Vaginoplasty

Conveniently located to serve Washington DC, Arlington, Bethesda

What is a Vaginoplasty?

Vaginoplasty or GRS surgery is a procedure to create a functional and aesthetic vagina out of the penile and scrotal tissue. The goals are to create a deep vaginal space to allow intercourse, a labia majora and minora and a new clitoris for sexual gratification.

A minimal depth technique can be performed instead if someone desires external genitalia and a new clitoris, but does not plan on having penetrative vaginal intercourse or does not want to dilate.

Ideal Candidate for Vaginoplasty in Washington, DC

This surgery in Washington is most commonly performed in transfemale patients, however, we also perform the procedure in patients who have genital dysphoria, and are non-binary, and gender nullification patients.  The requirements for surgery are that a patient should have lived as their preferred gender for at least 1 year and be 18 years of age.  Recommendation letters are also needed from your mental health professional.

Candidates must be in good overall health and must have no conditions that could negatively affect healing. Ideal candidates must have realistic expectations from vaginoplasty. Patients must thoroughly understand the full ramifications of penile inversion surgery.

What are the insurance requirements for covering the procedure? 

Each insurance has its own criteria, but the common requirements are 2 letters from mental health professionals that document your gender or genital dysphoria and a recommendation for surgery., One letter must be from a Master’s/Doctorate level mental health professional – generally a psychologist or psychiatrist, the other can be from any mental health therapist.

You must be in good mental and physical health and should have a good support system. Most plans cover the surgery, however, there are some individual insurance plans that may have a policy exclusion and may not cover the surgery. If this is the case, we can give you a quote for the surgery.

Patients should contact their insurance provider to determine if their health insurance will cover the cost of penile inversion surgery. We will consider your insurance coverage when determining the potential fees of your procedure in Washington, DC.

How long is the wait for surgery?

We understand that waiting long periods of time can be detrimental to your mental health which is why we hold dates for vaginoplasty patients and try to keep the time from consultation to surgery under 6 months.  As a busy practice, we often perform up to 6 vaginoplasty surgeries in a week.

The patient must have the ability to set aside time for their vaginoplasty surgery and for their recovery. Rushing the recovery process is not recommended.

What do I have to do prior to surgery?

Prior to surgery, we have an extended consultation to review the surgery, goals, risks, along with the preoperative and postoperative care. We offer both in person and virtual consultations for vaginoplasty patients who come from out of the area. We will review your health history and order basic blood work to make sure you are optimized for surgery. Smoking cessation 1 month prior to surgery is critical for best results. We review your medications, hormones, and supplements to advise what to discontinue prior to surgery. We provide you with information to purchase the GRS vaginal dilators that are required to have postoperatively for full depth vaginoplasty recovery. You will need to perform a bowel prep the day prior to surgery to clean out your intestines, aid with sterility, and decrease chance of complications.

We will create a personalized treatment plan based on your needs and goals. We will explain and provide written instructions for what to expect before, during, and after the surgery. We are available for and encourage you to raise any concerns during or after the consultation for a smooth surgical process.

How is the surgery performed?

Prior to surgery, you will speak with the surgery and the anesthesia team to sign consents, run through the process, and address any questions or concerns. The surgery often takes ~2 hours. A vaginal space is created, the external genitalia is shaped and contoured, and a new clitoris is created. Vaginal packing is placed in the vaginal canal, and a urinary catheter is placed and left in the urethra.

Incisions will be closed to complete the penile inversion surgery. The sutured area will be bandaged and protected to finish the surgery. The patient will be placed in the post-operative unit for the initial recovery process until they are transferred to a private in patient room for the 2-day hospital stay.

Dr. Praful Ramineni’s ‘hybrid’ technique for penile inversion vaginoplasty

We have developed a “hybrid” technique that has been used very successfully by our practice for years. The goals are to avoid abdominal incisions, maximize lubrication, sensation and depth all while decreasing surgical time. It is a modification of the inversion technique in that we create an open-ended tube (instead of a pouch lined by dry scrotal skin). This allows us to maximize the aesthetics externally, while using the natural lining exposed during the creation of the new vaginal space.

The middle and upper portions of the vagina are naturally lined by peritoneum and the smooth lining of the capsule of the prostate and serosal layer of the bowel. These smooth lubricated linings are exposed with dissection of Denonvillier’s fascia and provide better sensation and lubrication than scrotal tissue. We have also found our patients achieve better depth with this technique and since the abdominal cavity is not opened, there is no intrabdominal scarring or abdominal incisions.

Often times, the vaginal pocket is supplemented with a skin graft taken from the scrotum which is thinned while removing and burning the hair follicles to decrease the chance of hair growth inside the vagina. We do not require hair removal prior to surgery for this reason.

Since we only use a small portion of the scrotal skin, lack of tissue is not an issue.

Dr. Praful Ramineni performs the hybrid technique and traditional penile inversion vaginoplasty. Dr. Sarah Eidelson performs traditional penile vaginoplasty.

What is recovery like?

Inpatient hospital stay varies based on surgeon but is often as minimal as 2 days. Physical therapy is consulted and helps you to be comfortable with walking and transferring yourself from place to place the day after surgery. The nursing team manages your pain control with oral and IV pain medications. The surgical and nursing team helps monitor your surgical site, change dressings, and assure that your incisions are healing well.

Once you are discharged, we see you the following week to remove the urinary catheter, remove the vaginal packing and perform dilation teaching. Most patients take 4-6 weeks off work after surgery. Feminine pads are worn for drainage/oozing and incision care is thoroughly discussed an monitored throughout the recovery process.

Dilation is required at 3 times a day for 3 months (30 -45 minutes per session) and then is slowly decreased in frequency based on an individual’s recovery progression.

Some patients may undergo a quick touch-up surgery/cosmetic tweak after recovery dependent on aesthetic preferences. If desired, this can be performed any time after the 6 month post op mark.

What do I have to do prior to surgery?

Prior to surgery, we have an extended consultation to review the surgery, goals, risks, along with the preoperative and postoperative care. We offer both in person and virtual consultations for vaginoplasty patients who come from out of the area. We will review your health history and order basic blood work to make sure you are optimized for surgery. Smoking cessation 1 month prior to surgery is critical for best results. We review your medications, hormones, and supplements to advise what to discontinue prior to surgery. We provide you with information to purchase the GRS vaginal dilators that are required to have postoperatively for full depth vaginoplasty recovery. You will need to perform a bowel prep the day prior to surgery to clean out your intestines, aid with sterility, and decrease chance of complications.

We will create a personalized treatment plan based on your needs and goals. We will explain and provide written instructions for what to expect before, during, and after the surgery. We are available for and encourage you to raise any concerns during or after the consultation for a smooth surgical process.