According to the recommendations reported in the bibliography section, people who match the following criteria can undergo penile and scrotal inversion vaginoplasty:
In Italy, the following criteria have also to be matched:
Even if it is not an explicit criterion, regular visits, agreed on the basis of individual needs, with a psychologist and/or specialist doctor (e.g. endocrinologist) are recommended.
When the necessary criteria for carrying out the surgery are met (see above), the person concerned must:
Suspension of hormone therapy with oestrogens from one month before surgery to fifteen days after. In general, if you are taking any prescription medication, you should discuss it with your health provider. It may be necessary to stop taking it even several days before the surgery. Drug therapy may be resumed at the doctor's discretion.
The surgical procedure involves two phases, a demolition phase and a reconstructive phase.
The demolition phase involves the removal of the original genital organs: testes, epididymis and funicles (sacs and canals that contain spermatozoa), penis and part of the urethra (the urethra is a channel that connects the bladder with the outside and that constitutes the last tract of the urinary tract). It should be noted that the prostate is not removed. The demolition phase of the intervention irreversibly precludes the ability to reproduce. In the reconstructive phase, a new vagina (neovagina) is created between the rectum and the bladder using the skin of the penis and scrotum (the sac that encloses the testes). For this reason, it is essential to perform a definitive removal of the hairs of the skin of the scrotum before surgery in order to avoid its presence inside the neovagina. Surgeons proceed with vulvoplasty or the creation of the external genitalia (clitoris, large and small labia) and opening the urethra to the outside to allow the person to urinate. In particular, a portion of the glans (apex of the penis) is preserved during the demolition phase to build a clitoris that allows, in most cases, to have a good erotic sensitivity during sexual intercourse. At the end of the surgery, gauze soaked in disinfectant are introduced into the neovagina, a bladder catheter (cannula that allows urine to be eliminated) and a compression bandage are applied.
The person must remain in bed for a few days. Then the person is raised, the gauze, the catheter and the bandage are removed. Vaginal dilatations are then started, by means of dilators, which will be taught by the healthcare staff and which must be performed every day, twice a day for the first months after the surgery and in the remaining part of life following the indications of the surgeon. Sexual intercourse can be resumed about two months after the surgery. It should be noted that, while in cisgender people assigned female at birth is a moist surface over the entire cavity, which increases with the lubrication of arousal, in transgender women the lubrication (always partial) will depend very much on the surgical technique used.
Penile and scrotal inversion vaginoplasty remains the first choice technique due to the reduced risk of complications.
The surgical procedure lasts about four/five hours and takes place under general anesthesia.
Penile and scrotal inversion vaginoplasty involves hospitalization that varies from 5 to 8 days, depending on the characteristics of the person and post-operative recovery.
The complications of penile and scrotal inversion vaginoplasty are divided into immediate and secondary.
Secondary complications (delayed):
National Health Service (NHS): no cost.
Private care: at the discretion of the professional.
Coleman E, Radix AE, Bouman W, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022; Sep 6;23(Suppl 1):S1-S259.
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. Erratum in: J Clin Endocrinol Metab. 2018; 103(2): 699. J Clin Endocrinol Metab. 2018; 103(7): 2758-2759.