Vaginal Remnant after Phalloplasty or Metoidioplasty

What is a vaginal remnant?

A vaginal remnant is vagina like tissue remains after gender affirming surgery in transmen who have had their vagina surgically removed.

Wait I thought my vagina was removed – why do I still have a vaginal remnant?

The vaginal remnant occurs for 2 interrelated reasons. One – is that not all of the vagina is removed at the time of surgery.  The second reason is that a downstream stricture causes increased pressure into the area where the vagina was closed- reopening it and then vaginal cells populated the area to make it looks like a vagina.

What is the problem with having a vaginal remnant?

The vaginal remnant can retain urine when you urinate. This causes dribbling after you have urinated.  More importantly, perhaps, the remnant can be a source of infection, pain and fistula formation.

How do you fix a vaginal remnant after phalloplasty or metoidioplasty?

The vaginal remnant can be fixed in 2 ways. For large remnants, an approach from the abdomen using laparoscopic or robotic instruments can be helpful to cut out the section. For smaller remnants, the section can be removed by making an incision from behind the scrotum or in front of the rectum.

It is important to fix the underlying cause of the remnant as well or otherwise there is a risk that the vaginal remnant can come back.

How is recovery after surgery?

It depends on how big the remnant is and whether an underlying problem such as stricture needs to be fixed or not.  Usually patients stay in the hospital overnight and go home the day after surgery.