Dear Dr. Reed, Considering female to male bottom surgery, how is the vagina removed? What else is required? Lisa
In order to prepare for female to male bottom surgery which may be either a metoidioplasty and a phalloplasty, you will need to have your ovaries and uterus removed, usually laparoscopically. Removing the vagina is fraught with unnecessary complication in that it is close to adjacent structures such as the rectum, bladder and urethra. We recommend colpocleisis which is closure of the vagina.
Colpocleisis is accomplished by cauterizing the inner or mucosal lining of the vaginal, placing in a drain (temporary) and closing the space with a helical suture.
Colpocleisis is a procedure to close the vagina without removing the muscular wall. Although a few techniques have been described, our approach is the cauterize the inner lining (mucosa) of the vagina and place in a few helical or spiral sutures of absorbable material around a central drain bringing the cavity together. The drain is ultimately removed once adhesions are well formed.
This should be proceeded by a total hysterectomy, removal of the uterus and cuff of vagina (done by others). At that time your tubes and ovaries are also removed. Allow several months following bilateral salpingo-oophorectomy with laparoscopically assisted hysterectomy before proceeding to colpocleisis. An advantage of the laparoscopic approach is minimization of any abdominal incision.
Vaginal closure will provide a floor for the scrotum and subsequent insertion of testicular implants. Also when the vagina is closed there is more support for healing at the base of the urethra. You will undoubtedly want urethral extension for a stand to void result. Closure of the vagina reduces (but does not completely preclude) the likelihood fistula formation or urinary leakage through small opening that has not healed.
Occasionally a patient may wish to preserve bisexual capabilities. Please give careful consideration and confer with your therapists and surgeons.
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery | Dr. Harold Reed | Miami
Metoidioplasty after picture
Phalloplasty done by another transgender surgeon. Revision to provide glans refinement and penile implant insertion done by Dr. Reed