Vaginoplasty Pre-Operative Hair Removal NO LONGER REQUIRED!

Posted: March 27, 2018

Why We No Longer Require Hair Removal

We are changing our hair removal requirements for bottom surgery, for male to female gender confirmation patients, who are undergoing Vaginoplasty. Up until now we have insisted on hair removal, either laser or electrolysis, prior to Vaginoplasty. What we have always been keenly aware of is that:

  1. Both of these processes are very burdensome on the patient
  2. It is very expensive and rarely covered by insurance
  3. The experience of being required to have an awake procedure done to the genitals, can really add to a patient’s gender dysphoria

It is probably the single most significant cause of some of my patients holding back from undergoing their gender confirmation surgery.

This month Nicole and I went to Harrisburg in Pennsylvania to attend the Keystone Conference. The most valuable thing about that conference was that I was able to go to other surgeons’ workshops, most notably Dr. Cathy Rumer. Dr. Rumer runs the program at Drexel University’s teaching hospital, Hahnemann University Hospital in Philadelphia, she does so many gender confirming bottom surgeries and does really beautiful work. One of the most interesting aspects of her work is that she does not require any hair removal before surgery. As busy a practice as she has she tells me its not an issue for her patients.

I took some time to reflect on the rationale of why I was trained to require hair removal. I use a penile inversion technique, and I also use scrotal skin to line the deepest part of the new vagina. The rationale was that if a patient did not undergo hair removal before surgery, there was the possibility of getting hair growth in the new vagina which is a very difficult problem to treat. As surgeons, there are some things we do because basically we were trained in that practice. What we call surgical dogma, or doing things because “that’s how they are done”!

We should always however, strive to have an “evidence-based” practice. In order to do this, we research the data published and ask what the science says about some particular procedure or practice. In this case, on my return from the conference, that is exactly what I undertook. I did a literature review to find out what was published on this topic.

What we do know

  1. Firstly, as is often the case in gender confirmation surgery, there is not very much published. What I did find was one very useful study from 2006 published by Anne Lawrence, and in this study she surveyed 232 patients who had undergone gender confirmation bottom surgery. She asked these patients what particular problems they were experiencing. Only 7% had significant problems with hair growth in the new vagina, but the most interesting thing is that half of those interviewed, who experienced these problems, had undergone a lot of electrolysis prior to surgery. It therefore appears that undergoing hair removal does not make a significant difference.
  2. Another thing we took into consideration is the experience of cis-gender women. From older publications, we know that women who did not develop a vagina, or were born with the condition “vaginal agenesis” underwent similar procedures with hair baring skin being inverted. In one study biopsies were done on these new vaginas after some time, and it was found that follicles were not present. It would therefore appear that if there was a problem with hair growth it would short lived.
  3. During our procedures we carefully remove and burn all visible hair follicles on the scrotal graft and none of our vaginoplasty patients to date have had issues with hair growth in the new vagina.

Of course there are never any guarantees that hair growth won’t be a problem but it looks like whether or not patient had hair removal before surgery seems to make no difference. We are going to leave the hair removal diagram up, and patients who are still concerned will of course have the choice to undergo pre-op hair removal anyway.


Taking all of the above into careful consideration we are no longer going to require patients have hair removal for male to female vaginoplasty.

Dr. Sidhbh Gallagher
University Gender Affirmation Surgery

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