Understanding Complications After Gender-Affirming Surgery (GAS)

Gender-affirming surgery (GAS) is a life-changing procedure that helps individuals align their physical anatomy with their gender identity. While most patients experience successful outcomes, as with all major surgeries, complications can occur. At WIH, we believe in transparency and education — so our patients feel safe, informed, and supported throughout their journey.

General Surgical Complications

These are potential risks associated with any major operation, not specific to GAS:

  • Bleeding or Hematoma
    Excessive bleeding during or after surgery may require intervention or drainage.
  • Infection
    Although rare, infection can occur in any surgical site and may require antibiotics or further treatment.
  • Wound Dehiscence
    This refers to the surgical wound opening up, which may delay healing and require additional care.
  • Skin Necrosis or Delayed Healing
    Poor blood supply in certain areas may lead to tissue breakdown or the formation of granulation tissue that takes longer to heal.
  • Scarring or Pigmentation Changes
    Most scars heal well, but some patients may develop thickened or darkened scars depending on their skin type and healing response.

General Surgical Complications

These are potential risks associated with any major operation, not specific to GAS:

  • Bleeding or Hematoma
    Excessive bleeding during or after surgery may require intervention or drainage.
  • Infection
    Although rare, infection can occur in any surgical site and may require antibiotics or further treatment.
  • Wound Dehiscence
    This refers to the surgical wound opening up, which may delay healing and require additional care.
  • Skin Necrosis or Delayed Healing
    Poor blood supply in certain areas may lead to tissue breakdown or the formation of granulation tissue that takes longer to heal.
  • Scarring or Pigmentation Changes
    Most scars heal well, but some patients may develop thickened or darkened scars depending on their skin type and healing response.

General Surgical Complications

These are potential risks associated with any major operation, not specific to GAS:

  • Bleeding or Hematoma
    Excessive bleeding during or after surgery may require intervention or drainage.
  • Infection
    Although rare, infection can occur in any surgical site and may require antibiotics or further treatment.
  • Wound Dehiscence
    This refers to the surgical wound opening up, which may delay healing and require additional care.
  • Skin Necrosis or Delayed Healing
    Poor blood supply in certain areas may lead to tissue breakdown or the formation of granulation tissue that takes longer to heal.
  • Scarring or Pigmentation Changes
    Most scars heal well, but some patients may develop thickened or darkened scars depending on their skin type and healing response.

Complications Specific to Gender-Affirming Surgery

These issues are more closely related to the techniques used in vaginoplasty or other feminizing procedures:

  • Vaginal Shortening (Neovaginal Depth Loss)
    Common in skin graft vaginoplasty if routine dilation is not maintained or if scar tissue forms at the apex.
    Solution: Early intervention, strict dilation regimen, or revision surgery such as colon vaginoplasty.
  • Vaginal Stenosis or Circumferential Contraction
    Progressive narrowing of the neovaginal canal, leading to pain, difficulty with dilation, or inability to engage in penetrative intercourse.
    Solution: Depends on severity — from dilation under anesthesia to secondary colon vaginoplasty.
  • Vaginal Fistula
    An abnormal connection between the vagina and nearby organs like the rectum (recto-vaginal fistula) or urethra (urethro-vaginal fistula).
    Solution: Multilayered surgical closure, often with reinforcement using well-vascularized tissue such as colon.
  • Loss of Sensation or Nerve Damage
    Although rare with careful technique, sensation in the clitoris or labia may be reduced.
    Solution: Often improves over time; nerve-sparing techniques are always used by Dr. Chettasak.
  • Aesthetic Irregularities
    Asymmetry of the labia, irregular scarring, or unnatural appearance may require minor revision for optimal cosmetic outcome.

How WIH Prevents and Manages Complications

Dr. Chettasak Tulayaphanich brings over two decades of experience in gender-affirming surgery with a focus on minimizing risks. At WIH:

  • We use precise surgical techniques including the NPI method and laparoscopic colon vaginoplasty.
  • We provide a personalized postoperative care plan, including wound care, dilation, and follow-ups.
  • Our team offers advanced revision procedures for patients who underwent GAS elsewhere and now face complications.

Need Help or Concerned About a Past Surgery?

Whether you’ve had surgery at WIH or another center, we’re here to help. Our revision surgery program offers advanced solutions for patients seeking improved function, comfort, or appearance.

📞 Contact WIH International Hospital to schedule a confidential consultation.

Progressive Contraction of the Vaginal Canal After Skin Graft Vaginoplasty

Skin graft vaginoplasty remains a traditional method for neovaginal creation, particularly when other tissue sources are unavailable. However, skin—especially when used in a cavity with limited blood supply and mechanical stress—has a natural tendency to undergo contraction and fibrosis over time.

This progressive narrowing and shortening of the vaginal canal can lead to functional loss, discomfort, and poor quality of life if left untreated.

Step-by-Step Progression of Vaginal Canal Contraction

The process typically occurs in staged progression, which can be observed both clinically and radiologically:

  1. Early Depth Loss (6.5 → 6 cm)

The initial change is subtle. Fibrotic remodeling begins at the apex, causing slight shortening without major symptoms.

  1. Continued Depth Reduction (6 → 5 cm)

Tissue elasticity decreases, and patients may start noticing changes in dilation tolerance or a reduction in comfort during penetration.

  1. Depth and Diameter Change (5 → 4 cm)

The graft begins to contract circumferentially, leading to narrowing in both depth and diameter. This stage marks the onset of stenosis.

  1. Non-Functional Stage (4 → 3 cm)

At this point, the vaginal canal is severely narrowed, and often considered non-functional. Patients may experience pain, bleeding, or inability to engage in dilation or intercourse.

  1. Complete Collapse

The neovagina becomes almost entirely obliterated—resembling a fibrotic tunnel with little to no depth or width—requiring full surgical reconstruction.

Dr. Chettasak’s Classification of Vaginal Canal Contraction Grade 1
Dr. Chettasak’s Classification of Vaginal Canal Contraction Grade 2
Dr. Chettasak’s Classification of Vaginal Canal Contraction Grade 3
Dr. Chettasak’s Classification of Vaginal Canal Contraction Grade 4

How Dr. Chettasak Treats Vaginal Collapse from Skin Graft Contraction

At WIH International Hospital, Dr. Chettasak Tulayaphanich specializes in revision vaginoplasty using the sigmoid colon (secondary colon vaginoplasty)—a highly effective, permanent solution for patients with neovaginal contraction or collapse.

✅ Surgical Approach:

  1. Excision of scarred tissue: All fibrotic and non-elastic skin graft tissue is removed completely.
  2. Preparation of neovaginal space: A new, deep cavity is carefully created, ensuring anatomical alignment and avoiding injury to nearby structures.
  3. Sigmoid colon segment transfer: A well-vascularized segment of sigmoid colon is mobilized laparoscopically and brought down to form the new vaginal lining.
  4. Anastomosis and fixation: The colon segment is secured to the vaginal opening using tension-free techniques, ensuring smooth healing and long-term function.

Why the Colon is Superior for Revision:

  • Naturally lubricated mucosal surface
  • Highly resistant to contraction and fibrosis
  • Reliable blood supply, even in previously damaged tissue beds
  • Long-term depth and width preservation without the need for frequent dilation

Trust WIH International Hospital to provide safe, natural, and beautifully balanced results.