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Vulvaplasty / Vulvoplasty: Zero-Depth Vaginoplasty

Medically reviewed by Ellie Zara Ley, MD on June 23, 2025.

What is a vulvoplasty or vulvaplasty?

Vulvaplasty (also spelled vulvoplasty) is a gender-affirming bottom surgery commonly performed for transgender women and non-binary individuals who want the appearance and sensation of a vulva and clitoris without creating a vaginal canal. It’s sometimes referred to as a “zero-depth vaginoplasty” procedure.

During a vulvoplasty/vulvaplasty:

• A vulva and clitoris are constructed using the existing genital tissue (penis and scrotum).
• The clitoris retains full erogenous sensation and the potential for orgasm.
• The urethra is shortened and repositioned to maintain the ability to urinate.
• The vaginal canal is not created; instead, a dimple may be formed at the vaginal opening.

Vulvoplasty is a popular option for those who:

• Want the aesthetic and sensory benefits of a vulva. 
• Do not desire vaginal penetration.

Vaginoplasty vs. Zero-Depth Vaginoplasty

Similarities:

• Both are gender-affirming surgeries that create a vulva and clitoris. A second-stage labiaplasty surgery is recommended to create labia minora and a clitoral hood, as well as any other needed revisions.

• Both procedures preserve erogenous stimulation with the potential for orgasm by keeping the patient’s genital nerves intact.

• Both can alleviate gender dysphoria.

Main Differences:

Vaginoplasty

• Surgeon creates a vaginal canal and a vulva.
• Allows for penetrative/receptive vaginal sex.
• Requires lifelong dilation to keep the vaginal canal open at desired depth and width.
• Patients must have a BMI no greater than 30 to qualify for this procedure.

Zero-Depth Vaginoplasty (Vulvoplasty)

• Creates the external vulva only, with a vaginal dimple instead of a canal.
• Does not allow for penetrative vaginal sex. 
• No dilation is required after surgery.
• Patients must have a BMI no greater than 38 to qualify for this procedure.

Frequently Asked Questions about Vulvoplasty/Vulvaplasty

Can I get a vaginoplasty after I have a zero-depth vaginoplasty?

Yes. Even after a vulva is constructed without a vaginal canal, surgeons can still construct a vaginal canal for patients who decide they want a vagina after the initial surgery.

Do vulvoplasty results look real?

Every vulva is unique; no two look the same. Dr. Ley (she/her/they)–a trans woman of color, a former patient herself, and world-renowned bottom surgeon–approaches vulvoplasty in two stages for desired and consistent results. Dr. Ley creates the vulva first, and once the vulva is healed (about 5 months later), she performs a labiaplasty to construct the labia minora, clitoral hood, and revise any aesthetic or functional concerns. By splitting up this operation into two stages, the vulva has a better chance of healing properly. This has given Dr. Ley’s patients more consistent results, leaving them more satisfied with the outcome of their surgery and less likely to request a revision procedure later on. 

If you’d like to learn more, schedule a free, in‑person consultation with Dr. Ley.

What is the difference between a vulvoplasty/vulvaplasty and a labiaplasty?

Vulvoplasty/vulvaplasty is the first step of bottom surgery; it transforms the penis and testicles into a vulva.

Labiaplasty is a secondary surgery that reconstructs the vulva, adding features like clitoral hooding, labia minora, and adjusting the labia majora. Labiaplasty also allows the surgeon to address any asymmetry, functional concerns, or aesthetic preferences for a personalized result.

Do you need hair removal for a vulvoplasty/vulvaplasty?

Hair removal of the penile shaft, scrotum, and surrounding areas is strongly recommended, and usually required, for vaginoplasty to prevent hair growth inside the vaginal canal. However, for a zero‑depth vulvoplasty, hair removal is typically optional since a canal is not created. Always check with your surgeon for specific requirements and recommendations.

Can I still orgasm after a vaginoplasty or vulvoplasty/vulvaplasty?

Yes, you can still orgasm after a vaginoplasty or vulvoplasty. The clitoris is created using the glans of the penis without removing it from its initial blood and nerve supply, which preserves its sensitivity and erogenous sensation. Most patients regain full sensation and can experience orgasm once healing is complete (around 3 to 9 months post-op).

Preoperative Requirements

Requirements will depend on the providers, but generally, most require you to be:

• An adult who can give informed consent and is in stable health (with any medical conditions well-managed).
• Diagnosed with gender dysphoria in a support letter from a licensed mental health provider who has been seeing you continuously for 6–9 months.
• On continuous hormone replacement therapy (HRT) for 9–12 months before surgery.

Benefits and Risks

Gender-affirming bottom surgery, including vaginoplasty/vulvoplasty, has high satisfaction rates. Studies cited in the WPATH Standards of Care 8 demonstrate that surgeries completed by experienced, board-certified surgeons are associated with improved mental health, quality of life, and sexual well-being in qualified transgender and non-binary patients. 

Vulvaplasty patients can undergo an orchiectomy (testicle removal) when their vulva is constructed or prior to the procedure. If you undergo an orchiectomy before your vulvaplasty, we recommend you wait 8-12 months between the two procedures. With any surgery, there are risks. Before surgery, discuss your medical history with your surgeon and address any concerns you may have. Additionally, be sure to discuss fertility preservation options, as a vulvoplasty does result in irreversible infertility.

Recovery

Patients who undergo vaginoplasty or vulvoplasty typically stay in the hospital for at least 3 nights after surgery for close observation. Recovery generally takes about 6–8 weeks. 

Bleeding or spotting for up to six weeks is normal. Most swelling and bruising may also be present for up to 6 weeks. However, it can take 3–6 months for final results to appear.

Vulvaplasty Costs and Insurance Coverage for Bottom Surgery

Out-of-pocket costs for vulvoplasty/vulvaplasty are typically between $20,500–$22,000. This amount does not include anesthesia, facility, or hospital fees.

Some insurance plans do cover gender-affirming surgeries and will help pay for bottom surgery if you meet their criteria, which usually include:

• A support letter from a licensed mental health provider with a gender dysphoria diagnosis.
• At least 12 months of continuous hormone replacement therapy (HRT).

Contact your insurance company to review specific requirements for coverage. At the GCC, our insurance concierge provides free support to interested patients to help them secure coverage for their gender-affirming surgery; our team has a 90% success rate. 

Related Articles

• Bottom Surgery Preoperative Requirements & Information
• Reproductive Considerations Before Bottom Surgery
• Orchiectomy and Scrotectomy
• Revision Surgeries for Vaginoplasty and Vulvaplasty