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Vaginectomy Reduces the Risk of Urethral Complications

A 2018 study confirms what many Phalloplasty Surgeons have come to believe: that Vaginectomy reduces complications related to Urethral Lengthening. While Vaginectomy is not a strict pre-requisite for Phalloplasty, most surgeons will require Vaginectomy if Urethral Lengthening (UL) is also being performed. Here's important information to consider if you're planning to have UL and are on the fence about having a Vaginectomy.

Vaginectomy is a gender-affirming surgery procedure that removes the vaginal mucosa, fuses the vaginal walls and and closes the vaginal opening. There are several reasons why trans men and non-binary individuals opt to have a Vaginectomy, including:

  • The desire to have the vagina removed and have a male perineum.
  • To eliminate the secretions produced by vaginal mucosa.
  • To eliminate pain from a gynecological condition.
  • To eliminate the need for speculum exams or Pap tests.

Another reason that many Phalloplasty patients opt to have Vaginectomy surgery is because of the belief that it reduces complications related to UL.

A 2018 study confirms that Vaginectomy decreases the rate of urethral fistulas. The gender surgery team at VU University Medical Center and Gender Surgery Amsterdam in Amsterdam, Netherlands described the development and treatment of fistulas following Metoidioplasty and Phalloplasty with UL in 294 transgender men. At their institution, Vaginectomy is performed in Stage 1 ("primary" Vaginectomy) and UL is performed in Stage 2. (See: How Phalloplasty Is Staged) Vaginectomy is now a standard procedure prior to Phalloplasty with UL at Gender Surgery Amsterdam because of the decreased fistula rates in patients who underwent primary Vaginectomy.

"A urethral fistula developed in 111 of the 232 patients (48%) without Vaginectomy and in 13 of the 62 (21%) who underwent primary Vaginectomy. Secondary Vaginectomy resulted in 100% fistula closure when performed in 17 patients with recurrent urethral fistula."

Dr. Jonathan Keith - Phalloplasty in New Jersey Dr. Jonathan Keith, a Phalloplasty Surgeon in New Jersey, agrees that Vaginectomy should be done if UL is to be performed. "There is excellent data confirming that UL without Vaginectomy has significantly increased morbidity rates with respect to strictures and fistula formation."

Dr. Burt Webb, who works with Dr. Toby Meltzer in Scottsdale, Arizona, is one of the most experienced surgeons in the United States when it comes to FTM gynecological surgery and a noted expert in Vaginectomy. Dr. Webb believes that by eliminating vaginal secretions and improving blood flow to the urethra by fusing the vaginal walls, the urethral junction heals better. He noted very low rates of complication with UL in Phalloplasty patients who had Vaginectomy.

"A normal complication rate when [Vaginectomy] is not done is roughly 40-45% ...the complication rate when a Vaginectomy is performed with these procedures is less than 3%." - Source: ftmdoctor.com

Phalloplasty Surgeon Dr. Curtis Crane, who is based in Austin, Texas, described complication rates of at least 25% when Vaginectomy is not performed alongside UL, and rates of 10-20% when it is performed. Dr. Crane does not require patients to have Vaginectomy with UL.

Dr. Daniel Freet - Phalloplasty Surgeon in Houston, TexasLike Dr. Crane, Dr. Daniel Freet, a Phalloplasty Surgeon in Houston, Texas, also does not require patients to have Vaginectomy with UL but he thinks it is an important topic to discuss with patients at the time of consultation. "I do not require Vaginectomy for Urethroplasty, but I do counsel patients that they will be less likely to have Urethral Complications if they have Vaginectomy at the time of Urethroplasty," he says.

Because Vaginectomy appears to reduce complications associated with the neourethra, most surgeons require a Vaginectomy for patients undergoing Phalloplasty if Urethral Lengthening is being performed. However, if vaginal preservation along with UL is important to you, you can find a list of surgeons who don't require Vaginectomy with UL here.

Related Studies

Vaginal and reproductive organ preservation in trans men undergoing gender-affirming phalloplasty: technical considerations [FULL TEXT]
Christopher J Salgado, Kerstin Yu, and Maria J Lalama. J Surg Case Rep. 2021 Dec; 2021(12).
Preservation of the vaginal canal with reproductive organs is uncommon though becoming increasingly discussed in trans men. In cases where the vagina is preserved, the method with least complications is to maintain the native urethral orifice. Urethral lengthening requires modification of the anterior wall of the vagina, which may narrow the vaginal canal and risk urethral sequelae. In cases where the reproductive organs or vaginal canal with the cervix have been preserved, screening for cancer is best followed by both a urologist and gynecologist so that surveillance is adequately maintained by physicians knowledgeable of this particular anatomy.

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Last updated: 10/05/23



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