A recent trend in vaginoplasty is Zero Depth Vaginoplasty (ZDV) or Limited Depth Vaginoplasty (LDV)—creation of a female vulva without vagina. This trend has been partially driven by consumers interested in avoiding complications and/or eliminating the chore of daily dilation for someone not interested in receiving penetrative sex of any kind but, more ominously, by surgeons who offer ZDV as compensation for their own lack of confidence in completion of the quintessential portion of the operation (perineal dissection). There are even reports from patients that surgeons are promising patients that “vaginoplasty could be added later as a secondary procedure”. This is flat deception as a primary one-stage procedure is far more likely to yield a quality result when genital material is fully intact.
In my experience of more than 22 years performing vaginoplasty for females AMAB, consumer-driven requests for this procedure are rare. To be fair, this number may be limited by consumers who were previously unaware of ZDV—we did not talk about this as an option unless specifically asked. The troubling trend of late is that inexperienced surgeons, lacking confidence in their own abilities to perform the difficult and risky portions of the procedure, use fear of complications to convince patients to undergo ZDV rather than traditional vaginoplasty. Recently—in a public statement—one surgeon declared that more than 30% of his patients chose ZDV! Absurd! I will discuss ZDV in terms of potential application for patients making informed decisions.
Fear of complications: Relative to other surgical procedures, complications in vaginoplasty for patients AMAB are rare but can be severe and devastating (fistula) but mostly minor and inconvenient (granulation tissue or UTI). Injuries to the bladder, urethra or rectum are also rare but possible complications. They can occur only in patients undergoing vaginal dissection (true vaginoplasty)—but are rare, less than 1% for experienced surgeons and, frankly, even more rare for those who operate regularly. True, they do happen but so rarely. Relatively common complications, still rare—like granulation tissue, wound separation, poor cosmetic appearance and numbness—are not entirely avoided by ZDV/LDV.
NO interest in penetration: This is a legitimate reason to undergo ZDV. However, much of the vulvar appearance and sensation are retained in full. Physical properties of the vagina such as scent and G-spot are eliminated when ZDV is chosen.
Avoidance of daily dilation: True, avoiding dilation is a legitimate reason to choose ZDV. Dilation can be seen as a chore. If this is an issue for you, ZDV may be right for you. I will say, in the first ZDV I ever performed, that patient came to me one year later—at age 73—saying she had met someone and wished to have a vagina.
If your surgeon suggests ZDV, “buyer, beware!” Surgeons, lacking confidence, may speak of complications—as they should—but, when the centerpiece of their interaction is framed by a discussion of complications, seek care elsewhere. Ask about complication rates. Ask about outcomes. Trust your instincts. If ZDV is the procedure that the surgeon prefers to perform, that is a suggestion that confidence is lacking.
An honest appraisal of your desires is most important. Vaginoplasty should be considered unlikely to improve your sex life—it is hard being post-op. Orgasm is more challenging. Dilation is a pain. But your choice will impact the rest of your earthly life—make your choice work favorably for you.