GENDER AFFRMING SURGERY & RECONSTRUCTIVE UROLOGY
Rajveer Purohit is the Director of Reconstructive Urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City, and senior faculty in the Department of Urology. Dr. Purohit specializes in complex pelvic reconstructive surgery such as urethral strictures and fistula repair and gender affirmation surgery such as vaginoplasty, metoidioplasty and phalloplasty.
In 2018, Mt. Sinai appointed him co-director of its first fellowship in Reconstructive Urology that trains methods of gender affirmation surgery including vaginoplasty, metoidioplasty and phalloplasty.
Introduction to Genital Gender Affirmation Surgery for Transgender Women
Introduction to Genital Gender Affirmation Surgery for Transgender Men
Introduction to Transgender Care
Resumption of Surgery and Office Visits
I want to thank my many patients who reached out to me over the last few months – it was profoundly moving and reminded me of how strong a bond I have been lucky to form with so many wonderful people many of whom just happen to also be my patients.
I am pleased to announce that we have resumed our full surgery schedule as of June 8 and our full schedule of regular office visits will resume as of June 22. We have made substantial changes to our practice including steps to minimize the risk of Covid exposure to patients and also will continue to offer telehealth visits in the future.
Rajveer Purohit MD, MPH
Vaginoplasty is a surgical procedure that creates a new, sensitive vagina and adjacent tissues such as clitoris and labia typically using tissue from the penis in transwomen. The vaginoplasty allows transgender and non-binary people to confirm their body image with gender and alleviates gender dysphoria.
Usually, surgeons perform a vaginoplasty using the below-mentioned techniques:
The penile inversion procedure is a common technique in vaginoplasty. The surgeon will construct a vaginal lining using your penile skin. In this method, the surgeon will use the tip of your penis to create a clitoris and use scrotal skin to create the labia majora. The prostate will work as a G-spot, so the surgeon will leave it in place. The surgeon will also take skin from the scrotum, peritoneum or elsewhere to create the depth of the vagina when there isn’t enough skin on the penis. I generally do not consider using skin grafts to build the vulva but rather prefer to use skin that is already there to preserve sensitivity. They can recreate the skin’s sensitivity using skin from the genitals. This technique is one of the standard technique many surgeons use.
In this method, the surgeon will not use your penile skin but a short segment of your colon to create the new vagina . In this procedure, the tissue will self-lubricate. However, in the penile inversion procedure, you have to depend on artificial lubricants. We have typically been doing this surgery using a robotic surgery technique. This minimizes the scarring in the abdomen that some patient can have. The external appearance of the vagina looks very similar to the penile inversion vaginoplasty except internally the lining of the vagina looks softer.
The night before surgery, who will need to drink fluids to help you clean your bowels. In addition, Dr. Purohit asks patients to take a shower with an antibacterial soap the evening before and the morning of surgery. When you visit the clinic in the morning of surgery, Dr. Purohit and the anesthesiologist will be available for you should you have any more questions. They will provide step-by-step details about the procedure and debrief you about the process. Most people will feel anxiety while going through surgery – this is normal. When you undergo penile inversion vaginoplasty, the anesthesiologist will give you general anesthesia and you will gently fall asleep. When you wake up the surgery will be done!
The surgeon will work on your delicate nerve fiber, vasculature, and tissue, making this a complicated procedure. Testicles, if present, will be removed. Most of the penis will be removed and portions of the skin will become the lining of the vagina. The glans penis or the tip of your penis will act as the clitoris. The urethra will be reconstructed to more appropriate for female genitals.
Once they complete the procedure, the surgical team applies bandages. A catheter will be left to help drain urine and a packing will be left in the vagina. A experienced surgeon will take three to six hours to perform the surgery. You need to keep the bandages on for a few days. Typically, you are seen the week after surgery to remove the catheters and the packings.
Your surgeon will guide you through some measures you need to take the night before the surgery or when arriving at the surgery. The anesthesiologist will give you anesthesia, they will ask you to avoid eating or drinking before the surgery. Most surgeons will take skin grafts from areas where there is potential for the hair to grow so it is important to confirm pre-operatively that hair has been adequately removed. Here are some of the tips that you should consider before going through the surgery:
When you undergo any surgery, you are at risk. Sure, in the case of vaginoplasty, there are some risk of complications but most of these can be managed safely. For infections, for example, you can take antibiotics. There are other risks of surgery as well including:
The vast majority of the time surgery results are excellent and satisfying to patients with great cosmetic outcomes and the ability to experience sexual pleasure from the new vagina and erogenous zones’ depth. Furthermore, the clitoris is made from your penile sensitive skin. Your vulva will have a labia minora as well.
Schedule an in person or tele-appointment if you are looking for an expert vaginoplasty surgeon. Dr. Purohit will help you understand the process and best vaginoplasty surgery options.
Rajveer Purohit, MD, MPH
445 East 77th Street
New York, NY 10075