In male-to-female sex reassignment, the trans woman may choose to undergo vaginoplasty – the inversion of the penis to create a vagina – as part of her physical transition. This procedure can result in a fully sensate neovagina.
Dr. MacPhee performs this reconstructive procedure by disassembling the penis and utilizing the inverted penile and scrotal skin flap and urethral flap to construct a new vulva, clitoris and vagina. The blood and nerve supplies are preserved to provide sensation, and the urethra is used to create the mucosal part of the vagina that provides additional sensitivity and wetting. The remaining penile and scrotal tissue are used to form the clitoral hood and labia.
The depth and diameter of the neovagina may be limited due the narrowness of the male pelvis. At the time of surgery, a stent is put in place to form vaginal dimensions, and the patient will need to dilate the vagina following surgery, frequently at first and tapering over time. A typical post-op protocol will involve dilating three times a day for 50 minutes each time for the first year. After that, maintenance dilation will be necessary for life. View MTF genital reconstruction results in our Photo Gallery.
Dr. MacPhee also performs orchiectomy, scrotal skin removal and limit-depth vaginoplasty procedures as alternatives to full MTF genital reconstruction.