Vaginectomy
Vaginectomy is surgery to remove all or part of the vagina. It’s an effective treatment for vaginal cancer that can’t be treated with radiation and chemotherapy. It can also help transgender men who want to have gender affirmation surgery. Talk to your provider about your goals, including whether you hope to have vaginal intercourse in the future.
What is vaginectomy? Vaginectomy is a surgical procedure to remove all or part of the vagina. Healthcare providers perform this surgery to treat vaginal cancer that doesn’t respond to other treatments. Some transgender men choose to have this procedure as part of gender affirmation surgery. Recovery time varies depending on how much of your vagina your provider needs to remove and whether you need other surgeries, too. Talk to your provider about what you can expect during recovery.
Why do providers perform vaginectomy? You may need vaginectomy if you have vaginal cancer. Your provider will usually try other treatments first. These may include radiation therapy, surgery or chemotherapy. If those treatments don’t work, your provider may recommend vaginectomy. Part of the female reproductive system, the vagina is a tube made of muscle. It starts at the vulva (the external genitals) and extends to the cervix (the opening of the uterus). Depending on the location and size of the tumors, the stage of cancer and whether it has spread, your provider may recommend: Partial vaginectomy, to remove the upper portion of the vagina. Total vaginectomy, to remove the entire vagina. Radical vaginectomy, which removes the entire vagina as well as the tissue around it. Some transgender men get vaginectomy as part of gender affirmation surgery. Providers also call this female-to-male (FTM) “bottom surgery.” The procedure usually happens before metoidioplasty or phalloplasty. These are surgeries to create a penis.
How common is vaginectomy?
This procedure is relatively uncommon. Providers can usually
treat most vaginal cancer with radiation and chemotherapy. So, vaginectomy
isn’t often necessary.
Vaginal cancer is rare. Less than 2% of cancers in the
female genital tract are vaginal cancer.
What happens before vaginectomy?
Before surgery, your provider will examine you and ask about
your medical history. They may tell you to stop taking certain medications,
such as blood thinners, before the procedure. If you smoke or use tobacco
products, ask your provider about quitting before surgery. Smoking and tobacco
use can slow the healing process.
You’ll need to avoid eating or drinking anything the night
before the surgery. Your provider will give you details about the procedure and
how to prepare.
What happens during vaginectomy?
Your provider will give you general anesthesia through a
vein in your arm. You will be asleep throughout the procedure and won’t feel
pain during surgery. Your surgeon may perform this procedure vaginally (through
your vaginal opening). They make several small incisions (cuts) to separate the
vaginal tube from the tissues surrounding it. Depending on the technique, your
provider may close or leave the vaginal opening.
Your provider may do this procedure laparoscopically. This
means they use a long, thin instrument that looks like a telescope. Instead of
going through your vaginal opening, your provider may make several small
incisions in your abdomen. If you need other surgeries, your provider may do
that surgery while you’re under general anesthesia. These additional procedures
may include a hysterectomy to remove your uterus.
Some women choose to have a vaginoplasty following a
vaginectomy. This is surgery to reconstruct a vagina. A vaginoplasty procedure
allows women to have vaginal intercourse. If you’re interested in this
procedure, talk to your provider. They will discuss your options, including
when to get this additional surgery.
What happens after vaginectomy?
You’ll need to stay in the hospital after the procedure,
usually for a few days but up to a week. The length of stay depends on the type
of vaginectomy you had and whether you had other surgeries as well. While
you’re in the hospital, your provider will monitor you and give you medications
to relieve pain. These medications also reduce swelling and lower the risk of
infection.
When you’re able to go home, your provider will tell you how
to care for yourself and how to take care of your incisions. Follow your
provider’s instructions carefully. You should limit physical activity for at
least a few weeks. You’ll need to avoid lifting or carrying anything heavy.
Your provider will tell you how long you should rest.
What are the advantages of vaginectomy?
Vaginectomy is an effective procedure to treat vaginal
cancer. This surgery has a 95% survival rate two years following the procedure.
This procedure helps trans men live in a body that aligns
with the gender with which they identify. Trans men who choose this procedure
are generally very happy with the outcome.
Most transgender people who choose gender affirmation
surgery are happy with the outcome. Depending on the procedure, studies show
that 94% to 100% of people report satisfaction with their results.
What are the risks or complications of vaginectomy?
As with any surgery, there is a risk of complications. They
include:
Excessive bleeding.
Infection.
Problems with defecating (pooping) or leaking stool.
Vaginal fistula (a hole between the vaginal area and other
internal organs, such as the bladder).
Urinary retention.
In recent years, more transgender men have chosen to have
this procedure. While the risk of complications used to be higher, the
procedure is safer than ever before. There is a lower risk of complications
now.
What is the recovery time after vaginectomy?
You can expect to have some pain in the first week or so
following surgery. Talk to your provider about your pain relief options and what
activities to avoid.
Your recovery time depends on your overall health and the
type of surgery or surgeries you had. You’ll probably need to avoid physical
activity for several weeks. This may include intense exercise, all sexual
activity and any heavy lifting.