Our Summary

This research was carried out to understand the occurrence, treatment, and outcomes of rectal injuries and the subsequent creation of an abnormal connection between the rectum and vagina during gender-affirming vaginoplasty (a surgery that helps transgender women transition) at a center that performs a lot of these surgeries.

The team looked back at the data of all patients who had rectal injuries during this surgery from January 2016 to September 2022. They found that out of 1011 surgeries, 9 patients had rectal injuries. In 5 of these cases, a colorectal surgeon was consulted.

Out of these 9 patients, 6 continued with the full-depth vaginoplasty, while 3 had a simpler version of the surgery. Two patients had a particular muscle moved to help with the issue, and none had any injury to the urethra. Only one patient developed an abnormal connection between the rectum and the vagina, and this patient had previously had surgery in that area and did not have a specific check done during the operation. Half of the patients who had the full-depth surgery experienced narrowing of the vagina after the operation.

In conclusion, rectal injuries during this surgery are rare, happening in less than 1% of cases in this study. If the injuries were spotted and treated during the operation, the patients generally did well and did not develop an abnormal connection between the rectum and vagina, even if they had the full-depth surgery. The full-depth surgery can be completed, but patients should be aware there’s a significant risk of vaginal narrowing after the operation.

FAQs

  1. What is the incidence of rectal injury during gender-affirming vaginoplasty at a high-volume transgender surgery center?
  2. What are the potential post-operative complications of gender-affirming vaginoplasty?
  3. How are rectal injuries managed during gender-affirming vaginoplasty?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vaginoplasty is to be aware of the potential risks of rectal injury during surgery. It is important for patients to follow post-operative instructions carefully and to seek prompt medical attention if they experience any unusual symptoms or complications. Patients should also be informed about the possibility of developing vaginal stenosis postoperatively and the importance of regular follow-up appointments with their healthcare provider.

Suitable For

Patients who are typically recommended for vaginoplasty include transgender women who desire gender-affirming surgery to create female genitalia. These patients may have gender dysphoria and want to align their physical appearance with their gender identity. Vaginoplasty may also be recommended for individuals with congenital conditions such as vaginal agenesis or intersex variations who desire a functional vagina.

It is important for patients considering vaginoplasty to undergo a thorough evaluation by a multidisciplinary team of healthcare providers, including mental health professionals, endocrinologists, and surgeons, to ensure they are mentally and physically prepared for the surgery. Patients should have realistic expectations about the outcomes of vaginoplasty and understand the potential risks and complications associated with the procedure.

Timeline

Before vaginoplasty, a patient will typically undergo a thorough evaluation by a gender-affirming surgery center, including a physical examination, psychological evaluation, and hormone therapy. The patient will also be counseled on the risks and benefits of the procedure, as well as the expected outcomes.

During vaginoplasty, there is a risk of rectal injury, which occurred in 9 out of 1011 cases in this study. In cases where rectal injury occurred, it was managed intraoperatively with repair and evaluation by a colorectal surgeon. Some patients required temporary bowel diversion. In one case, a rectovaginal fistula developed postoperatively.

After vaginoplasty, patients may experience complications such as vaginal stenosis, which occurred in 50% of cases in this study. Patients who underwent full-depth vaginoplasty had a higher risk of developing stenosis compared to those who had minimal-depth vaginoplasty. Overall, patients did well after repair of rectal injuries during vaginoplasty, with no further complications such as RVF in most cases.

What to Ask Your Doctor

  1. What is the likelihood of experiencing a rectal injury during vaginoplasty?
  2. How is a rectal injury typically managed during the surgery?
  3. What are the potential complications of a rectal injury, such as developing a rectovaginal fistula?
  4. How often do patients who experience a rectal injury during vaginoplasty develop vaginal stenosis postoperatively?
  5. What are the steps taken to prevent and minimize the risk of rectal injury during the surgery?
  6. Are there any specific factors that may increase the risk of experiencing a rectal injury during vaginoplasty?
  7. How will the rectal injury be repaired and what is the expected recovery process?
  8. Are there any long-term implications or risks associated with having had a rectal injury during vaginoplasty?
  9. What follow-up care or monitoring will be needed after experiencing a rectal injury during vaginoplasty?
  10. Are there any alternative surgical approaches or techniques that may reduce the risk of rectal injury during vaginoplasty?

Reference

Authors: Stark T, Celtik K, Ting J, Purohit RS. Journal: Urology. 2024 Oct;192:141-145. doi: 10.1016/j.urology.2024.05.043. Epub 2024 Jun 6. PMID: 38851496