Find out about vaginal reconstruction and what you need to do after you have had it.
What it is
Vaginal reconstruction means creating a new or artificial vagina after you have had surgery to remove your vagina (vaginectomy).
How a vaginal reconstruction is done
If you are going to have your vagina removed during surgery, you could ask your doctor if a vaginal reconstruction is possible. One of the aims of reconstruction is to try to make vaginal intercourse possible after surgery.
During this operation a specialist doctor, called a plastic surgeon, uses skin and muscle from other parts of your body to create a new vagina. The surgeon might use:
- a skin graft from the side of your bottom (buttock)
- muscle and skin from your inner thighs
- muscle tissue from your lower abdomen (called a TRAM flap or transverse rectus abdominus muscle flap)
- a piece of your bowel
This operation is not suitable for all women and some women may decide they don't want to have this extra surgery.
A vaginal reconstruction adds to the length of the surgery and has possible side effects. Also, attempts to reconstruct the vagina might not be successful in some women. So it is important to discuss the benefits and risks of this operation with your doctor.
Your 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 might need to use dilators to keep the vagina open after surgery. 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.
Your doctor or nurse will explain how long the dilator should stay in place each time you use it. You use dilators with a water soluble lubricating gel. You begin with a dilator of a comfortable size, then start to use larger ones until your vagina is stretched enough for you to have sex comfortably.
It's important to use the dilator regularly to make sure the area heals well and works as well as possible. Usually, you can use the dilator less after about 3 months, but you may always need to use it from time to time.
Using dilators and having sex
If you are in a relationship then having sexual intercourse will also help to keep the vagina open. You might be able to stop using the dilator if you are having regular sex.
But don't worry if you don't feel ready for sex 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. You will need to keep your new vagina open either by using a dilator or having regular gentle sexual intercourse.
Tissue from lower abdomen or thigh muscle
You might not need to use a dilator if your surgeon uses tissue from your lower abdomen or thigh muscle. During this reconstruction the tissues are shaped into a sealed tube and sewn in place. The blood vessels and nerves stay attached, so this prevents the new vagina from narrowing.
Having sex after a vaginal reconstruction
It is very likely that having a new vagina will make sexual relationships difficult at first. You may not feel like having sex. Or you might be worried that sex will not be the same, or you might not enjoy it.
These are natural concerns and it may take some time. It might help to talk things through with your partner if you have one.
You will need to use a water soluble lubricant if you have intercourse. Your new vagina won’t moisten as well or as quickly as before. Ask your doctor or nurse which lubricants or creams to use.
If you have a vaginal reconstruction using skin and muscle taken from your thigh, you may feel a strange sensation in your inner thighs when you have sexual intercourse. Women have described this sensation as feeling as if your inner thighs are being stroked.
It happens because the nerves that supplied the thigh tissue now form the walls of the reconstructed vagina. Your brain picks up this message and thinks that the leg is being touched.
This can feel very strange and may be off putting at first. Over time, most women get used to it and it can even become sexually stimulating.
Women have also said that they do not feel that they can contract the muscles around the entrance to the vagina as easily as before their surgery. This means that you will not be able to squeeze your vagina as hard around your partner's penis.
You and your partner may need to experiment a bit and try different sexual positions. With time and patience, you will be able to find some positions that you both enjoy.
You may have a small amount of bleeding or spotting after sex. This is nothing to worry about. But if the bleeding becomes heavy then see your doctor.
Talk to your doctor or specialist nurse if you have any problems or questions. There are sex therapists you can see if you would like to. Your GP or specialist nurse will be able to put you in touch with a therapist.