An overview of neovaginal reconstruction options in male to female transsexuals

Abstract

Transsexualism is a complex condition in which the person experiences the inconsistency between the desired gender and their biological gender. Absence of the vagina is devastating in male to female transsexuals. Creation of the neovagina is the main surgical problem in these patients. Historically, beginnings of the neovaginal creation have their roots in the treatment of Mayer-Rokitansky syndrome and conditions such as cloacal anomalies, certain intersex disorders, vaginal malignancies, or severe vaginal trauma, but have more recently found great purpose in male to female sex reassignment surgery. Many operative procedures have been described but none is ideal. Therefore, the search for new, improved solutions continues. In neovaginoplasty reconstruction of the vulvovaginal complex is performed in its entity. The gold standard in neovaginal reconstruction in male to female sex reassignment surgery is penile skin inversion technique with or without scrotal flaps, which enables adequate sensation of the neovagina, good neovaginal depth, good erotic sensitivity of the neclitoris, and esthetically acceptable labia minora and maiora.

Figure 1

Marked incision lines for clitoroplasty and vaginoplasty.

Figure 2

Freed penile skin, dissected neurovascular bundle and mobilized urethra.

Figure 3

Penile disassembly is done. Conically shaped clitoris with preserved neurovascular bundle is created.

Figure 4

Removal of the corpora cavernosa deeply to their attachments on the pubic bones.

Figure 5

Long tube consisting of vascularized penile skin and urethral flap is inverted to form neovagina.

Figure 6

Neovagina is tied deeply to the sacrospinous ligament using Deschamps ligature carrier to prevent its prolapse.

Figure 7

Outcome at the end of surgery.

Figure 8

Harvested segment of sigmoid colon with its mesentery.

Figure 9

Anastomosis of the sigmoid colon with genital skin flaps, deeply hidden.

Figure 10

Appearance at the end of surgery.