Vaginoplasty

Urogenital Surgery

MTF Surgery

FTM Surgery

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Vaginoplasty (neovaginoplasty) is a reconstructive surgical procedure for creating a neovagina.

The principal indications for vaginoplasty are congenital anomalies (vaginal atresia, intersex disorder), acquired conditions (trauma or cancer) or male to female transgenderism.

Great variety of operative techniques for creation of neovagina is reported. There are two substantial tissues for vaginal replacement: skin and bowel. Either can be used for reconstruction in patients with congenital anomalies or in transgender patients. Moreover, for trans-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 ochidectomy. The penis is dissected into its anatomical components and corpora cavernosa are completely removed. Glans is reduced and fashioned to create a conically shaped of 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 that enables regular sexual intercourses with erogenous sensation.

Another option is vaginal replacement using part of a bowel (rectosygmoid vaginoplasty). Herein an appropriate segment of sigmoid colon is used for creation of neovagina. A vascular pedicle of the bowel loop must be preserved. The lower end is pulled and sutured to perinel skin to create vaginal introitus and upper end is closed and fixed. Freed parts of large bowel are directly anastomosed to preserve its continuity.

Operative technique (click image for larger view)

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

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.

Case1 (click image for larger view)

Result 6 months after penile inversion technique.

Prolapse of bulbar urethra is visible.

Outcome after reconstruction

Appearance 3 months later

Good depth of vagina is achieved.

Good depth of vagina is achieved.

Case2 (click image for larger view)

Result after surgery.

One month later.

Outcome after revision.

Appearance 6 months later.

Penile Enhancement Concealed Penis Curvature Epispadias Exstrophy
Hypospadias Labioplasty Trapped Penis Penile Inversion Sigmoid vaginoplasty
Metoidioplasty Phalloplasty Mastectomy Peyronie's Disease

1 Comments



Vaginoplasty December 08, 2010 202.156.10.240 Votes: +4	Good post! photos can help people set their expectations. more like this pls. Vaginoplasty report abuse vote down vote up

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