My opinions on vaginoplasty

Some of these are a bit controversial, and they only reflect my personal opinion. You should think about these issues yourself and discuss them with family, friends and therapists to make sure you've come to the right decision for you.

General comments

I have some very strong opinions on prioritizing vaginoplasty in your transition:

I think vaginoplasty is one of the last things to worry about, and shouldn't really even be dealt with until you are full-time.

I feel vaginoplasty has almost nothing to do with your ability to function in society. The only place it will be important is in a tiny handful of intimate situations (whether sexual or not). So, in other words, it's important, but it has almost nothing to do with your ability to keep a job or to walk down the street without being harassed for being a trans woman.

Facial hair removal, voice and face should be your first priorities (after coming to terms with your feelings). See my discussion of setting up your transition timetable for more on this.

My site has information on most major vaginoplasty surgeons' recommendations for genital electrolysis prior to vaginoplasty. This is a very important thing to consider, as genital electrolysis can make a major difference in the quality of your surgical outcome.

Why I chose to have vaginoplasty

While this might seem like a no-brainer, it's actually important to think long and hard about whether vaginoplasty is right for you.

Some reasons not to get vaginoplasty

  • It's expensive
  • It has almost nothing to do with your daily existence as female
  • It won't necessarily make you happier
  • Maintenance: regular dilation and douching is a must
  • There are serious potential complications, including loss of sexual sensation and even death

Some reasons to get vaginoplasty

  • It can make some women feel more complete
  • It can fulfill an emotional or sexual desire to have a vagina
  • It can make sexual intimacy easier
  • It can make highly gendered situations like locker rooms easier
  • It can make wearing certain types of clothes easier
  • It can make certain legal procedures like changing some documentation and marriage easier
  • Once vaginoplasty is important to you, having vaginoplasty eliminates the anxiety of wanting it

I decided for me, it was a good option, but to be honest, it was not a driving force in my life. I'm glad I did it, but I could have been fine without it. It was like fixing something that was a minor annoyance for me.

Importance/priority of vaginoplasty

I think far too many trans women overfocus on vaginoplasty as defining success in their transition. This can lead to a lot of frustration and disappointment. I feel it's more like icing on the cake than the be-all and end-all of transition.

Most people have limited financial resources to get through transition. Vaginoplasty is the last physical step most people take, and it should be treated as such. You should plan on getting everything else you want done first if you can. Those who focus on vaginoplasty to the exclusion of other transition issues like self-acceptance, hair removal, and voice practice often find that it's difficult to function in society at large.

I don't derive my identity from my genitals. Those who do are setting themselves up for some serious potential problems. If you think "I have a vagina, so I'm female," but you don't have what society considers to be acceptable "female" presentation, the general public may not necessarily agree with you.

That's what living as a woman is all about. If you can't deal with the daily interactions required to function in society, vaginoplasty isn't going to do a whole lot to change that.

Why I chose Meltzer

OK, people kept asking for my reasons, so here they are. However, the letters taking issue with my statements started coming in the day after I posted this page, so here's the disclaimer.

These are my personal reasons for choosing Meltzer in 1998, based on my own research and the experiences of several friends. All surgeons have both good and bad outcomes, and much has changed as far as options since then. The candid views and impressions I share here are no substitute for your own research.

That said, there are several good surgeons. My criteria were these in order:

I wanted to have orgasms.

I wanted the best cosmetic result.

I wanted the lowest occurrence of problems.

I wanted someone with a lot of experience.

I wanted someone in the US or Canada.

Money was not an issue. I think of vaginoplasty and other transition costs as an investment rather than an expense. Not to say it wasn't hard for me to get the money (I am by no means wealthy), but I wanted the best result regardless of cost. Vaginoplasty really isn't that much in terms of other major purchases. About the cost of a new car. The range for those who pay for vaginoplasty is about $5,000 to about $16,000. If I make it to 70, the difference between the least and most expensive options I was considering works out to an extra buck a day.

I know several Meltzer patients personally who were done and happy, and I had seen their results. After comparing them with results of other surgeons, and comparing patient experiences, I was down to Schrang and Meltzer.

I ruled out Menard's one-step procedure because I wasn't impressed with the labial/clitoral shape and placement on a friend.

I was also a little concerned that Schrang recommends patients donate blood in case of a transfusion, and that he frequently transfuses patients. My concerns about his blood loss in surgery were amplified in summer 1998, when a friend of mine nearly bled to death in her hospital room from a massive hemorrhage. I also heard from some patients that Schrang is especially friendly to attractive patients and a bit of a "father knows best" type when you have concerns.

Given these factors, after doing research, Meltzer came out as the frontrunner. My consultation with him in April 1998 sealed the deal, and I had surgery in June.

My straight-up opinion: if you want the best, go to Meltzer. For those with limited budgets, go to Sanguan in Thailand, or Brassard in Montreal.

If you want to put in a good word for your own surgeon because you feel my views don't match your own experiences, please submit a detailed account of your experiences.

Vaginoplasty won't solve all your problems

Vaginoplasty, and transitioning in general, will not necessarily make you happier. You need to be well-adjusted and happy prior to surgery. Vaginoplasty is a treatment, not a cure, I feel. You will not wake up after surgery and have everything in life suddenly change for the better. It can make you feel better about yourself. It can make you feel complete. These things can help you deal with other issues better, but problems don't magically disappear once you leave the hospital.

The key to all of this is self-acceptance. If you haven't read the essays on self-acceptance, I urge you to do so.

You're not "done" after vaginoplasty

Transitioning is never easy, and it's never really over. Eventually, transition takes up less of your mental energy. You suddenly have a disposable income again. You might feel comfortable in certain situations where you did not before. However, some of the quintessential issues of being a trans woman remain with you for the rest of your life. Being accepted as female socially. When to tell lovers/partners. Stealth or not. Discrimination. Employment issues. Financial issues. Family issues. The problems may change a bit, but you will still have many of the old problems and possibly some of the new ones.

Paula writes:

No doubt living with TS ness is unique. I have come to the conclusion that at some point I have or will have reached a spot where TS ness is just not that important. There are so many life issues that are just part of living. If you have made the effort to be a "woman" and that is how society sees and treats you, then TS ness submerges below the threshold of yours and others reality. You simply live. Just as life issue raise their heads above the threshold and you have to deal with them, so will TS ness issues. Just take them as they come, just like any other life issue. This is how I have begun to live. The major difference for me is that I now can live. I'm not a drone. I'm not what society has simply demanded of me because of my birth genitals I am me. I actually became me long ago but societal demands restricted my ability to live. Much of that goes away when you begin to pass and go full time. There is a lingering anxiety that a situation will come along which will be difficult to explain. SRS helps that but not much more. There is also the anxiety leading to the SRS date. It is quite a burden once you know SRS is right. I no longer have anxiety about reaching the point where its just me and reality. SRS took care of that.

Finally, many people get done with vaginoplasty and find themselves without direction. It's like striving to climb a mountain, and when you finally reach the top, you look around at everything and say, where do I go now? I did this to some extent. I also found myself quite depressed about a month after surgery. I was back at work, not healed yet, and feeling like I'd done all this stuff without anything really changing. It was very disconcerting.

Eventually, I found new direction, and started thinking about what I want in life. I've spent several years scrimping and saving, depriving myself, and I actually got used to this small existence I'd built for myself. I finally realized it's time to have some fun in life!

Again, the key to all of this is self-acceptance. If you haven't read the essays on self-acceptance, I urge you to do so.

Vaginoplasty can be a great procedure that can improve your life. Just make sure it's right for you.