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Vaginoplasty male to female revision requested

Dear Dr. Reed,

Had a vaginoplasty 4 years ago with another doctor and when I urinate the stream seems high, and I have to lean forward a lot to avoid hitting the toilet seat. Also the approach to by vagina seems elevated.  Is this easy to correct.

Laurie

Dear Laurie,  This is a familiar problem seen in many vaginoplasty patients.  The reason being the penile skin emerges about 30 degrees higher than natal female anatomy which is more perineal in location (under the pelvis).  Especially when vaginas are created from inverted penile skin, there is at times tension on the skin causing it to retract upwards to where it came from, which lifts the entire anatomy including your clitoris, the urethral meatus (opening) and occasionally the introitus or entrance way to the vagina.

Fortunately these problems are easy to correct.  Ideally during the initial vaginoplasty the pubic skin has to be undermined and released so the tension factor is reduced.  The elevation to the vagina can be corrected by a Y-V plasty.  You’ll look more natural, void more naturally, and coitus should proceed more easily. Sometimes, if there is no pink vulvar plate when we free up and re-site the urethral opening we may be able to provide that as well.  Normally pink should be seen from the urethral opening up to the underside of the clitoris.

Cordially,

Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
1-305-865-2000

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