Sexual Health (Vaginoplasty)

Welcome to your customized sexual health guide! This chapter is for anyone who was assigned male at birth (AMAB) and has had vaginoplasty. Most of this information will also apply if you’ve had vulvoplasty (i.e. bottom surgery without a vaginal canal).

If you are intersex and have had vaginoplasty or vulvoplasty, this guide is also for you. Whether you’re a trans woman, non-binary, or any other gender, we’ve got all the info you need for a healthy, happy sex life.

Safer Sex

Safer sex can mean different things to different people. In this guide, we use safer sex to mean ways to reduce risk for sexually transmitted infections (STIs) and HIV. Anyone can get or transmit an STI, no matter what kind of sex or how many partners you have. Here’s a few ways to make sex safer while still keeping it fun!

Condoms 

Condoms are thin, tube-shaped pieces of latex that make a barrier between people’s genitals. This stops bodily fluids and bacteria transferring from one person to another. They help prevent pregnancy, most STIs and HIV.

Condoms either go over the penis (external condoms) or inside the vagina or anus (internal condoms). External ones are a lot more common. You can also put them on sex toys, if you’re sharing them.

Using an external condom

You can use external condoms for oral, anal or vaginal sex. Condoms can protect people against HIV and STIs, whether they’re the insertive (top) or receptive (bottom) partner.

First, check the expiry date on the condom packet (yes, condoms expire!) and make sure it’s intact with no rips or tears. Open the packet with your hands, not teeth - this helps avoid damaging the condom itself. 

Next, make sure the unrolled condom is the right way up. Then pinch the tip with one hand to squeeze out any air and, at the same time, roll the ring all the way down the shaft with your other hand. To take a condom off a penis, the wearer should move away from their partner’s body and remove it while they’re still hard. This helps avoid any fluid spilling out.

Don’t reuse condoms. If it breaks, falls off or you want to go again, just grab a new one. It helps to keep a few around. You should also use a new condom every time you:

• Switch partners

• Switch between vaginal (front) and anal (back) sex

• Share toys (e.g. dildos)

Finding the right condom

Condoms are usually made of latex, but can also be made of polyurethane and polyisoprene. These are useful if you or your partner are allergic to latex. Avoid lambskin condoms - these have small holes in them, so they don’t prevent STIs and HIV.

Condoms come in all different sizes. They even come in flavours (but these should be used for oral sex only). If your partner is wearing an external condom, it should fit snugly. If it’s too tight or painful then they should try a bigger size, and if it’s loose they should try a smaller one. 

PrEP

If your sex partners have a penis they were born with, then you might benefit from PrEP. PrEP stands for Pre-Exposure Prophylaxis, and is a medication that prevents HIV. 

If taken as prescribed, PrEP reduces HIV risk by 99%. Most people take it as a single daily pill. If you’re on PrEP, it means you don’t need condoms to prevent HIV during sex. PrEP doesn’t work against STIs, though. To prevent STIs you can use condoms or doxy PEP (see below). 

You can get PrEP from most sexual health clinics that serve the LGBTQ2S+ community. You can also get it from family doctors, if they’re informed about LGBTQ2S+ health. If you are a Foria patient you can get PrEP from your clinician; another option is our sibling service Freddie, a virtual PrEP clinic. Visit www.gofreddie.com for more information.

Depending on where you live, public health plans may cover part or all of the cost of PrEP. It’s also usually covered by private insurance, if you have benefits through your employer. Freddie also offers financial assistance, so 90% of patients pay $0.

Doxy PEP

If your sex partners have a penis they were born with, then you might also benefit from doxy PEP. Doxy PEP is where you take an antibiotic called doxycycline within 72 hours (ideally within 24 hours) after condomless oral, anal or vaginal sex. This can significantly reduce the risk of syphilis, chlamydia and gonorrhea. It doesn’t eliminate risk though, so you’ll still need to keep up with regular STI testing.

You should be able to get doxy PEP from sexual health clinics that serve LGBTQ2S+ people. You can also get it from family doctors. However, access can vary depending on where you live – doxy PEP is new, and not all clinics are educated about it. If you’re struggling to access it, Foria and Freddie can connect existing patients with doxy PEP (if you’re eligible).

HIV Treatment

If you’re living with HIV, starting treatment as soon as possible and taking it as prescribed has huge benefits for your health. In fact, modern HIV treatment is so effective that someone diagnosed today can live just as long as someone who doesn’t have HIV. 

One of the main benefits of HIV treatment is that it stops HIV transmission through sex. Effective treatment can lower the amount of virus in someone’s blood so much that it wouldn’t be picked up by most types of HIV test. This is called “undetectable”. When someone is undetectable, their HIV is untransmittable (known as “U=U”). 

U=U means that you can’t pass HIV to someone else through sex. It’s not just a low or very low risk – it’s zero risk. This can help ease any anxiety you or your partners may have, so you can focus on having fun!

STI Testing

STIs often don’t have symptoms, so the only way to know your STI status is to get tested. STI testing can be daunting, especially if you’ve faced transphobia or other types of discrimination in healthcare before. We’re here to demystify the process. 

This section will tell you what tests to get and how often to get them. These will vary based on the kind of sex you’re having. If your healthcare provider doesn’t offer you the correct tests, you can ask them for the ones you need. 

What tests to get

A full routine STI test checks for syphilis, HIV, gonorrhea and chlamydia. Some parts of this test are standard for everyone:

• To check for syphilis and HIV, you’ll get blood taken from your arm. This is then sent to a laboratory to be tested. Some clinics will have rapid HIV tests, which use a few drops of blood from your finger and can give you results in minutes.

• To check for gonorrhea and chlamydia you’ll need to give a urine sample or give swabs (see below). 

Depending on your sex life, you may need to do some swabs. Some clinics will let you do these yourself, and others will have a provider do them for you. These are:

• A throat swab, if you’ve performed oral sex on someone with a penis.

• A vaginal swab, if you’ve had receptive vaginal (frontal) sex for someone with a penis or shared sex toys (e.g. vibrators or dildos). If you’ve had vulvoplasty, you won’t need to give a swab. *

• A rectal swab, if you’ve had receptive anal (back) sex for someone with a penis or shared sex toys (e.g. butt plugs or dildos).

You may also be screened for hepatitis C periodically, depending on your sex life. 

* You can still get vaginal STIs after vaginoplasty, but we aren’t sure how well vaginal swabs pick them up. If you have vaginal sex, we recommend testing regularly with both swabs and urine tests. You can also use condoms and doxy PEP to help prevent STIs.

How often to test

If you’re starting a new monogamous relationship, then you can test after you’ve been monogamous for three months. Some people might test sooner, but if so then it’s recommended to re-test at three months. This is because of the time it takes for an STI to be detected on a test, known as the “window period”. Window periods range from one to two weeks (for chlamydia) to three months (for syphilis). Testing after three months means you are outside the window period for all STIs, including HIV. Afterwards, you don’t need to test again unless you open up your relationship.

It’s recommended that everyone should test at least once per year if you have new sexual partners. If your partners have a penis and you use condoms, then test every three to six months. If you don’t always use condoms, then test every three months.

If you are on PrEP, then you’ll be required to get tested every three months.

STI Symptoms

STIs happen sometimes! Luckily, they can often be easily treated. Because there is a stigma around STIs, if you have symptoms these may bring up feelings of shame or guilt. Stigma towards LGBTQ2S+ people and our sex lives can make these feelings more intense. This is a normal reaction, but there’s no need to feel shame!

There are a few symptoms to look out for – if you notice any, avoid sex until you’ve managed to see a healthcare provider. These are:

• Blisters, sores or firm bumps in your genital or anal area

• Pain when peeing

• New or different discharge from your genitals (this can be yellow, white or green)

• Itching in the pubic area

• Pain, bleeding or discharge from your anus

• A rash

Some changes, like pimples in your pubic area, are usually harmless. 

STI Treatment

STIs can happen to anyone, no matter how many partners you have. Just like how going to a bar or using public transit carries a risk for colds or flu, sex carries a risk for STIs. What’s important is getting treatment as soon as you can to make sure that you stay healthy.

If you have symptoms, make an appointment with your sexual health clinic or visit them during walk-in hours. Most clinics can diagnose and treat you right away. For example, if you have genital or rectal discharge they may swab your vagina or rectum (ass) and test these on site. They may order some additional tests to confirm your diagnosis, and will get in touch when those results come back.

If you’ve had treatment, you’ll also need to avoid sex for a short period while the medication is working. Your healthcare provider can advise you on this.

If you test positive for an STI, you should notify your recent partners so they can get treatment if needed. However, this may not be safe for everyone. If you don’t feel comfortable contacting them directly, you can visit www.tellyourpartner.org. This is a free, anonymous service based in the U.S. that also works in Canada. It will send a text to your partner on your behalf. Note that if your partner is only having sex with you, they will know who the message is coming from.

Hepatitis A & B

These viruses affect your liver, and vaccines are recommended if your sex partners have a penis they were born with. They are usually covered in Canada for trans and non-binary people who fall into this group. Your clinician or sexual health center can check your immunity when they do blood tests, and should offer vaccines if you need them.

Human Papillomavirus (HPV)

This virus can cause genital warts and some types of cancer (throat, anal, cervical and penile). The HPV vaccine can protect you against the most common strains that are linked to cancers, but it can’t cure any strains that you already have. It is usually covered by the public system if you have sex with AMAB people and are under 26 years of age, but this can vary by location. If you have extended health benefits through work, this may also cover the vaccine.

Vaginal health

If you’ve had vaginoplasty, there’s a few things you’ll need to do to maintain your vaginal health. We’ve got a short guide here, but everyone’s body is different and surgeons will have their own recovery guidelines. It’s a good idea to stay in touch with your surgical team as you navigate the healing process. 

Dilating

In the months and years after surgery, you’ll need to dilate regularly. This is where you insert a dilator (a wand-shaped medical device) into the vagina to prevent complications like scar tissue and maintain the vaginal canal’s width and depth. Dilating is a lifelong commitment – without it, you can permanently lose vaginal function and the ability to have vaginal sex.

The size dilator you use, how often you use it, and how long you dilate for will vary depending on your body and where you are in the healing process. Your surgeon can give you guidance on all these as part of your post-surgical recovery plan.

Your surgery centre should provide you with a full set of dilators after surgery, and if you need new ones you can follow up with them to buy a replacement set. You can also get dilators from specialist online stores, but it’s important to make sure you’re buying the correct size.

Lube

Whether you’re using dilators, sex toys, fingers or having penetrative sex, lube is a must! This is because post-op vaginas don’t self-lubricate. Lube can be water-based, silicone-based or oil-based, but the type that’s best for you will depend on what you’re using it for. For example: 

• Water-based lube works well with toys and condoms. It’s also the only type of lube recommended for dilating, because other types can break down the material dilators are made of. It leaves less stains compared to silicone or oil-based lube, but it can dry out faster (so you need to reapply). You can get flavoured water-based lubes for oral sex, but these shouldn’t be used for vaginal (front) or anal (back) sex.

• Silicone-based lube works well with condoms and toy materials like glass or metal. It should not be used with dilators or silicone toys, as it can degrade them.

• Oil-based lube or other oil products (like coconut oil) should not be used with condoms. It can degrade them, which makes them ineffective and raises risk for STIs. It can also be harder to clean off toys.

Douching

Douching is when you use a douche to insert a solution into the vagina. This can help manage discharge or odour, and is also a part of your healing process after surgery. Some people might also douche after dilating or sex, to remove excess lube or bodily fluids.

Your douching schedule and the solution you use will vary depending on your surgeon and their recovery plan. Some examples of douching solutions include saline solution, vinegar solution, or antiseptic medication mixed with water. Plain water shouldn’t be used in the first few months after surgery.

Each surgical centre will have different recommendations, so it’s a good idea to stay in touch with them and follow their instructions closely. Once you have fully healed from vaginoplasty (usually around the one year mark), you can talk to your primary care clinician if you have any vaginal issues. In some cases, they may refer you to a specialist.

This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team.

by Foria Clinical Team

Dec 14, 2023・ minute read

Share article