Our Summary

This paper discusses two methods of performing vaginoplasty, a surgery often undergone by transgender women as part of their transition. The first method is the traditional perineal approach, which has been the standard for many years. The second is a newer technique called robotic peritoneal gender-affirming vaginoplasty (RPGAV), which involves the use of a robot to assist the surgeon. Both of these methods are variations of a type of surgery called penile inversion vaginoplasty, and they both have low rates of major complications.

The traditional perineal approach and the newer robotic method each have their own advantages. For example, the robotic method could be better for patients who don’t have a lot of genital tissue to work with, such as those who have undergone puberty suppression. It could also be safer for surgeries that need to be done again because of narrowing of the new vagina. However, the robotic method also comes with additional risks that are associated with robotic abdominal surgeries.

FAQs

  1. What is the Davydov peritoneal vaginoplasty?
  2. What are the differences between a perineal approach and a robotic peritoneal gender-affirming vaginoplasty (RPGAV)?
  3. What are the potential risks associated with RPGAV?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vaginoplasty is to follow post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include avoiding strenuous activities, keeping the surgical area clean and dry, and attending follow-up appointments with your surgeon. It is also important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for vaginoplasty are transgender individuals seeking gender-affirming surgery to create a neovagina. This procedure is most commonly performed on transgender women, but can also be performed on non-binary individuals or transgender men. Patients may have undergone hormone therapy and/or chest surgery as part of their gender transition process. It is important for patients to have realistic expectations and a thorough understanding of the risks and benefits of the procedure before undergoing vaginoplasty. Additionally, patients should be in good overall health and have appropriate psychological readiness for surgery.

Timeline

Before vaginoplasty:

  1. Patient consults with a gender-affirming surgeon to discuss the procedure, risks, benefits, and expectations.
  2. Patient undergoes a thorough evaluation, including medical history, physical examination, and psychological assessment to ensure readiness for surgery.
  3. Hormone therapy may be initiated to help prepare the genital tissue for surgery.
  4. Patient may undergo hair removal in the genital area to reduce the risk of complications post-surgery.

After vaginoplasty:

  1. Patient undergoes the vaginoplasty procedure, which may be performed using a perineal or robotic approach.
  2. Post-operatively, the patient will require a period of rest and recovery in the hospital before being discharged.
  3. Patient will be instructed on wound care, pain management, and any restrictions on activities during the recovery period.
  4. Follow-up appointments with the surgeon will be scheduled to monitor healing and address any concerns or complications that may arise.
  5. Over time, the patient will gradually resume normal activities and may undergo vaginal dilation therapy to maintain the depth and width of the neo-vagina.
  6. Patient will continue to follow-up with their healthcare team for long-term care and support.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with vaginoplasty surgery?

  2. What is the recovery process like after vaginoplasty surgery?

  3. How long will it take to see the final results of the surgery?

  4. What type of anesthesia will be used during the procedure?

  5. Will I need to undergo any additional surgeries or procedures in the future?

  6. How will vaginoplasty surgery affect my sexual function and sensation?

  7. What are the potential long-term effects or complications of vaginoplasty surgery?

  8. What type of follow-up care will I need after the surgery?

  9. Are there any specific lifestyle changes or restrictions I will need to follow after the surgery?

  10. What should I do if I experience any unusual symptoms or complications after the surgery?

Reference

Authors: Peters BR, Martin LH, Butler C, Dugi D, Dy GW. Journal: Curr Urol Rep. 2022 Oct;23(10):211-218. doi: 10.1007/s11934-022-01106-9. Epub 2022 Aug 30. PMID: 36040679