Our Summary

This research paper examines two cases of transgender women who faced serious complications after undergoing sigmoid vaginoplasty, a surgery to create a vagina using a piece of the sigmoid colon. These complications included narrowing of the neovagina (stenosis), abscesses, and eventual tissue death due to a lack of blood supply (ischemia and necrosis). These issues required more surgeries and a team of healthcare professionals from various specialties. The researchers believe that the initial narrowing caused a blockage and damage to the blood supply of the new vaginal tissue, leading to the need for removal of the affected bowel. Based on these cases, the authors feel that multiple specialties need to work together for optimal care and monitoring after surgery. They also suggest that we need better guidelines for managing these cases to reduce complications and the burden on healthcare resources. Despite these complications, the authors believe that sigmoid vaginoplasty is still a good option for gender confirmation surgery as it effectively replicates vaginal tissue and provides a greater depth for the neovagina.

FAQs

  1. What are the major complications that can occur following a sigmoid vaginoplasty?
  2. What measures can be taken to reduce the risk of complications following a sigmoid vaginoplasty?
  3. Despite the complications, is sigmoid vaginoplasty still considered a viable option for gender affirmation surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about vaginoplasty is to closely follow post-operative care instructions, including proper wound care and frequent follow-up appointments to monitor for any potential complications. It is important to communicate any concerns or changes in symptoms to your healthcare provider promptly to ensure optimal healing and outcomes. It is also crucial to engage in open and honest discussions with your healthcare team about any questions or anxieties you may have throughout the recovery process. By actively participating in your own care and staying informed, you can help reduce the risk of complications and achieve the best possible results from your surgery.

Suitable For

Patients who are typically recommended for vaginoplasty include transgender women seeking gender affirmation surgery, individuals with congenital vaginal agenesis or other vaginal abnormalities, and individuals seeking vaginal reconstruction after trauma or cancer. It is important for patients to undergo thorough psychological evaluation and have realistic expectations about the outcomes and potential complications of the surgery. Additionally, patients should be in good overall health and have a stable support system in place for post-operative care.

Timeline

Before vaginoplasty:

  1. Consultation: The patient meets with a surgeon to discuss the procedure, potential risks and benefits, and expectations.

  2. Pre-operative assessments: The patient undergoes various medical evaluations to ensure they are healthy enough for surgery.

  3. Hormone therapy: Some patients may undergo hormone therapy before surgery to help prepare the body for the changes.

  4. Psychological evaluation: The patient may be required to undergo a psychological evaluation to ensure they are mentally prepared for the surgery and understand the implications.

  5. Surgical preparation: The patient may need to stop taking certain medications and follow specific pre-operative instructions to prepare for the surgery.

After vaginoplasty:

  1. Hospital stay: The patient will typically stay in the hospital for a few days after surgery to recover and be monitored for any complications.

  2. Pain management: The patient will be given pain medication to help manage any discomfort following the surgery.

  3. Follow-up appointments: The patient will have follow-up appointments with the surgeon to monitor healing and address any concerns.

  4. Dilations: The patient will need to perform regular vaginal dilations to help maintain the depth and width of the neovagina.

  5. Complications: In some cases, patients may experience complications such as stenosis or abscess formation, which may require additional surgical interventions and multidisciplinary care.

  6. Long-term care: The patient will need to continue with regular follow-up appointments and may require ongoing care to ensure the health and function of the neovagina.

Overall, the timeline for a patient before and after vaginoplasty involves thorough pre-operative assessments, surgery, post-operative care, and long-term monitoring to ensure optimal outcomes and address any complications that may arise.

What to Ask Your Doctor

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

  2. How experienced are you in performing vaginoplasty surgeries, and what is your success rate?

  3. What are the expected outcomes and recovery time following vaginoplasty surgery?

  4. What type of anesthesia will be used during the procedure, and what are the potential side effects?

  5. Will I need to undergo any additional procedures or treatments before or after the surgery?

  6. How will the neovagina be created, and what materials will be used?

  7. What kind of post-operative care and follow-up appointments will be necessary?

  8. How will sensation and sexual function be affected by the surgery?

  9. What kind of scarring can I expect, and will there be any visible signs of the surgery?

  10. Are there any long-term risks or complications that I should be aware of?

Reference

Authors: Meece MS, Weber LE, Hernandez AE, Danker SJ, Paluvoi NV. Journal: J Surg Case Rep. 2023 Jun 13;2023(6):rjad333. doi: 10.1093/jscr/rjad333. eCollection 2023 Jun. PMID: 37325067