Penile inversion technique



Vaginoplasty (neovaginoplasty) is a reconstructive surgical procedure for creating a neovagina.
Male to female transgenderism is among the principal indications for vaginoplasty.


Great variety of operative techniques for creation of neovagina is reported. There are two substantial tissues for vaginal replacement: skin and bowel. For transgender patients penile inverted skin flap presents the best option.

Penile inversion technique includes creation of fully sensate neovagina from an inverted pedicled island penile skin flap and vascularized urethral flap. The important advance in this technique is complete penile disassembly, which ideally enables the use of all penile components (except the corpora cavernosa) in the construction of the new vulva, clitoris and vagina. Ordinarily, procedure is started with bilateral orchidectomy. The penis is dissected into its anatomical components and corpora cavernosa are completely removed. Glans is reduced and fashioned to create a conically shaped clitoris, with fully preserved neurovascular bundle. The skin of the penis is inverted, as a pedicled flap preserving blood and nerve supplies to form a fully sensate vagina. The urethra is then spatulated and used to create the mucosal part of the neovagina that provides additional sensitivity and wetting. Fixation of the vagina to the sacrospinous ligament is performed to achieve deep placement of the neovagina in the perineal cavity and to prevent prolapse. Clitoral hood, labia minora, and labia majora is finally created by fashioning remaining penile and scrotal tissue. Postoperative vaginal stenting and periodic dilatation is necessary. This way fully sensate and sufficient vagina is created, enabling regular sexual intercourses with erogenous sensation.

Related articles

1. Bizic MR, Stojanovic B, Djordjevic ML. Genital reconstruction for the transgendered individual. J Pediatr Urol 2017;13:446-52.

2. Djordjevic ML. Sexual reassignment surgery: male to female. In: Salgado CJ and Redett R, Eds. Aesthetic and functional surgery of the genitalia. New York: Nova Publishers; 2014.

3. Bizic M, Kojovic V, Duisin D, Stanojevic D, Vujovic S, Milosevic A, Korac G, Djordjevic ML. An overview of neovaginal reconstruction options in male to female transsexuals. ScientificWorldJournal 2014 (2014), Article ID 638919, 8 pages

4. Djordjevic ML, Salgado CJ, Bizic M, Kuehhas FE. Gender dysphoria: the role of sex reassignment surgery. ScientificWorldJournal. 2014;2014:645109.

5. Stanojevic DS, Djordjevic ML, Milosevic A, Sansalone S, Slavkovic Z, Ducic S, Vujovic S, Perovic SV. Sacrospinous ligament fixation for neovaginal prolapse prevention in male-to-female surgery. Urology, 2007 Oct;70(4):767-71.

6. Perovic S, Stanojevic D, Djordjevic M. Vaginoplasty in male to female transsexuals using penile skin and urethral flap. Int J Transgenderism, 2005; 8(Vol 1):43-64.

7. Djordjevic ML, Perovic, S. Clitoroplasty in intersex repair using disassembly technique. Eur Urol Video J, 2004; Vol. 10 Nr.4: 18-19

8. Perovic S, Djordjevic ML, Kollias A. Complex repair in failed male transsexual surgery. Eur Urol Video J, 2004; Vol. 10 Nr.4: 20-21

9. Perovic S, Djordjevic M, Djakjovic N. Klitoroplastik beim intersex mit der disassembly technik. Der Urologe, 2002; Suppl. 1: 93


Surgical procedure

Penile disassembly: corpora cavernosa are completely dissected from urethra, glans and neurovascular bundle


Removed corpora cavernosa


Removed corpora cavernosa


New vagina is created from penile skin and urethral flap


New vagina is created from penile skin and urethral flap


Appearance at the end of surgery


Outcome one year later: normal appearance of the vulva. Clitoris is hooded


Vagina has normal depth and width



Penile disassembly is performed.


Penile skin inversion.


Final result after surgery.


Outcome 3 months later.


Outcome 3 months later.



Outcome one year after penile inversion vaginoplasty




Result six months after penile inversion technique


Prolapse of bulbar urethra is visible


Outcome after reconstruction


Appearance three months later.


Good depth of the neovagina is achieved.


Good depth of the neovagina is achieved.



Outcome nine months after surgery.


Outcome nine moths after surgery.


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