(h/t Maddie for the title)
This past weekend I shared my big news about my upcoming vulvoplasty in December. Vulvoplasty - also known as zero depth vaginoplasty, since no vaginal canal is created - is a gender reassignment surgery that is growing in popularity. I want to add my voice to the number of personal accounts about this surgery by explaining why I chose it, my experiences that led me to it, and where I’m at with my feelings at the moment.
Full disclosure, this post is going to get into a fair bit about sex and anatomy and my experiences therein.
Road to Zero Depth
When you spend so much of your life telling yourself that you are wrong to want things, it can be hard after coming out to relearn how to recognize your desires. It was about six months into transition that I was first able to acknowledge that I wanted some form of GRS. I was going through the common early HRT experience of a sex drive crash and reboot, as well as the start of the slow changes that happen to transfem genitals on HRT. All this tumult in my body made me feel like this sexless amorphous blob. Eventually I realized that I wanted to enjoy seeing and feeling my body, but my genitals just weren’t cutting it for me any more. I began looking into vaginoplasty as an option and was crushed to find that the waitlists for nearby surgeons were years long. I decided to pursue an orchiectomy in the short term and get on a vaginoplasty waitlist in the hopes that several years down the road I could have the procedure without having to go out of state.
My orchiectomy in April last year changed things for me much more than I could have expected, and I started to find increasing comfort with my own body and sex. I learned that much of my pre-transition approach to sex had centered around projection and dissociation, often deflecting from my needs by focusing on my partners’ needs in order to distract myself and my partners from paying attention to my body. I slowly started to accept that it was okay for me to want things from my body and from sex, and that my partners were more than happy to meet me where I was. Though things had improved, vaginoplasty remained my longer term goal.
After more than a years’ wait, I attended a consult for a vaginoplasty this past May. The procedure I was interested in was a laparoscopic peritoneal pull through (PPT), or as Lilith calls it, a “robopussy.” Because the consult had been scheduled so far out I had done a lot of reading in the intervening year, and so I went into the appointment thinking that I would be familiar with most of what the PA planned to cover with me. Instead, I found myself absolutely devastated as we reviewed the surgery, potential risks, and what recovery and long term maintenance would look like. I learned that this particular approach has no advantages over penile inversion (PIV) besides maybe adding an additional centimeter of depth. It occurred to me then that depth wasn’t a priority for me, and that maybe I needed to do some more introspection about what it was that I wanted out of GRS. After the consult I felt dazed and depressed for a little while, but I decided to remain on the waitlist and do some more soul-searching and research. My next appointment before surgery was going to be the following May with surgery potentially in 2027, so I had plenty of time to reflect.
A few days after the consult, my “Cave Girl” moment helped solidify for me that I really wanted a vulva with labia and a clitoris more than a vagina. I started looking into minimal depth and zero depth options, and reached out to a couple of clinics. In a stroke of luck, the PA I had consulted with said that my surgeon also offered vulvoplasties, and that timelines would be much shorter. We scheduled a second consult at the end of August to review differences between the surgeries. Imagine my surprise when the PA ended the visit by telling me they were putting my surgery order in and that I would most likely be scheduled before the end of the year. Within a few days a scheduler reached out to me, and I had a date in December!
Why a vulvoplasty?
I know a lot of people might ask, “why get a vulvoplasty when you could get a vaginoplasty?” While it’s true that I’m a good candidate for full-depth, the simple answer is that it's not a commitment that I'm willing to make. While neovaginas are quite impressive in their construction and function, they come with their own compromises just like any GRS. With that in mind, I’ve been trying to think about GRS less as a way to resolve dysphoria or "correct" something to be closer to a cis genital experience. Instead, I'm trying to make my choices based on what will align best with my desires. I want to be clear here that just because I don't want a vaginoplasty doesn't mean that I don't think it's a good decision for someone else to get one, it's just not the right surgery for me.
Once I understood that I needed to look at GRS from a pragmatic perspective, I started reviewing my priorities. My top priority is my experience of seeing and handling my own body, so I know that I wanted to change my external genitalia. That means getting my clit rearranged, and having labia and a shorter urethra formed. I’m not terribly concerned about how my labia are going to look, as long as they’re there. There’s a lot of talk on places like the transgender surgeries subreddit about “aesthetics” or “cis-looking vaginas,” but ever since I worked tech for the Vagina Monologues in college in order to impress a certain person who I ended up marrying, I’ve internalized the knowledge that each pussy is unique in its appearance.
My next priority is my enjoyment of sex. Loss of clitoral sensation is an outcome for some in either vaginoplasty or vulvoplasty, and for others it’s a long slow process to relearn what pleasure feels like in the clitoris. Not having to deal with a penis any more is worth the risk for me. Penetration is important for me too, but I already have a way to do that that meets my needs quite well. Damage to prostate nerves is a risk in some approaches to vaginoplasty, and other people report reduced prostate response after vaginoplasty once the canal is in place between the prostate and rectum. Some surgeons doing minimal depth vaginoplasty (just inverting penile tissue, no dilation needed) attach the smaller canal to the prostate to enable easier stimulation, but I worry about long-term risks there. Given that I’m making big changes to my clit, I want to preserve at least one reliable avenue to pleasure, and for me that means leaving my p-spot be.
Lastly, I don’t want to deal with the maintenance of regular dilation of a vaginal canal. Plenty of women say that it’s not much of a concern most of the time, but the truth is I just don’t want to have to think about it. If I were incapacitated in some way I could lose depth by neglecting regular dilation, which could lead to further health complications. With my migraines and my chronic illness, my body requires enough maintenance as is. Thankfully if I realize later on that I would prefer a canal, I can still get one installed in a followup surgery. It won’t be as easy or affordable as a one-shot, but it’s nice to know that it’s not entirely off the table.
What’s Next
The next few months are going to be filled with a lot of anxiety and excitement for me as I prepare for my surgery and the weeks of recovery that will follow. I recognize in my gut what has become a familiar nervousness in my transition, that feeling of sizing up the chasm before the required leap of faith. It might seem like a contradiction to say that I feel confident as well, but I’m pretty sure that until they roll me back into the operating room and knock me out I’m going to be sitting with some anxiety no matter what. I’m confident in that I feel like I’ve done my due diligence in understanding my options for GRS, and in the steps that brought me to choosing vulvoplasty I’ve grown in my understanding of myself and how to recognize my desires. All of GRS is a compromise, but I’m compromising on my terms.