Reconstructing the vagina using intestinal segments creates an aesthetically pleasing vagina, which seems to be more compatible with sexual activity.

This method was proposed more than 100 years ago; the advantages include adequate vaginal length, natural lubrication, early intercourse and a low rate of shrinkage. Most segments of the intestinal tract have been used to create a neovagina. Sigmoid colon is particularly useful because it is anatomically close to the perineum, with sufficient length and mobility of the segment that allows it to be easily brought into the perineum.

Isolated segment of rectosigmoid should be from 8 to 11 cm long to avoid excessive mucus production as well as vaginal prolapse postoperatively. Stapling devices are used for the colorectal anastomosis as the safest procedure. Creation of the perineal cavity for vaginal replacement is done using simultaneous approach through abdomen and perineum. Very precise dissection must be done to avoid injury of rectum, bladder and urethra. Introital or perineal skin flaps are designed for anastomosis with rectosigmoid vagina. Circumferential anastomosis is avoided to prevent purse string scarring with subsequent vaginal stenosis.

Postoperative dilatation of the vaginal introitus is mandatory in first three months for stenosis prevention.

Segment of sigmoid colon is dissected and mobilized, closed proximal end forms the future neovagina.

Proper segment of rectosigmoid colon is identified and mobilized.

Isolated segment of rectosigmoid 8 to 11 cm in length was lifted with its blood supply.

Stapling device is used for the colorectal anastomosis.

Stapling device is used for the colorectal anastomosis.

Case 1 (click image for larger view)

Result 6 months after sigmoid vaginoplasty.

Normal depth and width of the vagina is achived.

Case 2 (click image for larger view)

Result 9 monts after sigmoid vaginoplasty.

Normal depth and width of the vagina is achived.

Normal appearance of the vulva is achived.