Gender Affirming Scare

In male-to-female (MTF) gender affirmation surgery, one component sometimes involves creating a neocervix, which is typically done through vaginoplasty.* However, the creation of a functional cervix is less common, as it does not serve a biological function in the new anatomy and carries additional surgical risks.

Most vaginoplasty procedures focus on creating external genitalia and a vaginal canal, but in some cases, surgeons create a small internal structure that mimics the cervix cosmetically.

Mayo Clinic’s overview
Verywell Health: post-op care guide
American Academy of Family Physicians Guidelines
*Jejunum option

For post-operative care, recovery can vary based on the complexity of the surgery and the individual’s healing process. Generally, immediate post-operative care lasts around one to two weeks in a medical facility, followed by about six to twelve weeks of rest and restricted activities. Dilation, which is the process of keeping the vaginal canal open, begins shortly after surgery and is a long-term commitment, requiring regular sessions multiple times per day initially and tapering off over months to years. Follow-up visits are typically scheduled at regular intervals within the first year to monitor healing and address any complications.

During male-to-female gender-affirming surgery, vaginoplasty techniques may include forming a cervix-like structure, though this structure does not have biological cervix function. Post-operative care is extensive, typically involving hospital observation for 3 to 7 days. During this period, dressings and surgical drains are monitored, and patients are introduced to vaginal dilation – a necessary procedure to maintain vaginal canal width and depth. Dilation generally starts soon after packing removal and continues daily for the first three months, with frequency decreasing over time.

After discharge, patients need to adhere to several activity restrictions. For example, avoiding baths for up to eight weeks, abstaining from sexual activity for approximately 12 weeks, and gradually resuming physical activities over six weeks. Diligent hygiene practices and long-term monitoring for potential complications, such as infections, are also essential. Lifelong follow-up care, including ongoing dilation if not sexually active, is necessary to maintain results and address any complications that might arise.

You can learn more in detail about the surgery and aftercare from the Mayo Clinic and other reliable sources like Verywell Health and the American Academy of Family Physicians.

https://youtu.be/xcZBa4TaLc8

https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.639430/full
https://www.transhealthcare.org/research/del-corral/
https://www.mdpi.com/2077-0383/13/10/2760

Jejunum option

In some male-to-female gender-affirming surgeries, the jejunum, part of the small intestine, is used to create a neovagina, especially in cases where patients lack sufficient genital or other donor skin, or in revision surgeries when the original procedure did not yield adequate vaginal depth or function.

This technique, known as intestinal vaginoplasty, uses a section of the jejunum to construct the vaginal canal, as it provides a mucosal surface similar to that of a natural vagina. This mucosal surface offers better lubrication, reducing dryness and making the outcome more satisfactory for some patients.

The jejunum also has a unique blood supply that allows for a stable, self-lubricating neovagina, potentially reducing the likelihood of complications like stenosis (narrowing of the vaginal canal).

This method may involve a longer surgery and recovery time than penile inversion vaginoplasty but often results in fewer cases of stenosis or contracture, making it a preferred choice for complex cases or revisions .