At the OHSU Transgender Health Program, you’ll find surgeons and teams who provide expert care for patients seeking a vaginoplasty or vulvoplasty. We offer:

• Urologists and a plastic surgeon who are leading experts in vaginoplasty and vulvoplasty.
• A full range of options to suit your needs and goals. We understand that every patient is different.
• A supportive team of skilled providers.
• Physical therapists who are international leaders in caring for vaginoplasty patients.
• Peer volunteers who can provide support during visits.

OHSU also offers the following bottom surgery options. In addition, we welcome you to request a procedure that isn’t listed on our pages.

• Phalloplasty and metoidioplasty
• Hysterectomy, oophorectomy, orchiectomy and nullification surgery

Preparing for surgery

Please see our patient guide page to learn about:

• Steps to surgery
• WPATH standards of care
• The letter of support needed for some surgeries

Vaginoplasty

Vaginoplasty creates a vulva and vagina. OHSU’s Dr. Daniel Dugi and Dr. Geolani Dy, highly trained urologists and researchers, specialize in vaginoplasty. For robotic-assisted vaginoplasties, Dr. Dy works with Dr. Blair Peters, an OHSU plastic and reconstructive surgeon, or with Dr. Dugi to create the vulva.

Before your consultation

We ask that you follow these five steps before your visit:

1. Read our vaginoplasty booklet

2. Watch this video on vaginoplasty and vulvoplasty at OHSU:

3. Write down your questions, and bring them to your visit.

4. Plan to discuss hair removal. Read our hair removal handout

5. Plan to discuss our strict nicotine restrictions.

Pelvic floor physical therapy

Our physical therapists are international leaders in caring for vaginoplasty patients and supporting successful outcomes. Before surgery, therapists show patients exercises to stretch and relax the pelvic muscles.

After surgery, they show patients relaxation exercises and positioning to ease the use of dilators (devices inserted to stretch the vagina). Read our dilation handout

How vaginoplasty is done

This is one way to do a vaginoplasty. Details vary for patients who choose a penile-preserving vaginoplasty. 

• Tissues of the penis and scrotum are used to make the vulva (the outer genitals — the labia, clitoris and urethra opening) and the vagina.
• The surgeon removes the penis and testicles.
• The surgeon creates the vaginal canal between the rectum and urethra.
• The vagina is lined with skin from the penis and scrotum, mostly with grafting and sometimes stretching the skin. Skin can also come from the hip or abdomen.
• Scrotal skin is used to make the outer labia. The inner labia are made from skin from the penis or urethra, depending on anatomy. The clitoris is created from a small piece of the head of the penis. The urethra is shortened and repositioned.
• The prostate is not removed. This avoids complications such as urinary leakage. The prostate can also provide sexual sensation.

Robotic-assisted vaginoplasty

This option is an alternative to open (perineal) vaginoplasty.

Your team will include Dr. Dy and Dr. Peters or, if you choose a penile-sparing approach, Dr. Dy and Dr. Dugi. Your team will create the vulva the same way as in an open vaginoplasty.

To create part of the vagina, Dr. Dy inserts robotic arms through two small incisions in the belly.

She creates space between your bladder and rectum for the vagina. Then she uses flaps of tissue from the lining of your belly, called the peritoneum, to create the deepest part of the vagina. Both robotic-assisted vaginoplasty and traditional vaginoplasty are done in one operation.

Recovery

You will probably spend five days in the hospital, followed by several weeks of reduced activity at home. We will provide detailed care and recovery instructions before you go home.

Dilation

For the first year after surgery, patients usually use a dilator often. This maintains the vagina’s desired size.

Typically, patients:

• Use a dilator for 30 minutes, three times a day, until reaching the desired size. Or they might use it twice a day in longer sessions to better fit a work or school schedule.
• Gradually decrease the number of sessions as dilation becomes easier. We’ll offer guidance at follow-up appointments.
• Plan to dilate once or twice a week for life.

Read our dilation handout

Considerations and risks

Serious risks from vaginoplasty are uncommon. Minor complications include temporary urine leakage, healing problems, and wound or bladder infection.

Your surgeons will discuss possible complications with you before surgery. They will also check on how you are healing in follow-up appointments.

Vulvoplasty

Vulvoplasty creates a vulva — the outer genitals. It is similar to a vaginoplasty but without creating a vaginal canal. The outward appearance is almost identical, with a labia, clitoris and shortened urethra.

Patients may choose this surgery over vaginoplasty because they have no interest in having a vagina. It also requires no hair removal or dilation. A surgeon may recommend vulvoplasty for patients with certain risks, such as having had treatment for prostate or rectal cancer.

How vulvoplasty is done

The surgery is almost identical to vaginoplasty except for creation of a vaginal canal.

These are the most common steps for vulvoplasty. Details will vary for patients who choose penile preservation.

• The outer labia are formed from part of the scrotum.
• The inner labia are formed with skin from the penis or urethra, depending on anatomy.
• The urethra is shortened and repositioned.
• The clitoris is created from the head of the penis, allowing sexual sensitivity. Remaining parts of the penis and scrotum are removed.

Recovery

Recovery is similar to that of vaginoplasty. You will probably spend one to three days in the hospital. It may be six to eight weeks before you return to work or resume strenuous activities.

Considerations and risks

Vulvoplasty has fewer risks than vaginoplasty. Serious complications are uncommon. More common risks include minor healing problems. Your surgeon will check on how you are healing after surgery.