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Review
. 2024 May 8;13(10):2760.
doi: 10.3390/jcm13102760.

Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty

Nicholas C Bene  1   2 , Peter C Ferrin  3 , Jing Xu  1 , Geolani W Dy  2   4 , Daniel Dugi 3rd  2   4 , Blair R Peters  1   2
Affiliations
Review

Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty

Nicholas C Bene et al. J Clin Med. .

Abstract

Gender-affirming vaginoplasty (GAV) comprises the construction of a vulva and a neovaginal canal. Although technical nuances of vulvar construction vary between surgeons, vulvar construction is always performed using the homologous penile and scrotal tissues to construct the corresponding vulvar structures. Therefore, the main differentiating factor across gender-affirming vaginoplasty techniques is the tissue that is utilized to construct the neovaginal canal. These tissue types vary markedly in their availability, histology, and ease of harvest and have different advantages and disadvantages to their use as neovaginal lining. In this narrative review, the authors provide a comprehensive overview of the tissue types and associated operative approaches used for construction of the neovagina in GAV. Tissue choice is guided by several factors, such as histological similarity to natal vaginal mucosa, tissue availability, lubrication potential, additional donor site morbidity, and the specific goals of each patient. Skin is used to construct the neovagina in most cases with a combination of pedicled penile skin flaps and scrotal and extra-genital skin grafts. However, skin alternatives such as peritoneum and intestine are increasing in use. Peritoneum and intestine are emerging as options for primary vaginoplasty in cases of limited genital skin or revision vaginoplasty procedures. The increasing number of gender-affirming vaginoplasty procedures performed and the changing patient demographics from factors such as pubertal suppression have resulted in rapidly evolving indications for the use of these differing vaginoplasty techniques. This review sheds light on the use of less frequently utilized tissue types described for construction of the neovaginal canal, including mucosal tissues such as urethral and buccal mucosa, the tunica vaginalis, and dermal matrix allografts and xenografts. Although the body of evidence for each vaginoplasty technique is growing, there is a need for large prospective comparison studies of outcomes between these techniques and the tissue types used to line the neovaginal canal to better define indications and limitations.

Keywords: gender-affirming surgery; gender-affirming vaginoplasty; intestinal vaginoplasty; penile inversion vaginoplasty; revision vaginoplasty; robotic-assisted peritoneal flap vaginoplasty; vaginal reconstruction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Penile skin (proximal, white arrow) and scrotal skin graft (distal, black arrow) which have been inverted over a vaginal dilator. This tissue will be used to create the lining of the neovaginal canal in the open Penile Inversion Vaginoplasty technique.
Figure 2
Figure 2
Intra-abdominal view of the peritoneal flaps that will be approximated to create the neovaginal apex. The extent of the anterior peritoneal flap is denoted by the black dashed line and the extent of the posterior peritoneal flap is denoted by the white dashed line.
Figure 3
Figure 3
Tunica vaginalis covering the testis.
See this image and copyright information in PMC

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References

    1. James S.E., Herman J.L., Rankin S., Keisling M., Mottet L., Anafi M. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality; Washington, DC, USA: 2016.
    1. Peters B.R., Martin L.H., Butler C., Dugi D., Dy G.W. Robotic Peritoneal Flap vs. Perineal Penile Inversion Techniques for Gender-Affirming Vaginoplasty. Curr. Urol. Rep. 2022;23:211–218. doi: 10.1007/s11934-022-01106-9. - DOI - PubMed
    1. Gillies H.D., Ralph Millard D. The Principles and Art of Plastic Surgery. Little, Brown and Company; Boston, MA, USA: 1957.
    1. Hage J.J., Karim R.B., Laub D.R. On the origin of pedicled skin inversion vaginoplasty: Life and work of Dr Georges Burou of Casablanca. Ann. Plast. Surg. 2007;59:723–729. doi: 10.1097/01.sap.0000258974.41516.bc. - DOI - PubMed
    1. van der Sluis W.B., Tuynman J.B., Meijerink W.J.H.J., Bouman M.B. Laparoscopic Intestinal Vaginoplasty in Transgender Women: An Update on Surgical Indications, Operative Technique, Perioperative Care, and Short- and Long-Term Postoperative Issues. Urol. Clin. N. Am. 2019;46:527–539. doi: 10.1016/j.ucl.2019.07.007. - DOI - PubMed

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