A neovagina is a surgically constructed vaginal canal. This procedure is performed when a vagina is absent or not fully developed, a condition that can arise from various circumstances. The goal of the surgery is to create a new, functional vaginal structure. This allows for the possibility of sexual intercourse and can contribute to a person’s sense of self, while aiming to restore anatomy that is as close to typical as possible.
Medical Indications for a Neovagina
There are several medical reasons a person might undergo surgery to create a neovagina. One of the primary reasons is a congenital condition, meaning a condition present at birth. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is one such condition, characterized by the underdevelopment or absence of the uterus and vagina and affects approximately 1 in 4,500 newborn girls.
Another congenital condition that can lead to this need is Androgen Insensitivity Syndrome (AIS). In individuals with AIS, the body’s cells are unable to respond to androgens. This can result in the external appearance of female genitalia but with an underdeveloped or absent vagina.
Gender-affirming care for transgender women is another reason for this type of surgery. For many transgender women, vaginoplasty is a part of their transition to align their physical body with their gender identity. The procedure helps to create a body that is congruent with their internal sense of self.
Reconstructive surgery after medical treatments for certain cancers, such as cervical or vaginal cancer, may also necessitate a neovagina. Surgical removal of cancerous tissue can sometimes involve removing all or part of the vagina. Traumatic injuries to the pelvic region can also require this type of reconstructive surgery.
Surgical Creation Techniques
The creation of a neovagina can be accomplished through several surgical techniques, each utilizing different tissues to form the new vaginal canal.
- Penile inversion vaginoplasty is a common method, particularly in gender-affirming surgery. This procedure uses the skin from the penis and scrotum to create the lining of the neovagina, inverting the penile skin to form the canal.
- The peritoneal pull-through (PPT) vaginoplasty is often performed laparoscopically. This method uses the peritoneum, the membrane that lines the abdominal cavity, to form the neovagina. A portion of the peritoneum is mobilized and brought down to create the vaginal canal.
- Intestinal vaginoplasty is a procedure that uses a segment of the intestine, typically the sigmoid colon, to construct the neovagina. A section of the colon is detached while maintaining its blood supply and then repositioned, providing natural lubrication.
- The McIndoe procedure involves creating a space for the vagina and then lining it with a skin graft. The graft is usually taken from another area of the body, such as the buttocks or thigh, and placed over a mold to form the lining.
Postoperative Care and Recovery
Following the creation of a neovagina, a dedicated period of postoperative care is necessary for proper healing and the long-term success of the surgery. A central component of this recovery is vaginal dilation. Dilation involves regularly inserting a medical dilator into the neovagina to maintain its depth and width, as the canal can otherwise narrow or close.
The schedule for dilation is most intensive in the months immediately following surgery and gradually becomes less frequent. Initially, patients may need to dilate multiple times a day, but this frequency is reduced over several months to a year. The healthcare provider will give specific instructions on the duration and frequency.
In addition to dilation, proper hygiene is important to prevent infection, which includes keeping the surgical area clean. Pain management is also a focus of the initial recovery period, with medication provided to ensure the patient’s comfort. The timeline for returning to daily activities varies, but most patients are advised to avoid strenuous activities for several weeks.
The hospital stay after surgery is a few days, during which the medical team monitors the initial healing process. Regular follow-up appointments are scheduled to track progress. Following the surgeon’s guidance on when it is safe to resume sexual activity is also a part of the recovery process.
Function and Sensation
A successfully created neovagina can accommodate sexual intercourse. The depth and width of the neovagina are designed to be sufficient for this purpose, with a typical length of 6-7 cm.
Sensation in the neovagina itself can vary depending on the surgical technique used, and the lining may have limited sensation. However, sexual pleasure is often achievable. In gender-affirming surgeries, a clitoris is often constructed from the sensitive tissue of the penis, and this, along with the surrounding tissues, is a primary source of sexual sensation and can lead to orgasm.
Lubrication of the neovagina also depends on the surgical method. If an intestinal segment is used, the neovagina will be self-lubricating. For other techniques, such as those using skin grafts or penile skin, the neovagina will not produce its own lubrication. In these cases, the use of artificial lubricants is necessary for comfortable sexual activity.