Vaginectomy
[2][3][4][5][6] If the uterus and ovaries are to remain intact, vaginectomy will leave a canal and opening suitable for draining menstrual discharge.
A partial upper vaginectomy is still the treatment of choice for certain cases of vaginal intraepithelial neoplasia as it has success rates ranging from 69 to 88%.
Depending on the reconstructive surgeon and which method is used, the basic outline of the procedure involves taking skin from an area of the body like the forearm or abdomen followed by glans sculpture, vaginectomy, urethral anastomosis, scrotoplasty and finished with a penile prosthesis implantation.
The ideal outcome of this procedure, as described by the World Professional Association for Transgender Health (WPATH), is to provide an aesthetically appealing penis that enables sexual intercourse and sensitivity.
[14] Neovaginectomy has been performed to remove the neovagina following vaginoplasty, for instance in transgender women who experience neovaginal complications or those who choose to detransition.
[19] Also, waiting for a period of time after completing a procedure, usually a minimum of 4 months, ensures that the person undergoing the surgery is clear of infections or risk thereof.
[19] For people with vaginal cancer, vaginectomy can be done partially, instead of radically, depending on the individual person's need as determined by the tumor's size, location, and stage.
[7] A partial vaginectomy removes only the outer most layers of tissue and is performed if the abnormal cells are only found at the skin level.
For example, individuals with rectal cancer that has spread to vaginal tissue may undergo a partial vaginectomy in which the posterior wall of the vagina near the anus is removed.
[3][19] Counseling is often provided to people considering gender-affirming surgeries prior to procedures in order to limit regret later down the line.
The walls of the vaginal canal are then sutured shut, but a small channel and the perineum area between the vagina and anus is typically left open to allow for discharge to be emitted from the body.
If the ovaries and uterus are left intact there are greater levels of vaginal discharge remain that can contribute to further gender dysphoria in individuals.
In addition to a greater degree of tissue removal, total vaginectomy also involves a more complete closure of the space in the vaginal canal.
[6] Total vaginectomy surgery is sometimes performed using robotic assistance which allows for increased speed and precision for a procedure with less blood loss and a quicker recovery time.
Some common complications that occur are urethral fistulas and strictures in individuals who undergo vaginectomy and phallic reconstruction for gender-affirming surgeries.
[28] Surgical techniques and medical knowledge developed slowly over time until the invention of anesthesia and antisepsis allowed for the age of modern surgery in the mid-nineteenth century.
Since then, many techniques and instruments were developed specifically for vaginal surgery like the standardization of sutures in 1937 which greatly improved survival rates by lowering risk of infection.
