A vaginectomy is the surgical removal of part or all of the vagina. It is performed for two main reasons: to treat gynecological cancers (most often vaginal or recurrent cervical cancer) and as part of gender-affirming surgery for transgender men or nonbinary individuals. The scope of the procedure varies significantly depending on why it’s being done and how much tissue needs to be removed.
Types of Vaginectomy
There are three main types, each defined by how much tissue the surgeon removes:
- Partial vaginectomy: Only the upper portion of the vagina is removed. This is typically used for smaller or earlier-stage cancers confined to one area.
- Total vaginectomy: The entire vaginal canal is removed. This may be performed for more extensive cancer or as part of gender-affirming surgery.
- Radical vaginectomy: The entire vagina plus the surrounding supportive tissues and sometimes nearby organs are removed. This is reserved for cancers that have spread beyond the vaginal walls or cases where radiation and chemotherapy aren’t options.
In the most advanced cancer cases, a vaginectomy may be part of an even larger operation called a pelvic exenteration, which can also involve removing the bladder, lower colon, rectum, uterus, or cervix depending on how far the cancer has spread.
Why It’s Performed for Cancer
Vaginal cancer is the primary reason for vaginectomy. The procedure may also be used for cervical cancer that has returned after initial treatment, particularly when prior radiation therapy rules out further radiation. In a study comparing vaginectomy to pelvic exenteration for recurrent cervical cancer, women who had the less extensive vaginectomy experienced significantly fewer major complications while achieving comparable survival outcomes. Median overall survival was 39 months in the vaginectomy group compared to 18 months in the pelvic exenteration group, though the difference was not statistically significant due to the small study size.
For appropriately selected patients, vaginectomy also preserves the option of additional treatments later, such as radiation or more extensive surgery if the cancer returns. This flexibility, combined with a lighter impact on quality of life, makes it a preferred choice when the cancer is limited to the vaginal area.
Vaginectomy as Gender-Affirming Surgery
For transgender men and some nonbinary individuals, vaginectomy serves a different purpose entirely. The procedure removes the vaginal lining and closes the vaginal canal permanently. It is often performed alongside or as a step toward other masculinizing surgeries.
This version of the procedure carries some unique technical considerations. Patients who have been on testosterone therapy typically experience changes to the vaginal tissue that make it thinner and less elastic. Combined with the fact that many of these patients have not given birth (which would have stretched the tissue), the surgery can be more technically complex. Specialized surgical techniques have been developed specifically to address these challenges.
What Happens During Surgery
The patient is positioned on their back with legs supported. The surgeon makes an incision around the full circumference of the vaginal opening, then carefully separates the vaginal lining from the surrounding structures: the bladder in front and the rectum behind. The blood supply to the vagina runs primarily along the sides, so dissection starts there. The surgeon works to stay within precise tissue planes to avoid injuring the bladder wall or rectal blood vessels, which reduces the risk of complications like fistulas (abnormal connections between organs).
Once the vaginal tissue is fully separated and removed, what happens next depends on the patient’s situation. For cancer patients who want to maintain the ability to have penetrative sex, a skin graft can be placed to create a new vaginal canal. For patients who don’t want or need vaginal reconstruction, or for those having gender-affirming surgery, the space is closed by stitching the front and back tissue layers together. Drainage tubes are typically placed to prevent fluid buildup during healing.
Risks and Complications
As with any pelvic surgery, the main risks involve injury to the bladder or rectum during the procedure. Fistulas are the most-discussed complication. These are abnormal openings that can form between the vaginal area and the bladder or rectum, allowing urine or stool to leak through. Staying within the correct surgical planes during the operation is the key factor in preventing them. Fistulas requiring repair are rare in the general population, occurring at a rate of roughly 0.6 per 100,000 women across pelvic surgeries.
Other potential complications include bleeding (particularly if dissection strays into the network of blood vessels near the rectum), infection, and nerve-related changes to pelvic sensation. In the study of recurrent cervical cancer patients, the vaginectomy group had a significantly lower rate of major postoperative complications compared to those who underwent more extensive pelvic surgery.
Recovery Timeline
Recovery varies depending on whether the vaginectomy is performed alone or as part of a larger operation, and whether it’s done through a minimally invasive approach. Modern surgical practices and enhanced recovery protocols have shortened hospital stays considerably. Some gynecological procedures now allow same-day discharge, though more extensive operations will require a longer stay.
Most gynecologic surgeons recommend lifting restrictions for at least six weeks after surgery. A survey found that 60% of surgeons maintained this six-week guideline even for minimally invasive procedures. Return to normal daily activities can happen within one to two weeks for less extensive surgeries, but full recovery from a radical vaginectomy or one combined with other procedures takes longer. Your surgical team will give you specific guidance based on the scope of your operation.
Effects on Bladder Function
Because the vagina sits directly in front of the rectum and behind the bladder, any surgery in this area can potentially affect urinary function. However, research on pelvic surgery outcomes is reassuring. A large meta-analysis of women who underwent hysterectomy (often performed alongside vaginectomy) found that urinary symptoms actually improved after surgery in most cases. Stress incontinence dropped from about 32% of women before surgery to 21% afterward. Urinary frequency and nighttime urination also decreased significantly. The likely explanation is that removing diseased or bulky tissue relieves pressure on the bladder and urethra.
That said, these numbers reflect hysterectomy patients broadly, not vaginectomy patients specifically. A radical vaginectomy that removes tissue near the bladder and urethra carries a higher risk of urinary changes than a partial procedure. Some patients experience temporary difficulty emptying their bladder fully in the weeks after surgery as the pelvic tissues heal and swelling resolves.
Sexual Function and Reconstruction
For cancer patients, the impact on sexual function depends on how much tissue is removed. A partial vaginectomy may leave enough vaginal length for penetrative sex without reconstruction. After a total vaginectomy, a new vaginal canal can be created using a skin graft, a procedure that adds recovery time but can restore the ability to have intercourse. The decision about reconstruction is made before surgery based on the patient’s preferences and goals.
For transgender men undergoing vaginectomy as gender-affirming surgery, the vaginal canal is intentionally and permanently closed. Sexual function is addressed through other aspects of their overall surgical plan, which may include additional masculinizing procedures performed at the same time or in a later stage.