Gender-affirming vaginoplasty in Thessaloniki and Athens, Greece

Vaginoplasty is the surgical creation of a vagina and feminine external genitalia. The most common technique is penile inversion, with a skin graft from the scrotum when needed. The clitoris is formed from part of the glans, keeping its nerves and blood vessels, and the whole operation is done in a single stage.

That single stage includes orchiectomy, removal of the corpora cavernosa, lining of the new vagina with penile skin, shaping of the clitoris and labia, and shortening and repositioning of the urethra.

The aim is a vagina with depth and width, with sensation preserved. The erectile tissue around the entrance is removed. The new vagina has no natural mucous lining and its moisture is limited, so sometimes lubricant may be needed.

Vaginoplasty suits adults with marked and persistent gender incongruence. I follow the WPATH Standards of Care, Version 8 (SOC8): an assessment by a qualified health professional and at least 6 months of hormone therapy, unless you do not want it or it is contraindicated. You also need good health and a firm commitment to dilation.

Preparation starts months before surgery. At the consultation we agree on realistic goals and I examine you. Then come permanent hair removal of the skin that will line the vagina, fertility planning, pre-operative tests, stopping smoking and, often, an adjustment of oestrogen. The date is set once all of this is complete.

What happens at the consultation?

We talk about what you expect from the operation and what it can realistically achieve. I examine the genital area and the amount of penile and scrotal skin, which determines the depth of the vagina and whether a graft will be needed. I ask for one assessment by a qualified health professional and an update from your endocrinologist on your hormone therapy. We discuss fertility: after orchiectomy, sperm production stops permanently, so if you want biological children in the future, sperm cryopreservation is done before surgery. I explain the dilation programme and the risks in detail. You receive a written plan and a quote.

What tests and instructions apply before surgery?

You need pre-operative blood tests, a check for general anaesthesia and anything else the anaesthetist asks for. Permanent hair removal from the skin that will line the vagina, by laser or electrolysis, starts several months beforehand, so that hair does not grow inside the new vagina. Oestrogen therapy is often stopped or reduced for a few weeks around surgery because of the risk of thrombosis, always in agreement with your endocrinologist. Smoking increases healing complications; stop at least 4 weeks before and 4 weeks after surgery. If you take anticoagulants or antiplatelet medicines, tell me; they are stopped only in agreement with the doctor who prescribes them. Bowel preparation is done the day before. The date of surgery is set once the assessment, hair removal and tests are complete.

Vaginoplasty is performed under general anaesthesia and usually takes 3 to 5 hours. The testes and corpora cavernosa are removed, the penile skin is inverted, and a long flap of urethra is added to it. The clitoris is formed from the glans. A few days in hospital with a urinary catheter follow.

The new vagina is created in a space carefully opened between the bladder and the rectum. At the end of the operation, packing is placed inside the vagina so that the skin adheres to the walls, together with a urinary catheter for the first days.

Penile inversion and hybrid vaginoplasty

The penile skin is freed, turned inside out like a glove and placed in the new space to form the vaginal walls. When the skin is not enough for the desired depth, it is supplemented with a skin graft from the scrotum. The testes (orchiectomy) and the corpora cavernosa are removed, and the spongy tissue around the urethra is reduced, so that the vaginal entrance does not swell during arousal. A variation I choose very often is hybrid vaginoplasty, in which I use part of the penile urethra to line the upper wall of the vagina. This gives better glide during intercourse, partial self-lubrication of the vagina and a better aesthetic result.

Clitoroplasty and labiaplasty

The clitoris is formed from part of the glans, moved together with the dorsal neurovascular bundle, that is, the blood vessels and nerves that supply it. This preserves sensation and the ability to reach orgasm. The labia majora are shaped from scrotal skin and the labia minora from the surrounding skin, so that the vaginal entrance is wide and the appearance feminine. The urethral opening is placed below the clitoris.

Alternative techniques

When very little skin is available, for example after early puberty suppression, or after a previous vaginoplasty has failed, other surgical teams use peritoneum or a segment of bowel to line the vagina. These are specialised techniques performed by general surgeons; if you need one, I will guide you accordingly.

Incisions and stitches

The incisions lie in the perineum and the labia and are hidden in the natural folds. The stitches are absorbable and do not need removing. The scars mature and fade within 6 to 12 months.

Can vaginoplasty be combined with other procedures?

Vaginoplasty is usually performed as a stand-alone operation. Other gender-affirming procedures, such as breast augmentation or facial feminisation (facial feminization surgery), are usually scheduled separately. Small revisions of the labia or clitoris, if needed, are done as a second stage a few months later.

Hospital stay

The hospital stay usually lasts 3 to 5 days. You stay in bed for the first days with the vaginal packing and the urinary catheter, and you receive anti-thrombotic treatment. Before discharge the packing and catheter are removed, we check that you pass urine normally, and I teach you how to dilate.

Recovery takes about 2 months and needs close follow-up. You spend the first days in hospital with a urinary catheter and vaginal packing. Once they are removed, dilation with dilators begins, several times a day at first and gradually less often. Dilation then continues for a long time on a lighter schedule.

Plan to stay in Greece for 3 weeks in total. The hospital stay is usually 3 to 5 days. After discharge you need time near the practice for the first check-ups and to settle into dilation before you fly. The stitches are absorbable, so there are none to remove.

• Hospital: usually 3 to 5 days, with packing and a catheter that are removed before discharge.
• Before flying: you can fly from day 21, keeping flights to 3 hours at most in the first weeks. I check the wound, urination and your dilation technique before you leave.
• Stitches: absorbable; no visit is needed to remove them.
• Check-ups after you return home: by video call at 10 days, 1 month, 6 months and 1 year; any in-person check takes place in Greece.
• What to arrange at home: time off work (office work usually after 6 to 8 weeks, heavy physical work later), privacy and time to dilate 3 to 4 times a day at first, your dilators, water-based lubricant and the written dilation schedule I give you.

If you travel to us, it is best to stay nearby for the first weeks after discharge, for the check-ups. Tell me early where you live, so that we can plan the visits around your travel.

Most patients report being satisfied with the aesthetic and functional result. Swelling settles within a few months and the final appearance develops over 6 to 12 months. Vaginal depth is maintained only with regular dilation or intercourse, and the ability to reach orgasm is preserved in most cases.

In large series and systematic reviews, satisfaction after vaginoplasty is high and regret is rare. The result is permanent, but it depends on you: without dilation the vagina can narrow or lose depth. Because the new vagina is lined with skin, its moisture is limited and it needs regular hygiene with water. There is no uterus or ovaries, so there are no periods and pregnancy is not possible. Regular check-ups continue after the first year.

Vaginoplasty is a major operation and carries more risks than a cosmetic procedure. The most common complications are minor healing problems, narrowing of the vagina and urinary problems. A fistula to the rectum is rare but serious. I explain the risks for your particular case in detail at the consultation.

Smoking. Stop at least 4 weeks before and 4 weeks after surgery. Smoking reduces the blood supply to the skin that lines the vagina and increases the risk of tissue loss and thrombosis, especially together with oestrogen. In active smokers who cannot stop, surgery is postponed.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

We do not publish prices. The cost of vaginoplasty depends on the technique, the length of the operation, the days in hospital and whether a graft or a combination with other procedures is needed. You receive a quote after the consultation, once you have been examined and we have agreed together on the plan that suits you.

• The technique and the need for a skin graft.
• The length of the operation and of general anaesthesia.
• The days in hospital and the hospital.
• The dilators and the follow-up visits after surgery.
• Combination with other procedures, or a corrective operation at a second stage.