Penile Inversion Vaginoplasty


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.  

Penile Inversion Basics

The Penile Inversion Vaginoplasty procedure consists of creating a vulva and neo-vagina that is both functional and beautifully feminine. This is done in a one-stage approach by reconstructing the male genitalia to give physical sensation, pleasure and urinary functionality that is consistent with that of female genitals. Full functionality regarding urinating 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. If MTF bottom surgery is a part of your transition and you are desiring a vaginal canal, a Penile Inversion Vaginoplasty may be right for you.

Penile Inversion Benefits

Penile Inversion Downsides

The Procedure

The Penile Inversion Vaginoplasty is a one-stage procedure and takes up to 3 hours. The procedure itself incorporates an orchiectomy, penectomy, labiaplasty, cliteroplasty and creation of vaginal canal. If not done already, an orchiectomy will be performed and the spermatic cord will be tied off to the inguinal canal. The penis is deconstructed and removed however, sensation is preserved through a portion of the glans of the penis and the neurovascular bundle that runs along the shaft of the penis, which remain attached at all times. The neurovascular bundle is placed in the correct anatomical position, on top of the pubic bone, to create the clitoris and clitoral hood. Skin from the penis and scrotum are removed and a graft is created to soon be the lining of the vaginal canal.  

The urethra is shortened and a functioning urethral opening is created as well as relocated to an appropriate female position below the clitoris. The remaining part of the scrotal skin and fat pads are used to construct both labia majora and minora. Once the graft is complete and follicle scraping has occurred, it's sewn to the remaining penile skin to be inverted thus creating the lining of your vaginal canal.  The vaginal canal lies between your rectum and bladder. 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.  


The penile inversion vaginoplasty is an outpatient procedure. Most commonly our patients go home, to your Airbnb or hotel if traveling out of town, the same day of surgery. After surgery, you will have 2 drains, a catheter, vaginal packing, a sutured compression dressing and a tape dressing. You will 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 drains, catheter, vaginal packing and dressings are 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 exercise, work and sex. 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 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 space. Therefore, dilations are important to keep the vaginal canal open while also preventing any loss of depth.

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?
Are there any diet restrictions before surgery?
Are their diet restrictions after surgery?
What is granulation tissue?
When can I work out?
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?
When can I have sex? Vaginal/Anal/Oral?
How much hair do I need to remove to be successful for surgery?
When should I stop electrolysis before surgery?
Will I have an odor after my procedure?
Why do I have to dilate? Is it lifelong?
Will I get intra-vaginal hair?