Vaginal reconstruction

• A quick guide to what's on this page
• What a vaginal reconstruction is
• How a vaginal reconstruction is done
• Looking after a vaginal reconstruction
• Having sex after a vaginal reconstruction

Vaginal reconstruction means creating a new or artificial vagina. This operation is sometimes done after surgery to remove part or all of the vagina (vaginectomy).

If you are going to have a partial or radical vaginectomy, you should ask your doctor whether vaginal reconstruction is going to be possible. One of the aims of reconstruction is to make vaginal sexual intercourse possible again. But this operation may not be suitable for all women because it adds to the length of surgical treatment. And, as with other vaginal surgery, has possible side effects.

A specialist doctor, called a plastic surgeon, carries out vaginal reconstructions. The plastic surgeon uses skin and muscle from other parts of your body to create a new vagina. The surgeon may use

• A skin graft from the side of your bottom (buttock)
• Muscle and skin from your inner thighs
• Muscle tissue from your lower abdomen (this is called a TRAM flap or "transverse rectus abdominus muscle")
• A piece of your bowel

To start with, your own surgeon will tell you how to look after your reconstructed vagina. They may advise you to have salt baths or ask you to use a vaginal douche to keep the area clean while it heals.

Once the area has healed, you will need to start a regular routine to keep the new vagina tissue healthy. Depending on how your surgeon has made the vagina, you may need to use a dilator to keep the vagina open. Your doctor or specialist nurse will give you a set of dilators if you need them.

Dilators are cone shaped objects that you put into your vagina to stretch it. They come in sets of different sizes. You use them with a water soluble lubricating gel. You begin with one of a comfortable size and use larger ones until your vagina is stretched enough for you to have sex comfortably. You may need to leave the dilator in place for long periods during the day or night for some months after your surgery. It is most important that you use the dilator regularly after surgery to make sure that the area heals well. This helps to make sure that the new vagina eventually works as well as possible. Usually, you can use the dilator less often after about 3 months, but you may always need to use it from time to time.

The dilator may be a constant reminder of what has happened to you and the loss that you are likely to feel. You will need to give yourself time to adjust to these changes. If you are in a relationship then having sexual intercourse will also help keep the vagina open. You may be able to stop using the dilator if you are having regular sex. But don't worry if you don't feel ready for this for a while after your surgery. Everyone is different and for most women this type of surgery is very difficult to come to terms with. But you will need to keep your new vagina open one way or another, as without a dilator or sexual intercourse it may shrink.

If your surgeon uses tissue from your lower abdomen (known as a TRAM flap) or your thigh muscle to make your reconstructed vagina, the tissues will be shaped into a sealed tube and sewn in place. With this type of reconstruction you don't need to use a dilator to keep your vagina open. This is because the blood vessels and nerves from these tissues will stay attached. Soon after surgery, the new vagina will begin to work in the same way as your original vagina did.

A new vagina made from tissue that comes from part of your bowel can hold its natural shape and is more likely to be able to produce lubrication. But, there can be problems with smell and a discharge when part of the bowel is used. This may not be the case for all women.

It is very likely that having a sexual relationship with a new vagina will be difficult at first. You will probably feel very strange and wonder if you will be able to feel anything or enjoy having sex. You may feel very self-conscious and be worried that your partner is not enjoying being with you. This is only natural, but with time, and loving support from your partner your new vagina will start to feel more like a normal vagina. And sexual intercourse will be possible.

You will need to use a lubricant when you have intercourse, as your new vagina will not moisten as well or as quickly as before. There is more information about sex and vaginal reconstruction in the section on living with vaginal cancer.