1: External Design and Limited Vaginal Dissection
In zero-depth vaginoplasty, a full vaginal canal is not created. However, a limited dissection of approximately 4–5 cm is still performed between the rectum and urinary tract (following the natural female anatomical plane) to form a shallow pocket. This small cavity at the end of the vaginal opening helps replicate the three-dimensional structure of a real vaginal introitus and provides depth for aesthetic realism.
Although not functional for penetration, this space allows the vulva to appear fully natural from the outside.
Step 2: Bilateral Orchiectomy
The testicles and spermatic cords (including the vas deferens) are removed up to the inguinal ring to eliminate any palpable remnants in the groin and ensure a smooth, feminine contour.
Step 3: Clitoris, Clitoral Hood, and Frenulum Creation
A feminine-sized clitoris is sculpted using the glans penis, and is precisely positioned on the vulva. The clitoral hood and frenulum are created to enhance both the aesthetic and sensory experience.
Dr. Chettasak’s technique preserves key sensory nerves from the pudendal branch, ensuring not only the clitoris but also the hood, frenulum, and nearby areas remain sensitive—supporting orgasmic potential and long-term sexual satisfaction.
Step 4: Penectomy and Urethral Feminization
The penis is removed, and the penile skin is preserved for later use in reconstructing external genitalia.
The urethra is shortened and repositioned just above the vaginal opening to match cis-female anatomy. The corpus spongiosum tissue is completely removed to avoid future engorgement or lumps. This careful removal supports a smooth and natural-looking urethral meatus.
Step 5: Labia Minora and Vaginal Introitus Formation
The inner prepuce and upper penile skin are used to construct the labia minora, creating delicate, pink inner lips.
The lower penile skin is vertically aligned to form the vaginal introitus, including the posterior fourchette, achieving a V-shaped appearance that mimics natal anatomy.
Step 6: Vaginal Opening and Labia Majora Construction
Although no vaginal canal is formed, the vaginal opening is carefully designed to resemble a typical introitus. The base of the opening is created using a combination of penile and perineal skin, forming a visible recess that gives the impression of depth.
The scrotal skin is split into two flaps and sculpted to form the labia majora (outer labia), completing the natural external female appearance.
This version of NPI vaginoplasty is ideal for patients who prioritize aesthetics and sensation but do not require penetrative depth. It eliminates the need for dilation and reduces surgical risks while preserving the look, feel, and function of a natural vulva.
Sensation and Climax
Although zero-depth vaginoplasty does not provide vaginal penetration, orgasmic sensation remains possible. The clitoris is constructed with preserved nerve supply, allowing for sexual stimulation and climax.
