Genital Reconstructive Surgery
This surgery is performed to create female genitalia, including a neoclitoris and neovagina (if requested), using the patient’s external genitalia.
Some patients do not wish to have a vaginal cavity created, electing instead to have a vaginal ‘dimple’ created.
Genital Reconstruction Patient 1
Genital Reconstruction Patient 2
Genital Reconstruction Patient 3
Genital Reconstruction Patient 4
Genital Reconstruction Patient 5
Mr Ives performs the “Inverted Penile skin” technique. Most surgeons performing genital reconstructive surgery use a variation of this technique, and Mr Ives, like them, uses his own variations on the procedure.
The skin of the penis is used to create the lining of some of the perineum, opening to vagina, and the lining of the vagina as well. Scrotal skin, if required, is used to line the top part of the vaginal cavity.
The testicles are removed. The head of the penis, the glans is used to create the neoclitoris, erating the nerves and blood vessels so that most patients can retain the ability to have an orgasm post operatively.
The operation takes about 3-4 hours to perform, in a single stage.
This procedure is similar to vaginoplasty, however, a neovagina is not created. Instead a vaginal dimple is created.
The final result of the procedure looks exactly the same as the vaginoplasty result externally. However, patients do not have to dilate since they have no cavity.
Frequently Asked Questions
During your consultation with Mr Ives, you will be asked about your past medical history and your general health. You will also be asked about your journey to date, including when you started your hormone therapy.
Mr Ives will then examine your abdomen and perineum. Skin quality and tissue volume will be assessed.
Mr Ives will then discuss the operation with you. He will also discuss the postoperative regime and the amount of time you will spend in hospital, as well as the length of time you will need to stay in Melbourne if you are from country Victoria or Interstate.
A second consultation will also be arranged. If you are one of our interstate patients this can be done over the phone or by Skype.
At the second consultation Mr Ives will discuss the operation and the risks of surgery with you again.
You can book surgery for whenever. However, Mr Ives will not perform the surgery without the WPATH criteria being met and having the relevant report(s) See “WPATH criteria”.
Laser hair removal or electrolysis is recommended but not required. Whichever is performed, you will need to complete your treatments at least 3 weeks prior to your genital reconstructive surgery.
An information sheet with the minimum areas that are recommended for treatment will be given to you as part of your information pack following your consultation.
Your general medical health is very important. Make sure you bring your referral letter with you. Also inform Mr Ives of all medical conditions that you have or have suffered from. This includes operations that you may have had as a child.
If you are a diabetic, it’s important to optimize your medical control of this in the lead up to surgery.
If you have a medical condition, or are over the age of 55, Mr Ives advises consultation with one of the general medical physicians at Masada hospital, who will help manage this medical condition whilst you are an inpatient at Masada. Mr Ives will discuss this with you at your initial consultation.
If you have a cardiac condition it may be necessary to perform your surgery at Knox Hospital. Please make certain you have up to date reports and results from your treating cardiologists when you come for your consultation.
You must also consider your weight. Mr Ives WILL NOT operate if your weight is over 100kg (unless height/weight proportional), or your BMI is >30 (again, unless height/weight proportional).
The anaesthetic complications and postoperative complications increase significantly above these parameters.
Smoking also increases the majority of complications following surgery. You must stop smoking at least 4-6 weeks prior to surgery, and abstain for at least 6 weeks following surgery.
Mr Ives performs most of his gender surgery at Masada Hospital in East St Kilda. He also operates at Knox Hospital in Wantirna, for patients who have complex medical histories.
It is therefore important to inform Mr Ives of all your past medical history so he can determine the safest place to perform your surgery.
Patients stay in hospital for at least 7 nights. The vaginal pack is removed on day 6 and the catheter on day 7. Patients then use a mould for 6 days, and then patients return to Mr Ives’ rooms to commence dilatation. The week using moulds gives the vaginal lining some extra time to heal, before commencing dilation, and insertion of the mould allows patients to become more familiar with their anatomy, before starting using the harder, larger dilators.
If you are from interstate, then you need to plan to stay in Melbourne for about 17-19 days in total. Of this, the first eight days are as an inpatient at Masada hospital. Obviously, this is only an estimation of the total time that may be required to stay.
Total recovery can take up to 12 weeks, but most patients are able to resume work after 6 weeks or so, depending on their occupation. Strenuous activity, including sex should be avoided for 8-12 weeks.
After your discharge from hospital you will be seen by Mr Ives at his rooms one week later to be given your dilators, and instructed on how to use them.
Our routine follow up after this is one month later, and then again at 3 months, six months and one year.
If you are from interstate, these appointments can be performed over the phone or via a Skype.
If you are in town though, we are happy to see you any time. It’s always nice to review results and your progress face to face. The rooms will always try and accommodate a time that is suitable for you.
However, the sooner you can let us know you are in town the easier it is to organise the appointment.
If you are from out of town or interstate, we advise organizing a review with your regular doctor about a month after you return home.
Long term follow up should again be organized with your regular doctor. A yearly review of your vagina with a speculum examination is recommended.
Some bleeding postoperatively can be due to the presence of granulation tissue. This can be treated with excision, and/or silver nitrate application.
This can again be performed or coordinated with Mr Ives.
Any operation has risks associated with it. Complications rarely occur. Mr Ives will discuss these with you during the consultation.
Complications from surgery can be divided into ‘General Complications’ that you can get from this or any other operation, and ‘Specific Complications’ that are specific to the operation itself.
General complications include:
- Keloids (lumpy scars)
- Deep Vein Thrombosis (DVT) – clots in the legs
- Haematoma (collection of blood in the wound) and bleeding
- Anaesthetic complications
Specific complications include:
- Perforation of bladder. May have permanent urinary incontinence
- Rectal perforation requiring repair
- Rectovaginal fistula – may need temporary/permanent colostomy
- Disruption of anal sphincter – causing faecal incontinence
- Loss of neoclitois
- Loss of vaginal depth
- Need for secondary surgery
Mr Ives will discuss with you the risks of surgery during your initial consultation.
Timing to restart hormones and what dose is controversial. Mr Ives advises that after discharge from hospital you contact the doctor who is prescribing your hormones and ask them when and what dose of hormones they would like you to recommence on.
As a general rule of thumb, half the dose that you were on prior to surgery is a good guide, but ask your regular prescriber.