Vaginoplasty Overview

A Vaginoplasty, also called MTF Bottom Surgery or Gender Affirmation surgery, is a surgical procedure where the male genitalia is reconstructed into aesthetically beautiful female genitalia including a clitoris, labia, urethra and possible vaginal vault.  As an innovative cosmetic surgeon, Dr. Stiller continues to evolve his techniques, focusing on giving the most natural looking outcomes. The emotional benefits our patients feel after bottom surgery is truly amazing and inspiring as we see the newfound comfort they have with their bodies.

Dr. Stiller has trained extensively in multiple vaginoplasty techniques and is the only surgeon in Washington state devoted solely to MTF Bottom surgery. He has been performing vaginoplasties for the past 5 years and is trained in Zero Depth Vaginoplasties, Penile Inversion Vaginoplasties, and Colovaginoplasties. He has performed over 1,000 vaginoplasties, averaging 5 procedures a week, making him extremely sought after for MTF bottom surgery. Not only does Dr. Stiller have an immense amount of technical expertise and attention to detail, his bedside manner is unmatched. You will feel calm the moment you sit down for your consultation with his warm and compassionate nature. You will leave your consultation full of confidence knowing you are supported and in excellent hands.  

Colovaginoplasty Basics

The Colovaginoplasty procedure consists of creating a neo-vagina using the ascending colon (right side) after the Zero Depth Vaginoplasty has been performed. The procedure is done in a two-stage approach by reconstructing the male genitalia to give physical sensation, pleasure and urinary functionality first and then dissecting the right side of the colon to become the vaginal canal 6-9 months later. Full functionality regarding urinating, lubrication and sexual intercourse can be expected when transfeminine surgeries are performed by experienced board-certified surgeons such as Dr. Stiller. He has spent years perfecting his craft with the utmost goal of giving his patients the most natural looking outcome.  

Many gender surgeons believe the Colovaginoplasty is a last resort procedure most commonly due to the lack of experience and knowledge regarding the technique. However, Dr. Stiller believes this is a great first option for patients depending on their own personal goals. Dr. Stiller performs 2-3 Colovaginoplasties a week, making him one of the most sought out gender surgeons to perform this technique. Due to his extensive background in general surgery, Dr. Stiller is the surgeon for every portion of the procedure, specifically regarding the colectomy and anastomosis. His extensive skillset and experience in laparoscopic surgery makes him on of the best gender surgeons to perform a Colovaginoplasty.  

Colovaginoplasty Benefits

Colovaginoplasty Downsides

The Procedure

The Colovaginoplasty is performed after you have already underwent your Zero Depth Vaginoplasty where your clitoral hood, clitoris, urethra and labia were created. After your vulva has healed and your authorization has been approved it is time for the Colovaginoplasty. The Colovaginoplasty itself takes up to 3 hours, is done laparoscopically and you will have 5 small incisions on your abdomen. Through this procedure, Dr. Stiller carefully and meticulously dissects the ascending (right) colon from its surrounding tissues. The right colon is then separated from the transverse colon and the ileum (last portion of the small intestine). The transverse colon and ileum are then reconnected to keep the normal flow of the digestive system. If not already gone, the appendix is also removed to prevent any future confusion as its normal anatomical position comes off the right colon.

The vaginal canal is then created, between the bladder and rectum, and your right colon is brought through your new canal. It's important to note your right colon remains attached to its blood supply at all times and is closed at the posterior aspect. Once the right colon is pulled through your vaginal canal, if needed, any excess colonic tissue is removed. The edges of the colonic tissue are then sutured to the vaginal entrance. The final result is an anatomically congruent, aesthetically appealing, and functionally intact vagina. The prostate gland is left intact to assimilate the sensation of the G-spot during vaginal intercourse. This surgery is not intended for candidates who have a history of Ulcerative Colitis, Crohn’s Disease, or Colon Cancer.  


Patients usually spend 2-4 nights at Deaconess Hospital after a Colovaginoplasty. After surgery, you will only have a catheter and vaginal packing- much different from your first stage surgery. The catheter is most commonly removed after 1 day. You will be on a liquid diet initially and slowly advance your diet as your bowels begin to normalize. Once you are able to have a bowel movement, you will be discharged.  

You will again stay in Spokane for 2 weeks so Dr. Stiller and Riley can monitor your progress. At 1 week, your daily dilation schedule will begin after your vaginal packing is removed. Your anatomy will also be reviewed to make sure you are comfortable and confident going home.  

The next follow up will be in another week to monitor your progress and you may return home after this appointment (if traveling out of town). The recovery process can look very different for every patient and you can find most of your recovery questions under our FAQs. However, the most common questions patients have are regarding diet, exercise, work and sex.  

You will be on a low fiber diet for 6 weeks after surgery. Patients usually return to light exercise when they feel comfortable however no heavy lifting, greater than 20 pounds, for 4 weeks after surgery. You may return to work once cleared by medical staff, most commonly around 4 weeks. No submerging in water or vaginal sexual intercourse until cleared by medical staff, most commonly 3 months.

You will be provided with detailed post-operative instructions upon completion of your procedure. If at any time you should have any questions or concerns after surgery, please contact our practice immediately.


You will receive your dilators from MultiCare Deaconess Hospital the day of your surgery and you will bring these to your 1 week post-op appointment. You will have four dilators that go up in size, purple, blue, green and orange. After all dressings are removed, we will go over your new anatomy and dilate, yay! It's important to remember, your vaginal canal was created in a space that was not originally there or lined with your own tissue and unfortunately your body will try to heal itself by closing the entrance to the space. Therefore, dilations are important to keep the vaginal canal open.

Initially, dilations can be painful but improve as swelling goes down and healing continues. After a few months, dilations become much easier and become a simple easy routine. And don't be afraid to ask questions! There are no silly or uncomfortable questions you could ask. Dr. Stiller and Riley are there to best support you and make sure you are comfortable and confident.  

When it comes to dilating, patients should dilate 3 times a day for 30 minutes each session for about 6 months. You will douche with water after your first and last dilation of the day. Initially, dilating at home can be difficult compared to first dilating in the office. It's important to get multiple pillows to prop yourself up on, a mirror to familiarize yourself and water-base lubricant. Staying calm and attempting to relax your pelvic muscles will help dilations go much smoother. The goal is to get to the orange dilator by 3 months. However, the dilation process is different for everyone, some may get there sooner than 3 months or later than 3 months so try not to stress. Around 6 months, the frequency of dilations can decrease depending on personal preference of depth and width however it is a lifelong commitment.  

Frequently Asked Questions

When can I schedule my surgery?
How long do I need to stay in Spokane?
Will I need a caregiver?
Where do I stay and how will I get to and from the office and the hospital?
Does Stiller Aesthetics provide lodging?
How much will I owe after surgery?
I received bills from offices other than Stiller Aesthetics. Why?
Why does my insurance company say they have no record of a prior authorization submitted for my surgery? (Applies to Medicaid patients ONLY)
Why did I get a letter from Medicaid stating that they need more information?
Why can’t my bottom surgery and top surgery be performed at the same time?
When do I need to stop my hormones?
How long is my surgery? How long will I be in the hospital?
What does the anesthesia entail?
Will I have scars?
What can I do for scar care?
What is the discomfort level after surgery? For how long?
When can I return to work?
How long do I have to ice?
When can I start exploring my clitoris?
When can I go back on my hormones?
When can I shower? How do I wash?
Why am I “spraying” when I pee?
What is granulation tissue?
When can I work out?
How does the pain compare to my first stage?
Will I have any additional scars?
Are there any diet restrictions before surgery?
Will I bleed after surgery?
Will I have an odor after my procedure?
Why is there stool looking material/discharge coming out of my vagina?
I heard you do not need to dilate as much with a Colovaginoplasty, is this true?
Do I have to use the dilators given?
How do I move up the dilator size?
When should I get to the largest dilator (orange)?
I feel resistance. How much is too much resistance?
I’m having trouble dilating 3 times daily, what are my options?
What lube do I use?
How do I douche?
Will I have to wear panty liners? For how long?
When can I have sex? Vaginal/Anal/Oral?
Are there diet restrictions after surgery?