Had vaginoplasty elsewhere, tissue swelling blocks entrance to vagina

Dr. Reed, May need a vaginoplasty revision.  Although I can dilate with the smaller stents fairly easily, when aroused I get swelling especially on the left side of the vagina and my boyfriend has trouble entering.  What can you do to fix this?  Is this fairly easy to correct?  Gabriella

Dear Gabriella,

More likely than not, you have a remnant of urethral tissue called a urethral spongiosum rest.  A rest is an anatomic term relating to a known tissue type which is in an incorrect location.  Normally the urethra swells in men when aroused, as it is surrounded by erectile tissue.  During transgender vaginoplasty, the surgeon will try to suture over and/or coagulate this tissue to reduce its potential for swelling.

The approach we use is trans-vaginal.  The urethra is catheterized. A longitudinal incision is made under the urethra.  The catheter is palpated and as much of the spongy tissue on either side is ligated with suture as deeply in as possible. Then opened distally and coagulated.  The trans-vaginal incision is then closed.  If the urethral opening is too high (voiding up, instead of down), we can fix this at the same time.  Similarly we can provide more pink for your vulva.  A non-specific but generalized term would be urethroplasty.

Hoping this is of help,

Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery | Miami


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