Our Summary

This research paper is about a complication that can occur after a specific type of transgender surgery. When a person undergoes a vaginoplasty (which is when a vagina is surgically created), sometimes they may develop a medical problem called a rectovaginal fistula (RVF). This is when an abnormal connection is formed between the rectum and the vagina, which can lead to discomfort and other medical issues.

The researchers in this paper reviewed different ways this complication can be fixed and how successful these methods are. They looked at 282 studies and included 17 of them in their review, which involved 41 patients in total.

They found that there are many different ways to fix a RVF. Some methods are conservative, meaning they try to fix the problem without surgery. Others involve closing the abnormal connection and some even include removing it. There are also reconstructive surgical techniques, which involve creating new tissue to fix the problem.

The researchers found that the success rates of these methods varied. For conservative methods, the success rate was 75%, for non-reconstructive surgery, it was 54.5% and for reconstructive surgery, it was 88.9%.

The paper concludes that there’s still a lot of variation in how this complication is treated. It suggests that reconstructive surgical techniques might be the best option since they don’t require creating an artificial opening in the body (stoma), but this depends on where the RVF is located, what the patient wants and their overall health.

FAQs

  1. What is a rectovaginal fistula (RVF) and how is it related to vaginoplasty?
  2. What are the different methods of treating a RVF after a vaginoplasty, according to the research paper?
  3. What is the success rate of the various methods of treating a RVF as found in the research paper?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vaginoplasty is to make sure to follow all post-operative care instructions carefully to reduce the risk of complications such as a rectovaginal fistula. It’s also important to communicate any concerns or symptoms to your healthcare provider promptly so they can be addressed as soon as possible. Additionally, attending follow-up appointments and staying in touch with your healthcare team throughout the recovery process is crucial for optimal healing and outcomes.

Suitable For

Overall, patients who are recommended vaginoplasty are typically transgender individuals seeking gender confirmation surgery. However, any patient undergoing vaginoplasty should be informed about the potential risks and complications, including the development of a rectovaginal fistula. Patients with a rectovaginal fistula may experience symptoms such as fecal incontinence, vaginal discharge, and recurrent urinary tract infections.

In conclusion, patients who have developed a rectovaginal fistula post-vaginoplasty may be recommended various treatment options depending on the severity of their condition. Conservative methods, non-reconstructive surgery, and reconstructive surgical techniques are all potential options for addressing this complication. It is important for patients to work closely with their healthcare provider to determine the best course of treatment for their individual situation.

Timeline

Before vaginoplasty, a patient typically undergoes a thorough evaluation by a medical team to determine if they are a suitable candidate for the surgery. This evaluation may include physical exams, blood tests, and psychological assessments. The patient will also need to undergo hormone therapy and possibly hair removal in the genital area.

After the surgery, the patient will experience pain, swelling, and discomfort in the genital area. They will need to follow post-operative care instructions, such as keeping the surgical site clean and avoiding strenuous activities. The patient will also need to attend follow-up appointments with their medical team to monitor their recovery and address any complications that may arise.

Over time, the patient will gradually heal and begin to experience the full benefits of the surgery, such as improved genital appearance and function. They may also undergo vaginal dilation therapy to maintain the depth and width of the vagina. Overall, vaginoplasty can have a positive impact on the patient’s physical and emotional well-being, allowing them to live more comfortably in their gender identity.

What to Ask Your Doctor

Some questions a patient should ask their doctor about vaginoplasty and the potential complication of a rectovaginal fistula include:

  1. What is a rectovaginal fistula and what are the symptoms?
  2. What are the risk factors for developing a rectovaginal fistula after vaginoplasty?
  3. How common is the occurrence of a rectovaginal fistula after vaginoplasty?
  4. What are the different treatment options for a rectovaginal fistula?
  5. What is the success rate of each treatment option?
  6. What are the potential complications or side effects of each treatment option?
  7. How will the treatment for a rectovaginal fistula affect the overall outcome of the vaginoplasty surgery?
  8. What is the recovery process like after treatment for a rectovaginal fistula?
  9. Are there any lifestyle changes or precautions that should be taken to prevent a rectovaginal fistula?
  10. How can I best communicate any concerns or symptoms related to a potential rectovaginal fistula with my healthcare provider?

Reference

Authors: Lava CX, Huffman SS, Berger LE, Marable JK, Spoer DL, Fan KL, Lisle DM, Del Corral GA. Journal: Plast Surg (Oakv). 2025 Feb;33(1):149-158. doi: 10.1177/22925503231190923. Epub 2023 Aug 2. PMID: 39876853