Sexual Relationships 
Sexual Health 
I’m transgender, MtF , and I’m hesitating between two options of bottom surgery.
The full vaginal cavity vaginoplasty versus the zero depth vaginoplasty.
The full vaginal cavity vaginoplasty provides you with a vaginal cavity and a vulva. The zero depth option provides you with a vulva, without creating a vaginal cavity.
The vaginoplasty with full depth is a much riskier surgery because they have to create a cavity in the pelvic area and they have to work between rectum and bladder and that way they could create a “ tear “ between these two organs. This is called a fistula. While a fistula is rather rare it’s still a concern that shouldn’t be left undiscussed. When a fistula occurs one would need revision surgery and you would need to wear a colostomy bag for a limited amount of time.
When going for vaginoplasty without depth, there is no such a risk because they don’t have to create a cavity.
Full vaginoplasty requires you to stretch out the tissue of the vagina regularly because the depth could atrophy otherwise.
This stretching happens by inserting a silicone prosthetic on a daily basis into the vaginal cavity for about half an hour. This is called dilation/dilating.
With the zero depth option you don’t have to dilate as obviously you don’t have any depth.
The zero depth vaginoplasty creates all the minutiae ( details ) of the vulva like a clitoris, a clitoral hood, labia minora and labia majora , the urethra is shortened, but they don’t create a cavity.
With zero depth vaginoplasty you can’t receive any vaginal penetration but you can still receive cunnilingus ( oral sex as a female ).
Both surgical options allow for an orgasm. The zero depth vaginoplasty provides you with a clitoris that can be stimulated. The vaginoplasty with depth also allows the ability for orgasms to happen but the orgasms are also for the biggest part coming from clitoral stimulation. Penetration only doesn’t lead to orgasming in a trans female.
At this point I’m hesitating between the full vaginoplasty with penetrateable depth or the zero depth vaginoplasty that would give me a vulva without a vaginal cavity.
The neovagina is not self-lubricating and not self-cleaning. While the lack of lubrication can be solved by simply using KY lube, the not self-cleaning part is more complex to solve. A neovagina is made by ligning a cavity created in the pelvic area with penile skin. This penile skin doesn’t have the same PH balance as in a natural vagina. There are also no milk acid bacteria present ( lactobasilli ) like in a natural vagina. Therefor the neovagina can’t clean itself and needs to be douched internally regularly. It is prone to bad odor ( foul odor or sour smell ) and smegma build up can happen inside.
With a zero depth vaginoplasty I wouldn’t have to worry about these things. I would get the good parts from the neovagina ( the vulva ) without getting the bad parts ( the difficult to maintain cavity ) .
While I know that it’s not normal for a woman to not be able to have penetrative vaginal sex, it would still allow me to look female even without my clothes on and it would prevent a lot of strain on my body by not going for the more invasive full depth surgery that comes with lots of complications. I would also still be able to receive oral sex as a female.
The contra is that I will be restricted to anal penetration for the rest of my life. I would never be able to receive a penis in my vagina.
For me the most important part about getting gender reassignment surgery is to have female external genitalia so that I can go to the sauna without looking out of place between other naked people and to be able to undress in the presence of my partner without feeling shame for having something down there that doesn’t belong on a woman.
At this point, with my penis, I cannot receive any kind of sexual pleasure related to my genitalia, because I can’t stand to be touched down there. It just doesn’t feel like a part of me.
I’m hesitating between the creation of a vulva only and between the creation of both a vulva and a vagina. As I explained, the latter option comes with a lot more problems. With the former surgery, the time in the operating theater would be much reduced and I wouldn’t have to be put under general anesthesia, they could give me spinal anesthesia only.
I would also have a lot less risks related to the surgery itself and I could get back to my activities within 4 weeks after surgery. With the other option ( the full depth ) recovery can take up to a year and many complications are possible.
I worry though that it would be a major turn off for a male partner, if his girl had only a vulva and no vagina that he could penetrate.
But it’s my body after all.
Whatever I will decide, I will think very long and hard about it.
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