Vaginoplasty (Penile Inversion)

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

Who is a candidate for surgery?

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 see you for an extended consultation to review the surgery, goals, risks, and preoperative and postoperative care.  We will order blood work and review your health history to make sure you are optimized for surgery.  Smoking cessation 1 month prior to surgery is critical for best results. You would stop hormones (not spironolactone) 2 weeks prior to surgery to minimize the chance of blood clotting.  We will also give you information to purchase the dilators that you will need postoperatively.  You will need to perform a bowel prep to clean out your intestines the day prior to surgery.

We will inquire about any supplements and medications you are currently taking since this knowledge can reduce potential risks. We encourage you to raise any concerns so we can address them during the consultation.

We will create a personalized treatment plan based on your needs and goals. We will explain what you can expect during the surgery and discuss potential fees. Instructions will be provided to prepare for the surgery.

How is the surgery performed?

Prior to surgery, the anesthesiologists place a small epidural catheter in your back to numb the area after surgery.  This helps with pain and increases comfort level after surgery.  The surgery often takes 2-3 hours and a vaginal space is created, the external genitalia is shaped and contoured and a new clitoris is created.  Packing is placed in the vagina and a urinary catheter is left in place.

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 a hospital room for the initial recovery process.

What is recovery like?

Most patients spend 3 days in the hospital.  We consult the anesthesia pain service to follow you to keep you as comfortable as possible. We make sure you are up and walking before going home, your pain is controlled on oral pain medications, and your incisions are healing well.  

Once you are discharged, we see you a few days later to remove the urinary catheter, remove the packing and perform dilation teaching.  Most patients take 2-4 weeks off work after surgery.  Feminine pads are worn for about a month for drainage/oozing. 

 Dilation continues at 3 times a day for 3 months (30 minutes per session) and then is slowly decreased in frequency.  

Some patients require a quick touch-up surgery/cosmetic tweak after about 3-6 months, although this may not be needed and can be done even later if your schedule doesn’t allow it.

Before & After

Risks

Any surgery has some risks and vaginoplasty is no exception.  The specific risks to the surgery are:

1. Bleeding – some amount of bleeding after a vaginoplasty is normal and at times can be heavier.  In a small percentage of surgeries, a blood transfusion may be needed.
2. Infection – uncommon, but would be treated with antibiotics
3. Pain – pain generally improves over time, although there are some patients who can have long term discomfort
4. Need for revision – some patients require minor touch-ups and some patients could potentially require revision for their depth/width if they lose some during the dilation process
5. Injury to other structures – there is a very small chance that there can be an injury to the urethra, bladder, or rectum during the creation of the vaginal space.  This can potentially lead to issues of incontinence or even fistula.  This may require further surgery 
6. Clitoral loss, inability to orgasm – we keep a very high blood and nerve supply to the clitoris, but there are very rare cases when a patient may not be able to achieve orgasm
7. Loss of depth – this is usually avoided with dilation but may require further surgery if you are unable to have intercourse
8. Intravaginal hair growth – we remove follicles in surgery and “scrape” the back of the graft, however, there is a very small chance you can have some minimal hair growth (this is still possible after electrolysis or laser hair removal).  This could require further surgery to correct

Following the recovery and aftercare instructions provided will help minimize the risk of complications. It is important for the patient to contact Dr. Ramineni if any of the above-mentioned issues occur.

How Much Does Vaginoplasty Cost in Washington?

The cost of a Vaginoplasty will depend on several factors. The price can be affected by body type, type of technique performed, surgical complications, and even allergies. Find out more by scheduling a consultation.

Schedule Your Consultation

To learn more about vaginoplasty (penile inversion) in Washington DC, visit us at District Plastic Surgery. Contact us today to schedule your informative and helpful consultation.