Our Summary

This research paper discusses the main steps involved in vaginoplasty, a surgical procedure often used for male-to-female sex reassignment. The process includes the removal of the male genitalia, the creation of a new vaginal cavity and lining, and the reconstruction of female genitalia such as the urinary opening, labia, and clitoris.

During a specific part of the procedure called pedicled intestinal transfer, a section of the intestine is moved to a cavity created between the bladder and rectum. This is done using a completely laparoscopic technique, which is a minimally invasive surgical procedure.

The paper emphasizes the importance of accurately creating the labia majora and minora, the clitoris, and a clitoral hood in order to closely resemble natural female genitalia, both in function and appearance.

It is mentioned that vaginoplasty using intestinal tissue seems to have a low risk of complications. However, the need for lifelong vaginal care and regular stretching to maintain the size of the new vagina is highlighted. The procedure is particularly relevant for transgender women.

FAQs

  1. What are the major steps in a vaginoplasty procedure?
  2. What is a pedicled intestinal transfer and how is it used in a vaginoplasty procedure?
  3. What are the post-operative recommendations after undergoing a vaginoplasty?

Doctor’s Tip

A doctor might advise a patient undergoing vaginoplasty to maintain lifelong vaginal hygiene and regularly perform dilations to ensure the success and longevity of the procedure. It is important to follow post-operative care instructions and attend follow-up appointments to monitor healing and address any concerns.

Suitable For

Vaginoplasty is typically recommended for transgender women who wish to undergo gender-affirming surgery to create female genitalia. This procedure is often performed after the individual has undergone hormone therapy and has lived as a woman for a certain period of time. It is important for patients to have realistic expectations and a thorough understanding of the risks and benefits of the surgery before undergoing vaginoplasty. Additionally, patients should be in good overall health and have a stable mental health status before undergoing this procedure.

Timeline

Before vaginoplasty:

  1. Consultation with a gender-affirming surgeon to discuss the procedure and potential risks and benefits.
  2. Psychological evaluation and counseling to ensure readiness for surgery.
  3. Hormone therapy to prepare the body for surgery and promote tissue changes.
  4. Pre-operative tests and evaluations to assess overall health and fitness for surgery.

During vaginoplasty:

  1. Orchiectomy and penile amputation to remove male genitalia.
  2. Creation of the neovaginal cavity using tissue from the penile skin or other sources.
  3. Reconstruction of the urethral meatus, labia, and clitoris to create female external genitalia.
  4. Pedicled intestinal transfer, if necessary, to line the neovaginal cavity with tissue from the intestine.
  5. Bowel harvest using a laparoscopic technique.

After vaginoplasty:

  1. Post-operative recovery and monitoring for complications.
  2. Pain management and wound care.
  3. Dilatation therapy to maintain vaginal depth and prevent stenosis.
  4. Follow-up appointments with the surgeon for long-term care and monitoring.
  5. Continuation of hormone therapy and potential additional surgeries for further feminization.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with vaginoplasty surgery?
  2. What type of anesthesia will be used during the procedure?
  3. How long is the recovery process and what can I expect in terms of pain and discomfort?
  4. Will I need to follow a specific post-operative care routine, such as vaginal dilation or hygiene practices?
  5. What are the expected results in terms of appearance and function?
  6. Are there any long-term effects or considerations I should be aware of?
  7. How experienced are you in performing vaginoplasty procedures?
  8. Are there any alternative treatments or procedures that I should consider?
  9. Will I need to undergo any additional surgeries or procedures in the future?
  10. What is the cost of the surgery and will it be covered by insurance?

Reference

Authors: Claes KEY, Pattyn P, D’Arpa S, Robbens C, Monstrey SJ. Journal: Clin Plast Surg. 2018 Jul;45(3):351-360. doi: 10.1016/j.cps.2018.03.006. Epub 2018 May 1. PMID: 29908623