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Vulvaplasty or Vulvoplasty Surgery: Zero-Depth Vaginoplasty

Medically reviewed by Lin-Lin Liu, PA on June 29, 2026.

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:

• 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 need for revisions.

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

Principle Differences:

Frequently Asked Questions about 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 scrotum 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.
• Patients will need to quit tobacco and nicotine use prior to surgery (specific timeframe)?

Mental Health Letters of Support

Most surgeons require a support letter from a licensed mental health provider. Some insurers require letters of support from two separate licensed mental health professionals — sometimes with differing degree requirements. Check with your provider and insurance plan for specific requirements. For example, Dr. Ley (she/her/they), generally requires that first-time bottom surgery patients present a letter of support from a gender care professional that has provided continuous care to the patient for at least nine months.

Benefits and Risks

Outcomes and Patient Satisfaction

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. A 2018 study — the first published series specifically examining vulvoplasty — found that 93% of patients reported satisfaction with their procedure and decision.

Impact on Patient Fertility

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.

Possible Complications and Challenges

Your informed consent paperwork will review all possible complications for the bottom surgery procedure that you undergo. Complications can include infection, nerve injury, hematoma at the surgical site, incisions that do not heal well, and ongoing pain. Carefully following recovery instructions can help significantly reduce your risk of complications.

Please note that it is normal for patients to experience urethral concerns (such as urinating more frequently after the urethra has been shortened), granulation tissue, and perineal dehiscence (or opening of surgical wounds) during the first stage of recovery. Your care team will give you instructions on how to manage each of these challenges.

Recovery

Vulvoplasty surgery typically takes about 4 hours and is conducted while the patient is under general anesthesia. Patients who undergo vulvoplasty typically stay in the hospital for at least 3 nights after surgery for close observation. Recovery generally takes about 6–8 weeks.

Patients will receive detailed instructions from their care team about how to care for themselves during recovery. In general, you can expect the following:

• Hormones and hair removal: 2 weeks prior to surgery, patients will be asked to suspend estrogen and stop any laser hair removal or electrolysis in the surgical area. Patients can resume taking estrogen after being discharged from the hospital. It is recommended that you start at half of your usual dose, then follow-up with your HRT provider for adjustments if needed.
• Bleeding and spotting: Bleeding or spotting for up to six weeks is normal.
• Pain management: Patients are most often discharged from the hospital with prescription pain medications. When taking them, patients should refrain from NSAIDs, like Ibuprofen (Advil, Motrin) and Aleve (Naproxen).
• Swelling and bruising: Patients will be instructed on daily icing protocols to reduce inflammation and pain. 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 as swelling and bruising resolve.

• Wound care: Patients will be given instructions on daily wound care involving antibiotic ointment.

• Diet: Eating a high protein, low sodium and high fiber diet can help patients recover, reduce inflammation and mitigate digestive issues like constipation during the first two weeks of recovery.

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