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Vaginal reconstruction

Vaginal reconstruction means creating a new or artificial vagina after surgery to remove part or all of your vagina. One of the aims of the reconstruction is to enable you to have vaginal sexual intercourse again. But this operation may not be possible for all women. You can ask your doctor whether reconstruction will be possible in your case.

How a vaginal reconstruction is done

A plastic surgeon uses skin and muscle from other parts of your body to create a new vagina. The surgeon may use

  • A skin graft from the side of your bottom
  • Muscle and skin from your inner thighs
  • Muscle tissue from your lower abdomen (called a TRAM flap)
  • A piece of your bowel

Looking after a vaginal reconstruction

Once the area has healed, you will need to start a regular routine to keep the new vagina healthy. You may need to use dilators to keep the vagina open. Your doctor or specialist nurse will give you a set of dilators if you need them.

It is very likely that getting used to a new vagina will make sexual relationships difficult at first. You may worry about whether you will able to enjoy sex, or about your partner’s reaction. But with time, and loving support from your partner, sexual intercourse will be possible. You will need to use a lubricant whenever you have intercourse.

 

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What a vaginal reconstruction is

Vaginal reconstruction means creating a new or artificial vagina after surgery to remove part or all of the vagina (vaginectomy).

 

How a vaginal reconstruction is done

If you are going to have a partial or total vaginectomy, you can ask your doctor whether vaginal reconstruction is going to be possible. One of the aims of reconstruction is to enable you to have vaginal sexual intercourse again. But this operation is not suitable for all women because it adds to the length of the surgical treatment. And, as with other vaginal surgery, it has possible side effects.

A specialist doctor, called a plastic surgeon, carries out vaginal reconstructions. The plastic surgeon uses skin and muscle from other parts of your body to create a new vagina. The surgeon may use

  • A skin graft from the side of your bottom (buttock)
  • Muscle and skin from your inner thighs
  • Muscle tissue from your lower abdomen (this is called a TRAM flap or transverse rectus abdominus muscle flap)
  • A piece of your bowel
 

Looking after a vaginal reconstruction

To start with, your own surgeon or specialist nurse will tell you how to look after your reconstructed vagina. They may advise you to have salt baths or ask you to use a vaginal douche to keep the area clean while it heals.

Once the area has healed, you will need to start a regular routine to keep the new vagina tissue healthy. Depending on how your surgeon has made the vagina, you may need to use dilators to keep the vagina open. Your doctor or specialist nurse will give you a set of dilators if you need them.

Dilators are smooth cone shaped objects that you put into your vagina to stretch it. They come in sets of different sizes. You use them with a water soluble lubricating gel. You begin with one of a comfortable size and use larger ones until your vagina is stretched enough for you to have sex comfortably. You may need to leave the dilator in place for long periods during the day or night for some months after your surgery. It is important that you use the dilator regularly after surgery to make sure that the area heals well. This helps to make sure that the new vagina eventually works as well as possible. Usually, you can use the dilator less often after about 3 months, but you may always need to use it from time to time.

The dilator may be a constant reminder of what has happened to you and the loss that you are likely to feel. It can take time to adjust to these changes. If you are in a relationship then having sexual intercourse will also help to keep the vagina open. You may be able to stop using the dilator if you are having regular sex. But don't worry if you don't feel ready for this for a while after your surgery. Everyone is different and for most women this type of surgery is very difficult to come to terms with. But you will need to keep your new vagina open either by using a dilator or having regular gentle sexual intercourse.

If your surgeon uses tissue from your lower abdomen (known as a TRAM flap) or your thigh muscle to make your reconstructed vagina, the tissues will be shaped into a sealed tube and sewn in place. With this type of reconstruction you don't need to use a dilator to keep your vagina open. This is because the blood vessels and nerves from these tissues stay attached and prevent the new vagina from narrowing. Soon after surgery, the new vagina will begin to work in the same way as your original vagina did.

A new vagina made from tissue that comes from part of your bowel can hold its natural shape and is more likely to be able to produce lubrication (mucus). But, there can be problems with smell and a discharge when part of the bowel is used. This may not be the case for all women.

 

Having sex after a vaginal reconstruction

It is very likely that having a new vagina will make sexual relationships difficult at first. You will probably feel very strange and wonder if you will be able to feel anything or enjoy having sex. You may feel very self conscious and may be worried that your partner is not enjoying being with you. This is only natural, but with time, and loving support from your partner, your new vagina will start to feel more like a normal vagina. And sexual intercourse will be possible.

You will need to use a lubricant when you have intercourse, because your new vagina will not moisten as well or as quickly as before. There is further information at the links below.  

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Updated: 23 September 2015