Vulvoplasty

What is a vulvoplasty?

A vulvoplasty is a gender-affirming surgery that creates a vulva. The vulva is the external genitalia of people assigned female at birth (AFAB). A vulvoplasty creates a mons pubis, clitoris, and outer and inner labia in people assigned male at birth (AMAB) using their penis, scrotum and other genital tissue.

If you’re transgender or nonbinary and were AMAB, a vulvoplasty changes the appearance of your genitals so that the way they look matches your understanding of your gender, or gender identity, better. A vulvoplasty is just one option for trans and nonbinary AMAB people who want to live more comfortably as their authentic selves.

Surgeons most often perform a vulvoplasty for gender affirmation, but there can be reasons a person AFAB chooses to have a vulvoplasty.

Why are vulvoplasties done?

A vulvoplasty can help if you feel uncomfortable with the appearance of your genitals. A vulvoplasty may be the right choice for you if you’d prefer your genitals to look closer to a vulva. Or, you may choose a vulvoplasty because it’s less invasive and has fewer risks than a vaginoplasty, a surgery that creates a vaginal canal in addition to a vulva. Everyone’s gender journey is different.

If you’re AFAB and have vulvar damage due to trauma or a congenital condition (meaning you’re born with it), vulvoplasty may reduce painful symptoms and improve your quality of life.

What should I consider before a vulvoplasty?

A vulvoplasty is a major, irreversible surgery. This is why it’s so important to have a care team you can trust. This includes surgeons and behavioral health specialists with expertise in transgender care. They can help determine whether a vulvoplasty is right for you. They’ll evaluate your physical and mental health to ensure you’re a strong candidate for surgery.

Physical health evaluation

Your provider will do a physical evaluation to be sure you’re healthy enough for surgery. They’ll:

• Review your medical history.
• Conduct a thorough physical exam.
• Order lab tests to check your hormone levels and the health of your organs.
• Note any infections or prior conditions you may have, treating or helping you manage them as needed.
• Ensure that you don’t smoke tobacco or use certain drugs, offering resources and support as needed.

Your provider will also talk with you about how having a vulvoplasty will affect your future health and family planning goals. After surgery, you won’t be able to conceive a child biologically. If you want to conceive a child in the future, you can bank your sperm for later use.

Behavioral health evaluation

You’ll meet with two different behavioral health specialists, both with expertise in transgender health. They’ll work with you to be sure that having a vulvoplasty is a healthy option for your psychological well-being, too. Topics you discuss may include:

• Your feelings about the disconnect between the way your body looks and your gender identity.
• Your experiences of gender acceptance and discrimination in places where you interact with others — like work, school and at home.
• Your goals for vulvoplasty, including the support network and resources you have to help you through your surgery, from preparation to recovery.
• Your history with behavioral health conditions or mood disorders.
• Your history with self-harm or other risk-taking activities.

Both specialists must submit a letter of support before you can get approved for a vulvoplasty. The letters must confirm that you meet the World Professional Association of Transgender Health (WPATH) standards of care for surgery. The letters should confirm that:

• You’ve been undergoing hormone therapy for at least a year unless there are medical reasons that prevented it.
• You’ve been living in a way that syncs with your gender identity for at least a year.

Finally, you’ll need to confirm that you understand what a vulvoplasty involves, including its risks, benefits and costs. A vulvoplasty is expensive, and not all insurance plans cover it. And you must consent to having the surgery.

What happens before a vulvoplasty?

Your healthcare provider is your best resource for explaining how to prepare for your vulvoplasty. They’ll share detailed instructions with you about how to plan, including what to pack for your hospital visit and what medications you should and shouldn’t take in the weeks leading up to your surgery.

As you plan for your vulvoplasty, think ahead to how you can make your recovery process as easy as possible for your future self.

Address any workplace responsibilities

You’ll need to take eight to 12 weeks off work to recover. Make sure that your employer has approved your leave of absence. If your job requires heavy lifting or lots of physical activity, see if you can negotiate for a lighter workload when you return.

Take care of your physical and mental health

The following tips can help you best take care of yourself:

• Eat healthy. Eating nutritious foods each day can help you heal faster after your surgery.
• Staying physically active can also support your recovery process. Talk to your provider about an exercise routine that’s best for your health.
• Don’t smoke. Smoking or using other tobacco products can cause complications during surgery and slow your healing.
• Keep counseling appointments. Stay in touch with your counselor or therapist in the days, weeks and months leading up to your surgery. They can help you process what you’re feeling as you prepare to take this big step toward affirming your gender. They can also connect you with resources and support to address any concerns you may have about the surgery or adjusting to life after your vulvoplasty.

Make your home a cozy place to recover

Before your surgery:

• Complete any chores or errands.
• Plan your meals and buy groceries.
• Pick out loose, comfortable clothes and nonslip shoes to wear during recovery.
• Arrange any items you’ll regularly need so that you can get them without having to reach or bend over.

Assemble your support network

You’ll need friends and family members’ support during your recovery. It’s a good idea to have people lined up to help with chores and errands, especially during the first two weeks after surgery when you’ll need the most rest. It may be a good idea to have an extra key made so that it’s easy for friends and family to come and go as they help you. Also, having people who love and support you close by can boost your spirits.

What happens during a vulvoplasty?

During the procedure, your provider will use your genital tissue to create a vulva. Your provider will:

• Remove the penis, scrotum and testes.
• Use the tissue from the head of the penis to form your clitoris.
• Shorten the tube that carries urine out of your body (urethra).
• Use the tissue from the scrotum, penis and urethra to form the rest of your vulva.
• Insert a urinary catheter to help you pee after your surgery. You’ll likely go home wearing a catheter that your provider will remove later.

How long does a vulvoplasty take?

The surgery takes about two to four hours. The exact timing can vary, though.

What happens after a vulvoplasty?

After surgery, your healthcare provider will keep a close watch on you to make sure that you’re healing without any complications. You’ll likely stay in the hospital for the next several nights so that your provider can monitor your progress.

Your provider will give you medications to ease your pain and prevent infection. Still, you may notice unpleasant side effects that are all part of the healing process. After your vulvoplasty you may notice any of the following symptoms in the days, weeks and months ahead:

• Bleeding from your incisions. You may bleed for up to two days after surgery.
• Itchiness at the surgery site. The itching lets you know that your wound is healing.
• Spraying or dribbling when you pee. This should get better in time, as your wounds heal.
• Electrical sensations at the surgery site. This is just your nerve endings healing.
• Bruising in your genital area, your belly and thighs. The bruises may take up to a month to fade.
• Swollen labia. It may take up to six months for the swelling to go down.
• Scars that may be red, dark pink or purple. These may take up to a year to disappear.
• Numbness in your genitals. The numbness usually gets better within the next few months, but it can take up to 18 months to regain full sensation.

You’ll have physical limitations during your recovery for at least six weeks or longer. This could include avoiding sexual intercourse, exercise, walking up and down the steps, driving and more. Be sure to follow your provider’s recommendations on these and other restrictions.

In addition to following any after-care instructions that your provider shares with you, plan to attend regular checkups so that your healthcare provider can ensure you’re healing as you should be.

What are the advantages of this procedure?

A vulvoplasty can make you feel more comfortable and happier with the way you look. With a vulvoplasty, you:

• Have genitals that look closer to the way you want them to.
• Can stop or reduce your dosage of hormone therapy.
• Have the possibility of experiencing clitoral pleasure and orgasm.

You can also do everyday things that people with vulvas do, like peeing while sitting down. These simple, everyday changes may help you feel more comfortable in your body.

Is vulvoplasty worth it?

Only you can decide if the procedure is worth it to you. But most people who choose to have gender-affirming surgery are happy with their decisions. They feel happier in their body, which improves their everyday life and sex life. It’s important to take the time to find the right healthcare provider to do your vulvoplasty so that you’re less likely to have complications and more likely to be pleased with the final results.

What are the risks or complications of a vulvoplasty?

Any surgery comes with risks. But when an experienced surgeon performs your vulvoplasty, the chance of complications is low. Let your provider know if you notice any of the following:

• Numbness in your legs.
• A pus-filled mass at the surgery site (abscess).
• A collection of blood at the surgery site (hematoma).
• A collection of clear pus at the surgery site (seroma).
• Signs of an infection, like a fever, swelling and warmth near your incisions.
• Signs of a blood clot, like pain or redness in your calf, knee, thigh or genital area.

Sometimes, people who’ve had vulvoplasties feel less sexual sensation in their genitals and have a harder time achieving orgasm. But this is rare. Or they may not be happy with the way their vulva looks. If you’re unhappy with your vulva, talk with your provider about surgical options for correcting its appearance.

Is vulvoplasty reversible?

No, this isn’t reversible. Your surgeon will reshape and remove tissue in your genital region to change its appearance. Once this happens, it’s hard to switch it back to its original state. Before seeking care, discuss your goals with your healthcare provider and make sure you understand the risks of vulvoplasty.

What is the recovery time for a vulvoplasty?

You should start feeling better after the first two weeks following your surgery. After four months, you should’ve healed enough so that you know what your vulva will look like once the swelling is completely gone. And within eight to 12 weeks, you should be able to go back to work.

Healing completely may take a little longer — up to a year, in some cases. During this time, it’s important to follow your provider’s instructions about your care and to attend all checkups. Follow your provider’s advice about how much physical activity, including sexual activity, is safe.

When should I call my healthcare provider after a vulvoplasty?

Call your healthcare provider if you have any of the following symptoms during your recovery:

• Signs of infection like fever, leaking pus from your incision or feeling warmth and swelling near your incision.
• Signs of a blood clot like numbness and pain in your legs or genitals.

You should also contact your provider if you feel your recovery is slow or that your pain levels are getting worse instead of better.

Does insurance cover vulvoplasty?

Insurance coverage varies depending on factors like your insurance plan, geographical location and reason for having the procedure. One study found that vulvoplasty is covered in about 1 in 5 cases. Talk to your insurance provider to make sure you understand your coverage.

A note from Cleveland Clinic

A vulvoplasty is a major surgery with the potential to help you live in your gender more comfortably. As you consider whether a vulvoplasty is right for you, find a support network that can help you talk through the pros and cons of surgery. In addition to speaking with friends, family and medical professionals who support you, connect with others who’ve experienced gender-affirming surgery firsthand. Listen and learn from their experiences.