Vaginal reconstruction

Vaginal reconstruction means creating a new or artificial vagina. You might be able to have a vaginal reconstruction if you have surgery to remove all or part of your vagina.

How doctors reconstruct a vagina

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 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. It might not always be successful. It is important to discuss the benefits and risks of this surgery with your doctor.

After surgery

Your surgeon or specialist nurse will tell you how to look after your reconstructed vagina while it heals.

Using dilators

Once the area has healed, you may 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. Dilators are smooth cone shaped objects that you put into your vagina to stretch it. They come in sets of different sizes. Your specialist nurse will tell you if you need to use them and when to start.

Your nurse will explain how to use them. You begin with a small dilator of a comfortable size, afterwards you can use larger ones. You continue using them until your vagina is stretched enough for you to have sex comfortably. Using dilators can also help vaginal examinations be less uncomfortable. 

It's important to use the dilator regularly to help keep the vagina open. 

Usually, you can use the dilator less often after about 3 months, but you may always need to use them from time to time.

Speak to your healthcare team if you have any problems or questions, or if you don’t feel comfortable with using dilators for any reason.

Using dilators and having sex

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 people 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 the 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

Coping

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.

Lubrication

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 healthcare team which lubricants or creams to use.

Sensation

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. Some people describe this sensation as feeling as if their 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 people 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.

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.

Bleeding

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.

Getting help

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.

Possible risks of surgery

Wound infection

You are at risk of getting an infection after surgery. Tell your doctor or nurse if your wound:

• looks red or swollen
• feels warm
• is painful
• leaks fluid (discharge)

Other symptoms of infection include:

• a high temperature
• shivering
• feeling hot and cold
• feeling generally unwell
• feeling sick

Your doctor can give you antibiotics. Occasionally you may need another operation to treat the infection.

Swelling and bruising 

You may have some swelling around the area of surgery. This should settle in a few days.

Bleeding

You may notice spotting or bleeding for a few days after your surgery. Call your hospital advice line if this continues longer or becomes heavy.

Pain

It’s normal to have pain for the first week or so after your surgery. You have painkillers to help.

Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

Immediately after surgery you might have painkillers through a drip into the bloodstream that you control. This is called patient controlled analgesia (PCA). Analgesia is another word for painkillers. 

You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your doctor if you still have pain or if it gets worse.