Types of vaginoplasty

The most appropriate type of vaginoplasty for each case depends more on the available tissue than on personal preference. It is important to discuss any questions or concerns you may have with your surgeon.

Penile Inversion Vaginoplasty

This is the first option in most cases, although it is generally not suitable in cases involving a small penis or extensive circumcision. It combines an anteriorly based fasciocutaneous penile flap with a posteriorly based perineal skin flap to create the internal lining of the vagina. The advantages include the use of sensitive, elastic and durable skin that is free of hair. If additional length is required, full-thickness skin grafts obtained from the scrotum can be used to line the vaginal vault.

The neoclitoris is created using a sensate pedicled glans flap, while the clitoral hood and labia minora are created using foreskin skin, the vestibule using urethral tissue, and the labia majora using a scrotal fasciocutaneous flap.

Vaginoplasty with Scrotal Skin Grafts

Unlike the fasciocutaneous flap used in penile inversion vaginoplasty, this technique uses grafts from excess scrotal skin. As a result, the lining is less elastic and more fragile than that created using penile inversion. It is rarely used to line the entire vagina and is generally used as a complementary technique alongside penile inversion when a few centimetres of tissue are lacking to cover the vaginal vault.

Colovaginoplasty (Vaginoplasty Using a Pedicled Sigmoid Colon Flap)

This technique is usually reserved for secondary vaginoplasty, although in some cases it may be the first option. The sigmoid colon is generally used because of its larger diameter and lower volume of secretions, although the jejunum or ileum may also be used. Its advantage is that it creates a vagina lined with mucosa, reducing the need for post-operative vaginal dilation and the use of lubricants during penetration. However, disadvantages include the need to add an intra-abdominal procedure involving an intestinal anastomosis, the possibility of painful intestinal spasms, neovaginal secretions and post-coital bleeding due to the fragility of the mucosa.

Surgical procedure

Duration: 4 hours for penile inversion vaginoplasty and 5–6 hours for colovaginoplasty.

Anaesthetic: General anaesthetic with orotracheal intubation.

Hospital stay: A hospital stay of 5–7 days is required for post-operative monitoring and appropriate care.