Dr. de Clermont-TonnerrePlastic Surgeon

Paris 16th & Pontoise — Gender-Affirming Surgery

Gender Reassignment Vaginoplasty

MtF reassignment surgery — Paris 16th & Pontoise

Gender reassignment vaginoplasty is the major surgical procedure in the MtF transition pathway. It creates a functional neovagina and an anatomically feminine vulva. Performed in Paris 16th and Pontoise by Dr. de Clermont-Tonnerre, within a rigorous and compassionate multidisciplinary care pathway.

This procedure is reimbursed under ALD 31. It requires significant personal commitment, particularly for the essential post-operative dilation.

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Step by step

How the procedure works

01

Pre-operative consultations

Several consultations to assess your project, anatomy and expectations. Coordination with the multidisciplinary team. Assistance with ALD 31 file compilation.

02

Full pre-operative assessment

Extended blood tests, cardiological consultation, anaesthetist. Hormone therapy stopped 3 to 4 weeks before surgery.

03

Surgery

Under general anaesthetic, duration 4 to 6 hours. Bilateral orchidectomy, creation of neovagina by penile inversion, vulva reconstruction, creation of neoclitoris from the glans.

04

Hospital stay

5 to 7 days in clinic. Urinary catheter 5 to 7 days. Vaginal pack removed at D+5–7. Initial dilation care taught in clinic.

05

Dilation and follow-up

Multiple daily vaginal dilations essential for 6 to 12 months. Close consultations in the first month, then at 3 months, 6 months and 1 year.

Practical information

Duration
4 to 6 hours
Anaesthetic
General
Hospital stay
5 to 7 days
Time off work
6 to 8 weeks
Dilation
6 to 12 months post-op
Reimbursement
ALD 31 (subject to conditions)

Benefits

  • Functional, anatomically feminine neovagina
  • Neoclitoris with preserved erectile sensitivity
  • ALD 31 coverage possible
  • Very significant reduction in gender dysphoria
  • Comprehensive multidisciplinary support
  • Definitive and lasting results

Risks

  • Vaginal stenosis if dilation is insufficient
  • Rectovaginal fistula (rare but serious)
  • Urinary complications
  • Partial neoclitoral necrosis (rare)
  • Aesthetic result may require revision
  • Need for surgical revisions

French Social Security Coverage

Gender reassignment vaginoplasty is reimbursed under ALD 31. It requires documented multidisciplinary follow-up and agreement from the CPAM. Dr. de Clermont-Tonnerre assists you in all administrative and medical procedures.

Expected results

Gender reassignment vaginoplasty creates a functional neovagina enabling vaginal intercourse, with an anatomically feminine vulva including a sensitive neoclitoris. The psychological impact and quality of life improvement are generally profound and transformative.

Maintaining dilation is absolutely essential for a lasting result. The medical team provides support throughout the post-operative pathway.

Before and after photos available during the consultation on request.

Frequently asked questions

What is gender reassignment vaginoplasty (SRS)?+
Gender reassignment vaginoplasty (also called SRS — Sex Reassignment Surgery, or GRS — Gender Reassignment Surgery) is the surgical creation of a functional neovagina in transgender women (MtF). The most widely used technique is penile-scrotal inversion, which uses penile and scrotal skin to create the neovagina and vulva.
Is trans vaginoplasty covered by French national health insurance?+
Yes, gender reassignment vaginoplasty is covered by the Assurance Maladie (French national health insurance) under ALD 31 (gender dysphoria long-term condition). Standard conditions apply: multidisciplinary diagnosis, documented transition follow-up, agreement from the CPAM (local health insurance fund). Dr. de Clermont-Tonnerre works with specialist referral teams to facilitate this process.
What are the prerequisites for vaginoplasty?+
Generally recommended conditions include: documented multidisciplinary follow-up, living continuously in a feminine role for at least 1 to 2 years, ongoing hormone therapy, and no surgical or psychiatric contraindications. These criteria are defined by your specialist care team. Hormone therapy must be stopped a few weeks before surgery.
What is post-operative vaginal dilation?+
Vaginal dilation is essential after vaginoplasty to maintain the depth and diameter of the neovagina. It involves inserting dilators of progressively increasing size several times daily for several months. This follow-up is essential for the functional success of the procedure and requires significant personal commitment.
What functions does the surgically created neovagina provide?+
The neovagina created by vaginoplasty allows vaginal intercourse. It is surrounded by a reconstructed vulva including labia majora, labia minora and clitoris (neoclitoris from the glans). Erectile sensitivity of the neoclitoris is generally preserved. Natural lubrication is absent (artificial lubrication needed during intercourse).
Which technique is used for trans vaginoplasty (penile inversion, sigmoid flap)?+
The reference technique is penile inversion vaginoplasty: penile skin, turned on itself, forms the lining of the neovagina, while scrotal skin is used to reconstruct the labia majora. This technique is favoured for its reliability and reproducibility. When penile skin tissue is insufficient (particularly following incomplete laser hair removal), a sigmoid colonic mucosal flap may be used to extend or replace the vaginal canal. Dr. de Clermont-Tonnerre determines the appropriate technique during pre-operative consultations.
Is trans vaginoplasty fully reimbursed under ALD 31?+
Yes, gender reassignment vaginoplasty is fully covered under ALD 31. Required conditions are: a diagnosis of gender dysphoria established by a multidisciplinary referral team (psychiatrist, endocrinologist), documented transition follow-up, and prior agreement from the CPAM. Dr. de Clermont-Tonnerre assists you in compiling this file and coordinates with your care team.
What conditions are required before vaginoplasty (psychiatric follow-up, hormones, indication letter)?+
Best practice guidelines generally require: specialist psychiatric or psychological follow-up for gender dysphoria, continuous feminising hormone therapy for at least one year (unless contraindicated), documented social role in a feminine identity, and no surgical or anaesthetic contraindication. An indication letter from your multidisciplinary team is required for ALD 31 coverage. Hormone therapy is suspended 3 to 4 weeks before surgery to reduce thromboembolic risk.
What is post-operative vaginal dilation and how long does it last?+
Vaginal dilation is the essential post-operative protocol to maintain the depth and diameter of the neovagina. It involves inserting vaginal dilators of progressively increasing diameter, several times daily. The protocol is intensive for the first 3 months (3 to 4 sessions daily), then gradually reduces over 6 to 12 months. Abandoning or neglecting dilation can lead to vaginal stenosis. The medical team teaches the protocol during the clinic stay and supports you at every follow-up consultation.
Is sexual sensitivity preserved after trans vaginoplasty?+
Erectile sensitivity of the neoclitoris is generally preserved, as it is reconstructed from the penile glans whose dorsal innervation is maintained during surgery. Overall sensitivity of the vestibule and labia minora varies between patients and with technique. Natural lubrication is absent after penile inversion vaginoplasty (artificial lubrication is needed during intercourse). Functional outcomes and sexual satisfaction are generally positive, provided healing is good and dilation is carried out diligently.
What are the specific risks of trans vaginoplasty?+
Possible complications include: vaginal stenosis if dilation is insufficient or poorly conducted; rectovaginal fistula (communication between the rectum and neovagina — rare but serious, requiring surgical revision); urinary complications (meatal stenosis, transient incontinence); partial or total neoclitoral necrosis (rare); and an aesthetic result that may require one or more revisions. These risks are significantly reduced by surgical expertise and strict adherence to post-operative care.
How long is hospitalisation after trans vaginoplasty?+
Hospitalisation after trans vaginoplasty typically lasts 5 to 7 days in clinic. During this stay, a urinary catheter is maintained for 5 to 7 days, and the vaginal pack is removed around D+5 to D+7. Initial dilations are performed and taught by the care team before discharge. Minimum time off work is 6 to 8 weeks. Close follow-up consultations are scheduled at D+30, 3 months, 6 months and 1 year.
Is surgical revision possible after vaginoplasty?+
Yes, surgical revisions (labiaplasty, clitoral revision, vaginal deepening, scar correction) are possible and sometimes desired to refine the aesthetic or functional result. They are generally performed at least 12 months after the initial procedure, once healing has stabilised. Some minor revisions can be performed under local anaesthetic; others require general anaesthesia. Coverage of these revisions under ALD 31 depends on their nature and should be discussed with your surgeon and CPAM.

Patient testimonials

★★★★★

“Vaginoplasty with Dr. de Clermont-Tonnerre was the culmination of a long journey. His expertise, compassion and mastery of this complex procedure put me at ease. The anatomical and functional result is very satisfying.”

Lucie

★★★★★

“The ALD 31 process was perfectly supported. The surgeon coordinated with my multidisciplinary team in an exemplary way. Recovery was longer than expected but the result is worth every effort. I finally feel whole.”

Camille

★★★★★

“A major procedure requiring significant personal commitment for post-op dilation. Dr. de Clermont-Tonnerre had prepared me fully for this reality during consultations. His team is available and reassuring throughout the whole journey. Excellent result.”

Sophie

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See also

Gender surgery — all proceduresFacial feminisation (FFS)Top surgery (FtM)Phalloplasty / MetoidioplastyChest feminisationIntimate surgery
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