I seem to be on something of a mission at the moment. I began laser hair removal on my face which has had dramatic effects already (I'd already had 60 hrs of electrolysis), laser hair removal on my chest and breasts, and now I've begun Lhr down below too. I asked my laser lady to do as much as possible around my genital area in preparation for surgery, and she did. She asked me to stretch the appendage from the top whilst she zapped around the penis. Yay!

I was conscious that what I was doing was effectively preparing for full vaginoplasty. And that's certainly been on my mind.

As things stand I'm on the NHS (UK) waiting list for what they term vulvoplasty or in other words Minimal Depth Vaginoplasty. In the recommendation letter the clinic have stated that I  am "100% sure that this is they type I want."

Which is rubbish. As most of you know on here I have been vacillating (couldn't resist another V word) about this for months, even years. I'm not 100% at all as to which type of vaginal GRS to have.

I've found that since the Supreme Court ruling in the UK I am more and more leaning towards full vaginoplasty. I think it has something to do with authenticity, rather than the dystopian nightmare that we maidens might one day be subjected to internal inspection - although I wouldn't put it past them.

I'm also aware from reading other journeys that there is no guarantee that a supposedly easier surgery will necessarily be anything of the sort. As @Devlyn can testify, it's not that simple. Yes the full depth version is a longer op and prone to more complications, but it doesn't follow that a MDV version gets you off more lightly.

So I now look at the penis below and find myself saying to the outer skin: you're going to become my vagina. 

If that is indeed my trajectory then I don't know how it will affect the NHS GDNRSS side of things. Do I fess up now and risk them messing around with my place on the waiting list? Or do I, as I feel, wait until the hospital themselves call me for consultation and then I mention it to the consultant?

Meanwhile I am also very conscious that I am pushing through all the laser hair removal to complete all three sets of treatment by 28th October. That leaves me free to fly to Thailand on 30th October.

Why?

Because I have been left a bit of money and I am so so tempted to go and have a chat with my lovely surgeon at PAI, Dr Sutin, who did such a brilliant job with my orchidectomy and full facial surgery. I am so tempted to hand over the cash and just get this done. It has already been too long and waiting another 3 years or maybe more for the NHS, especially given the current climate, feels like 3 years too long.

I feel confident that Dr Sutin would do a fabulous job down below.

Should I just go for it?!

xx

Also, I based a lot of my reasoning on the notion that I would never want a penis anywhere near my vag.

But as I've read other reports from sisters on here I've realised that I might actually really enjoy the sensation of self-lubricated internal pleasuring and that it might be more stimulating for orgasm. Quite aside from the sensate feeling of the vaginal canal, there's the little matter of the prostate gland which is a serious G-spot that a dilator or other similar toy can approach. With a MDV I don't think that's going to be possible and I don't particularly want to consider the other route to that particular erogenous zone.

Thank you for this topic! This is something that I have been wrestling with as well!

My biggest obstacle has been that there are no surgeons in this area with whom I can consult. There isn't even anyone in Western South Dakota who does electrolysis, so I have been unable to move forward as quickly as I wanted. I have many questions and would prefer to discuss them with a surgeon who does the work and can properly advise me of the pros and cons as they apply to my state of health and needs.

As an asexual, I have no interest in penetrative sex, except as a curiosity. How would it feel? Is it something I might enjoy? But it seems to end there. The idea of MDV adds more pros to the list, as another year or so of hair removal for vaginoplasty would delay a surgery date. Lower cost, less maintenance, etc. So the question I have is, do I need a full vaginoplasty?

As Asche so perfectly stated, if I can't have a vagina, I would prefer to have no genitals at all. Again, an MDV would meet this criterion and present something more aesthetically pleasing to me. I doubt anyone else would see it except in a medical environment.

Like you, I am also concerned about the political/legal environment. If my ID documents were to be questioned, I would want to be less anxious about a strip search. I think that would merely involve a quick visual inspection and not a "depth gauge" examination.

So, at the moment, I am leaning toward the vulvoplasty. Just when I think I have made that decision, I wonder, what if I meet someone whom I would want to offer more? At such a point, it would not be about my own pleasure but about theirs. Yes, there are other options, but what if? Well, there is the possibility of going back and getting the vaginoplasty through skin grafts, but do I really want another surgery down there after I turn 70 two years from now? Probably not.

And that puts me back to the MDV decision. I am looking forward to my upcoming move to an area where I can sit down with a surgeon and discuss my options.

Really great post, @Lori Dee . Thank you for this. Your wrestling is similar to mine in so many respects except that now I'm starting to tilt to the full vaginoplasty.

And I love your "not a "depth gauge" examination" . I know it's not a laughing topic but that did make me laugh out loud.

I went with the vulvoplasty.  I must definitely did not want a penis anywhere near my genitals, so having a vagina for its biological purpose was not something I needed.  I wouldn't say that the min-depth surgery qualifies as "easier".  Both are major surgeries, and both can have the complications that are possible with major surgery.  What is easier with MDV is the upkeep.  That was the main factor for me.

I can totally see why having full-depth vaginoplasty would be preferable in the current political climate in some countries, including yours.  If one has to submit to a body cavity search before using the washroom, or just because the dictator-du-jour says so, more realism is definitely in order.  I sincerely hope that it doesn't come down to that anywhere.  If that ever happens here, I will flunk the test, but I promise I won't go down without a fight.

Leaving politics aside, and just considering what I wanted for myself, I am happy with my choice.  I would make the same choice again if I had to, for the same reasons.

I had my surgery with Dr. Brassard.  He does a follicle scrape on the skin tissues that are supposed to be hairless, so he does not require hair removal in the area.  I have heard people worry about what happens if he misses some follicles.  Yes, that would be a problem, and removing them after the surgery is a lot harder than before, so many of his patients opt for hair removal anyway.  With MDV, this is much less of a factor. 

On the other hand, Dr. Brassard does require the area to be hairless on the day of surgery, but a recent shave is acceptable.  That is what I did.  Afterwards, no hair grew back where it wasn't supposed to, so the follicle scrape was successful.  However, it did grow back everywhere else, and that was quite an unpleasant experience.  It was like having a porcupine (an echidna for Aussies) in my pants!

Whenever I get the surgery in the future, my dream will be to walk down the aisle to my waiting husband and as husband and wife, be able to do what husbands and wives have been doing since Adam and Eve.  So I'll want the full vaginoplasty so that my husband and I can do that.

This is such a personal decision that hearing others preferences is not really helpful. I know it can be challenging to forecast exactly what we will be feeling in 5, 10 or 20 years from now, but you do have to base things on how you feel right now! I understand many need a feeling of 'completeness' for 'authenticity', and many of us wonder if we did meet the 'right' person, would our sexual needs change? There is an argument for covering all bases, but, as with everything, there is a cost.

The various methods of full depth all come with some level of maintenance, even if it is simply managing internal microbiomes, but this is a daily issue which must be accepted. I know a few people who cherish their daily, or even weekly dilator sessions, but many more who see it as a chore. The political considerations are hard to distinguish between the two, and I have never hear of a government carrying out internal exams? I accept that body scans at airports can detect basic genitals, but doubt the difference would be apparent to untrained eyes. Certainly trained eyes would notice a prostate gland!

The process of creating a neovagina involves opening a path through pelvic muscles, and some risk of affecting the bowel. There are also other risks above MDV which you need to be aware of and balance against perceived future benefits. If you see a video of genital surgery, you will see that it is quite significant, and both full depth and minimal depth are similar, except for the vaginal canal.

Externally, there is very little difference in appearance, and depending on the skill of the surgeon, even medical staff performing small procedures like installing a catheter, might not realise you are not cis. So, it comes down to your needs and lifestyle. I know looking after young children all day influenced my decision, and philosophically, I could never feel 'complete', so that was a factor. We need to critically examine our lives and try to forecast as best we can, and choose which procedure best fits. Remember, it is possible to create a vaginal canal later on, it's just more expensive, another recovery period, and less options, so your decision doesn't have to be final.

Hugs,

Allie

You're absolutely right @Allie Jayne that it's such a personal decision.

I've genuinely been on the fence about which one to choose so I have found this site brilliant. Listening to how others have found it has been so helpful. The danger comes of course if you take one person's viewpoint or experience and then assume that's right for yourself. But with that important caveat I find it so helpful to listen and ask questions. There are so many brilliant contributors.

I'm conflicted on several counts as to whether to go full vaginoplasty or what the UK call Vulvoplasty, but which is really also vaginoplasty with minimal depth.

I used to think the faff of dilation would get to me but, then, in a separate discussion with @Devlyn about hormones I realised that every single day I apply gels to my body. I get up at 4 am and apply one set to my lower torso. Then in the late afternoon I apply another to my upper arm. In each case I have to wait at least 30 minutes for it to dry. In many ways the hardest one is the afternoon application because I have to be in a t-shirt, and pin up my sleeve. Doesn't matter what I'm doing, I have to do it.

And this has been ongoing now for some years. So much so that I don't really notice it. Surely if I'm that dedicated with that I'll be fine with dilation?

I'm not into men at all (the opposite: I'm a lesbian) but I do still have a libido and the idea that dilation, or some insertion, might assist orgasm is really quite attractive.

And then there's the current situation and a sense that I'd like to give myself the best chance should things turn really nasty, which is not impossible.

I think I'm talking myself into the full depth. The risks concern me but I'm prepared to roll the dice in order to be completed as me.

If so then it's down to timing. Do I wait the potential 3 years or more for the NHS wait list, with no guarantee in the current climate that funding will continue.

Or do I use the money I've been left towards getting this done? I've been today offered a date later this year in Bangkok once my laser hair removal is completed.

My experiences with PAI (Preecha Aesthetic Institure in case anyone doesn't know) were superb. Dr Sutin did an outstanding job with my Full Facial Surgery. The orchidectomy was also faultless. Thailand has a long tried and tested history of vaginoplasty.

So do I place myself back in his hands for this most important of procedures?! Semi-rhetorical because I know y'all say it's my decision

xx

Looking at the PAI website they have performed over 6800 SRS surgeries, 'successfully' according to them.

That is a heck of a lot of experience. For comparison, around 400 are performed across the entire UK per year.

xx

As Allie says, this is a personal decision, but there are some considerations here. First, experience is gained per surgeon and with surgery like this where a good cosmetic result is needed as well as one without complications then the skills and audit profile of the person operating on you and their immediate team matter much more than those of the larger organisation (I write this with some feeling having spent years on the trail of an orthopaedic surgeon whose patients loved him, but whose abysmal operative safety record was never disclosed in full until we forced it into the open through mandatory audit.)

So there'll be good surgeons in PAI, but also good surgeons in the UK, and if you can get like for like audit data, you'll be able to spot them. If you can't get audit data for a surgeon, then beware, because there'll be a reason.

A second consideration is I'm not sure I would be having as major and operation as a vaginoplasty on the grounds I might have to undergo a strip search before having a pee! No country I'm aware of is yet proposing this (does anyone know of any?) and if it actually got to that, I'd be thinking of emigrating, rather than choosing a particular line of surgery. Does that make sense?

It does Tanya but it's just one small consideration to add to my scales. Strip searches or scanners are perhaps unlikely but who knows? The general climate, which you and I have been discussing elsewhere, makes me feel more inclined to go for full vagino alongside several other considerations.

That's very interesting about audits. I've no idea how I go about finding them. I've heard only good things about Dr Sutin and he was brilliant with my FFS and orchie.

I don't really know anything about Dr Tina Rashid to be honest (my UK option).

My bigger concern would be the aftercare in Thailand. PAI now use a different hospital to the one I was in where I felt the nursing care was less-than-attentive. But some hospitals in Thailand are fantastic and far better than the UK. And if I was rushed back into hospital in the UK following an op it wouldn't be to the Nuffield. It would be an NHS General Hospital. Which apparently would also now mean being put on a male ward. Ludicrous.

Ah, swings and roundabouts!

xx

Quote from: Tills on May 29, 2025, 04:55:02 AMAnd if I was rushed back into hospital in the UK following an op it wouldn't be to the Nuffield. It would be an NHS General Hospital. Which apparently would also now mean being put on a male ward. Ludicrous.

Even the Nuffield would put you on a male ward under the current interpretation of the rules but most likely you would get a private room. Once the EHRC gets onto - as it's said it will - new guidance about what obligations institutions have toward protecting the rights of trans people, it is possible our views on them may change. So it's watch this space, but my experience of the NHS is that staff are much more tolerant than the recent case in the papers would lead an outsider to believe.

I would caution anyone reading this thread not to get too hung up about cosmetic outcomes. Due to our physical differences, surgeons are unable to guarantee precise cosmetic outcomes, and I urger everyone to search for the sculpture 'wall of vaginas' and have a good look at the variations in cis vulvas. TBH, after the first year or so most of us rarely look at ourselves down there.

The surgeon who performed mine had a specialist nurse who had been working with him doing vaginaplasties for over 20 years, and she told me that more than half of women over 50 who had full depth penile inversion surgeries stopped dilations within 2 years as they came to believe they would never use their new equipment for penetrative sex and the need to dilate regularly became onerous.

All surgeries come with risks, and even with great surgeons, revisions are sometimes needed. This is something to consider when planning surgeries overseas. And don't forget to include a carer in costings, as it's far better to have someone you know with you during recovery in a country where they may not speak your language.

And yes, things can go horribly wrong, a friend had colon vaginoplasty in Europe and ended up having 6 further hospital visits, a couple of those emergencies, and she now has a lifelong stoma and bag. Gender surgery was life saving for me, but not everyone has ideal results. It is serious stuff, and you need to know and accept the risks.

Hugs,

Allie 

Quote from: Allie Jayne on May 29, 2025, 05:26:35 AMThe surgeon who performed mine had a specialist nurse who had been working with him doing vaginaplasties for over 20 years, and she told me that more than half of women over 50 who had full depth penile inversion surgeries stopped dilations within 2 years

Hi Allie,

I've seen you mention this before and so it's equally important to state for anyone looking at this thread that this is anecdotal. It's one nurse's apparent belief and is not quantifiable or evidential. It may be completely untrue. I'm not meaning to be spikey it's just that this remark is factually unproven.

I love the wall of vaginas. Great isn't it? And you're absolutely right about the variation in cis vaginas. Mind you, I've also seen some really bad cosmetic results from SRS so I suggest for a lot of transgender women it does matter greatly that you find someone who is competent and proven.

xx

This is an interesting remark in a peer-reviewed paper:

" Lastly, some surgeons are moving toward continuation or partial reduction of estrogen in the perioperative period instead of cessation "

https://pmc.ncbi.nlm.nih.gov/articles/PMC10226616/

I see the remarkable statistic in this meta-study that 38.9% of surgeons continued with full estrogen dosage. Wow.

I've long been of the opinion that I will not cease mine, partly because having already had an orchidectomy I know that taking out hormones altogether is hell on earth. And partly because having read around the subject, the evidence for operative VTE linked to transdermal estrogen gels is non-existent. If I were taking oral forms of estrogen I would have a different, more cautious, approach. Just my view so don't anyone else take that comment on board for their own pathway.

xx

Should also be added that sigmoid colon vaginoplasty carries greater risks than penile inversion. Interesting to see that these authors state:

"there has been a strong trend away from the intestinal vaginoplasty as a primary procedure"

https://pmc.ncbi.nlm.nih.gov/articles/PMC10226616/


(I have diverticulitis so that would be an absolute no-no for me)

This is interesting:

'Vulvoplasty creates the external appearance of female genitalia without creation of a neovaginal canal; it is associated with high satisfaction and low decision regret. Of those who completed surgery, 93% were satisfied with the surgery and their decision for vulvoplasty .'

https://pubmed.ncbi.nlm.nih.gov/29706578/

Quote from: Tills on May 29, 2025, 09:33:23 AMVulvoplasty creates the external appearance of female genitalia without creation of a neovaginal canal; it is associated with high satisfaction and low decision regret. Of those who completed surgery, 93% were satisfied with the surgery and their decision for vulvoplasty .

It has always struck me as offering most of the benefit with few of the risks and a high percentage of patients can orgasm after vulvoplasty so the only downside is no vaginal canal. Also it's a lot less major an operation and there's more scope for spending time on getting it to look right. Which does matter to many.

Quote from: TanyaG on May 29, 2025, 09:52:33 AMIt has always struck me as offering most of the benefit with few of the risks and a high percentage of patients can orgasm after vulvoplasty so the only downside is no vaginal canal. Also it's a lot less major an operation and there's more scope for spending time on getting it to look right. Which does matter to many.

Well yes, quite Tanya.

Is that definitely true about a high percentage can orgasm after vulvoplasty? That's the bit which probably concerns me more than anything. I'd still like to enjoy things down there

Quote from: Tills on May 29, 2025, 10:08:01 AMIs that definitely true about a high percentage can orgasm after vulvoplasty? That's the bit which probably concerns me more than anything. I'd still like to enjoy things down there

The chances are good after penile inversion carried out by a good surgeon never mind vulvoplasty. I read a paper on this recently and I'm trying to find it right now.

Some papers that touch on aspects of the entire subject are:

Sahmoud, A., A. Castellanos, S. Gupta, and R. Pope. "(072) Genital Self Image and Orgasm Post Trans Affirming Vulvoplasty or Vaginoplasty." The Journal of Sexual Medicine 22, no. Supplement_1 (2025): qdaf068.66. DOI: 10.1093/jsxmed/qdaf068.066

Gieles, Noor C., Karl Gerritse, Eva Zandbergen, Stephanie Both, and Baudewijntje P. C. Kreukels. ""No One Told Me How This Could Be Pleasurable" a Qualitative Focus Group Study into Experiences and Needs of Transgender People in Addressing Sexuality in the Context of Gender-Affirming Medical Care in the Netherlands." Journal of Sex & Marital Therapy  (2024): 1-21. DOI:10.1080/0092623X.2024.2402315

Raigosa, Mauricio, Stefano Avvedimento, Tai Sik Yoon, Juan Cruz‐Gimeno, Guillermo Rodriguez, and Joan Fontdevila. "Male‐to‐Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients." The Journal of Sexual Medicine 12, no. 8 (2015): 1837-45. DOI: 10.1111/jsm.12936

Sabbagh, Paul, Claire Richard, Alice Bourillon, Jean-Nicolas Cornu, Thierry Lebret, Nicolas Morel-Journel, Benoît Peyronnet, et al. "Penile Inversion Vulvo-Vaginoplasty with Scrotal Graft for Trans Women: Surgical Technique and Results of Initial Experience." The Journal of Sexual Medicine 22, no. 1 (2025): 156-64. DOI: 10.1093/jsxmed/qdae135

If you can't get 'em DM me and I'll see what I can do but some are open access and the first one is right on target.