make sure the surgery is safe and right for you. These steps follow medical guidelines and help support your long-term health and wellness.
WPATH STANDARDS OF CARE
Most surgeons follow the World Professional Association for Transgender Health (WPATH) guidelines. These standards usually require:
1). At least one letter from licensed mental health professionals confirming gender dysphoria and readiness for surgery
2). At least 12 months of hormone therapy (unless medically not needed)
3). Living at least 12 months in your gender role, known as the “real-life experience”
4). Your insurance company may have other requirements to authorize your surgery
These steps are meant to make sure you are well-prepared both physically and emotionally.
PHYSICAL HEALTH REQUIREMENTS AND EXPECTATIONS
Before surgery, your care team will check your overall physical health. This can include reviewing your medical history, current medications, and any chronic conditions like diabetes, high blood pressure, or heart issues.
Having a stable and healthy weight, being a non-smoker (or quitting well before surgery), and being able to follow post-op care instructions are also important for optimal healing.
AGE REQUIREMENTS (AND YOUTH/ADOLESCENT CARE IF APPLICABLE)
Most clinics perform vaginoplasty on individuals who are 18 years or older. Each clinic has its own policy, but youth care is handled with extra attention to emotional readiness and long-term support.
READINESS ASSESSMENT WITH OUR CARE TEAM
RISKS AND CONSIDERATIONS
What You Should Know Before Having Vaginoplasty.
While vaginoplasty can be life-changing and affirming, it’s important to be aware of the possible risks and what long-term care involves. Being informed helps you make the best decisions for your health and well-being.
COMMON RISKS: BLEEDING INFECTION, SCARRING, LOSS OF SENSATION
Like any major surgery, vaginoplasty carries some risks, including:
- Bleeding during or after surgery
- Infection at the surgical site
- Scarring that may affect appearance or function
- Possible loss or changes in sensation in the genital area
These risks are usually rare, and your surgeon will take steps to reduce them. Still, it’s important to understand what may happen and how your body may respond.
LONG-TERM CARE (DILATION, HYGIENE, ETC.)
If you have a full-depth vaginoplasty, you’ll need to dilate regularly to maintain the shape and depth of the vaginal canal. This is a lifelong commitment, especially in the first year after surgery when dilation is most frequent.
Good hygiene is also important to prevent infection or odor. You’ll receive guidance on how to clean and care for your new anatomy safely.
REVISION PROCEDURES (IF NEEDED)
Some people may need or want revision surgery later on. This can be for functional reasons (such as tightness or scarring), or cosmetic reasons to adjust the look of the genitals.
Revision rates vary depending on surgical technique and individual healing, and your surgeon will talk to you about this possibility during your consultation.
WHY CHOOSE ALIGN SURGICAL ASSOCIATES FOR YOUR VAGINOPLASTY?
Supportive care. Trusted experts. A place where you’re seen and heard.
At Align Surgical Associates, we are honored to be part of your gender affirmation journey. We offer safe, personalized care in an inclusive space. Here’s what makes our clinic special:
BOARD-CERTIFIED, GENDER AFFIRMING SURGEONS
Our surgeons are board-certified and highly experienced in performing vaginoplasty and other gender-affirming surgeries.
They use proven techniques and stay up-to-date with the latest practices to help you achieve your goals safely and confidently.
PATIENT-CENTERED, INCLUSIVE APPROACH
We take a patient-centered and respectful approach to care. This means we honor your boundaries, listen closely, and create a safe environment where you feel seen and supported.
Our staff is trained in LGBTQIA+ inclusive care to ensure you are treated with dignity at every step.
MULTIDISCIPLINARY SUPPORT
From your first consultation to post-op recovery, our care team works together to support you.
This Includes:
1). Licensed mental health professionals to guide you through readiness assessments
2). Experienced nurses trained in gender-affirming care
3). Ongoing post-op support to help with healing, dilation, and long-term wellness
This team-based approach ensures you’re never alone in your journey.
BY DR. MICHAEL SAFIR, MD
Dr. Michael Safir, MD is a board-certified reconstructive urologist based in Los Angeles, specializing exclusively in genital gender-affirming surgery. With a subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS), Dr. Safir is uniquely qualified with advanced fellowship training in both male and female genital reconstruction. He earned both his undergraduate and medical degrees from Northwestern University’s Honors Program in Medical Education, where he also completed his urology residency. Dr. Safir went on to complete dual fellowships in Male Genitourinary Reconstruction at UCSF and Female Reconstructive Urology at UCLA, mentored by leading experts Dr. Jack McAninch and Dr. Shlomo Raz. His professional leadership includes serving as Section Chief of Reconstructive Urology at New York Medical College, President of the Los Angeles Urological Society, and Clinical Instructor at UCLA and UCSF. He is board-certified by the American Board of Urology, a Diplomate in FPM-RS, and an active member of the World Professional Association for Transgender Health (WPATH). Dr. Safir is highly regarded for his expertise in procedures such as orchiectomy, metoidioplasty, and phalloplasty, and is a compassionate advocate for affirming, individualized care for transgender patients.
No. 1 Gender Affirming Surgeons in Los Angeles and San Francisco
“An incredibly professional, welcoming, supportive, and affirming experience”