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Vaginoplasty is any surgical procedure to construct a vagina (such as for male-to-female transsexuals), to treat structural defects, or to produce aesthetic changes. The term vaginoplasty is used to describe any such vaginal surgery, while the term neovaginoplasty is more specifically used to refer to procedures of partial or total construction or reconstruction of the vulvovaginal complex.

File:Vaginoplasty.JPG

There are many different vaginoplasty techniques. Some involve the use of autologous biological tissue from other parts of the body of the patient to construct areas of vagina. Areas that may be used include oral mucosa, skin flaps, skin grafts, the vaginal labia, penile skin and/or tissue, scrotal skin, intestinal mucosa, and others.

NeovaginoplastyEdit

Neovaginoplasty is a reconstructive surgery procedure used to construct or reconstruct a vaginal canal and mucous membrane. These may be absent in a woman, due either to congenital disease such as vaginal atresia or to an acquired cause, such as trauma or cancer. Some transwomen opt for vaginoplasty as part of their gender transition.

The outcome of neovaginoplasty is variable. It usually allows sexual intercourse, although sensation is not always present. In genetic women, menstruation and fertilization are assured when the uterus and ovaries have preserved a normal function. In a few cases, vaginal childbirth is possible.

Male-to-Female transsexual patientsEdit

Main article: Sex reassignment surgery (male-to-female)

Most neovaginoplasty procedures are performed on male-to-female transsexuals. The penile inversion technique was improved by Georges Burou during his pioneering work in sex reassignment surgery.

For the creation of the male-to-female neovagina, there is also the possibility of using penile skin flaps (so-called penile inversion), as well as the "Suporn technique" and "Wilson method".

In the 1990s and continuing to the present, neovaginal construction has been further advanced by Toby R. Meltzer, M.D., whose technique involves the use of both penile and scrotal tissue to form the vaginal vault, and has yielded more reliable sexual sensation, maintenance of vaginal depth, and a stronger pelvic floor by maintaining a nearly intact levitor ani muscle complex.[1]

Meltzer creates a neurologically sensate clitoris, constructed from a penile glans pedicle, with its attached blood supply and nerves. During a secondary procedure using Meltzer's technique, he forms a labia hood for the clitoris using the inverted Y plasty suturing method, leaving only a single midline incision scar.[2][3]

When the trans woman is ready, there are two steps to Sexual Reassignment Surgery.[citation needed] The first procedure is called Vaginoplasty. Vaginoplasty is the procedure that essentially turns the penis into the vagina.[How to reference and link to summary or text] It is often followed several months later by the Labiaplasty. The Labiaplasty refines the labia or external female genitalia.

During Vaginoplasty "the right spermatic cord is clamped and ligated. The primary incision is continued up the ventral side of the shaft of the penis. [Then] the anterior flap is developed from the skin of the penis. The urethra is dissected from the shaft. The corpora cavernosa are separated to assure a minimal stump. [After that] the anterior flap [is] perforated to position the urethral meatus. The skin flaps are sutured and placed in position in the vaginal cavity. [When that is completed], the preservation of the vaginal cavity is assured by the use of a suitable vaginal form."[citation needed] Finally the vagina is complete.

When a patient receives Labiaplasty, a frequently used procedure, labia and a clitoral hood are created. This is often performed a few months after the first part of the procedure. In some cases, labiaplasty is an elective procedure to improve appearance after a one-stage Vaginoplasty. Labiaplasty (2000).

Even after SRS there are many complications that range from minor to major. There are the minor complications which include infections, bleeding and loss of grafted skin.[citation needed] "The more serious complications include major infections or bleeding, and damage to the bladder. There is a possibility of damage to the prostate or major nerves during the dissection to form the vagina."[citation needed]

While undergoing this surgery the most severe complication is the formation of a vaginal-rectal fistula. This occurs when the doctor accidentally cuts through the rectal wall during vaginal cavity dissection. As a result, excrement bypasses the anal stricture and exits through the vagina. This prevents proper healing.[citation needed] This process can be remedied through a long process of surgeries and many months of wearing of a colostomy bag.[citation needed] Because of the embarrassment, the complication often goes untreated, leading to serious infections.[1]

The Vecchietti procedureEdit

The Vecchietti procedure is a laparoscopic procedure that has been shown to result in a vagina that is comparable to a normal vagina in patients with Mullerian agenesis.[4][5] It is carried out in the operating theatre with the patient asleep. In this procedure, a small plastic “olive” is threaded against the vaginal area, and the threads are drawn though the vaginal skin, up through the abdomen and through the navel using laparoscopic surgery. There the threads are attached to a traction device. The operation itself takes about 45 minutes. The traction device is then tightened daily so the olive is pulled inwards and stretches the vagina by approximately 1cm per day, creating a vagina approximately 7cm deep in 7 days, although it can be more than this.[6]

Balloon vaginoplastyEdit

In balloon vaginoplasty, a Foley catheter is laparoscopically inserted in the recto-vesical[7] or retropubic space[8], whereupon gradual traction and distension is used to create a neovagina. It is a new technique for treating vaginal aplasia.[8][7] It is a simple, safe, and effective alternative approach for creation of a neovagina, especially when conventional laparoscopy is unfeasible or unsafe.[8]

ColovaginoplastyEdit

With colovaginoplasty, sometimes called a colon section, a vagina is created by cutting away a section of the sigmoid colon and using it to form a vaginal lining.

This surgery is performed on females with androgen insensitivity syndrome, congenital adrenal hyperplasia, vaginal agenesis, Müllerian agenesis, and other intersexed conditions, where non-invasive forms of lengthening the vagina cannot be done and, mostly, on male-to-female transsexuals as an alternative to penile inversion with or without an accompanying skin graft (usually from either the thigh or abdomen).

Due to numerous potential complications (such as diversion colitis) most surgeons will recommend a colovaginoplasty only when there is no alternative.

Penile inversionEdit

Penile inversion is a surgical technique for genital reassignment (sex change) used to construct a neo-vagina from a penis for transwomen, sometimes also for intersex people. It is one of two main sorts of vaginoplasty, along with colovaginoplasty.

The erectile tissue of the penis is removed, and the skin, with its blood and nerve supplies still attached (a flap technique first used by Sir Harold Gillies in 1951), is used to create a vestibule area and labia minora, and inverted into a cavity created in the pelvic tissue. Part of the tip (glans) of the penis, still connected to its blood and nerve supplies, is usually used to construct a clitoris; the urethra is shortened to end at a place that is appropriate for a female anatomy.

NeoclitorisEdit

There are two ways to create a clitoris for a transsexual woman. The most common method is to remove the head or glans of the penis, and use some of that tissue to function in the position of a biological woman's clitoris. Some transsexual women have the entire penis head used as their clitoris. Some transsexual women have spongiform from their urethras to function as the neoclitoris.[How to reference and link to summary or text] The success rate for the creation of a clitoris for transsexual women varies greatly. If the relocation of the glans penis is successful then the transsexual woman may have a sensate neoclitoris capable of orgasm. Most transsexual women's bodies readily accept the relocation of glans penile tissue in the area of a biological woman's clitoris. However, as with all surgeries nothing is perfect and there have been cases of the glans penis neoclitoris bleeding and even falling off entirely. There are many SRS surgeons who do not attempt any creation of a neoclitoris for their transsexual patients. Instead they allow the trans woman to orgasm with the penile lined vagina. Some SRS surgeons do not agree with using the head of the penis to create a neoclitoris. They prefer to either use urethral spongiform or make no attempt at the creation of a clitoris at all. Some SRS surgeons take the head of the penis and surgically place it inside the body in the position of a cervix. The late Stanley Biber preferred this method. Many transsexual women like the glans penis being inside their bodies because it can be greatly stimulated during vaginal penetration.

Related proceduresEdit

LabioplastyEdit

Labiaplasty is a plastic surgery procedure involving the labia, any of four folds of tissue of the vulva. Labiaplasty may be performed alone or as part of vaginoplasty.

"Vaginal rejuvenation"Edit

Non-reconstructive vaginoplasty or "vaginal rejuvenation" is used to restore vaginal tone and appearance, largely by removing excess tissue and tightening supportive structures. The popularity of surgery to change the cosmetic appearance of a female's genitalia has increased in North America over the last few years. The term "designer vagina" refers to an idealized image of female sex organs attained through vaginoplasty. In recent years laser has been introduced to assist in the procedure. The rejuvenation procedure is intended to reduce or undo effects of age and childbearing. The American College of Obstetricians and Gynecologists, however, warns that this procedure lacks supporting data regarding safety and efficacy.[9] Vaginal rejuvenation surgery can lead to decreased sensory perception of the clitoris and the rest of the genital area, potentially to such an extent as to prevent the possibility of orgasm, and can lead to complications such as infection, adhesions, and scarring.[10]

TerminologyEdit

The term vaginoplasty has also been applied to:

  • Hymenotomy, a surgical procedure to create an opening in an imperforate hymen
  • Hymenorrhaphy, a surgical procedure to recreate a ruptured hymen.

See alsoEdit

ReferencesEdit

  1. Anne Lawrence, MD Vaginoplasty: Dr. Meltzer Multipage photographic surgical presentation Note Surgical Photos
  2. Anne Lawrence, MD Labiaplasty: Dr. Meltzer Performs Labiaplasty - Multipage photographic surgical presentation Note Surgical Photos
  3. Toby R. Meltzer, M.D. - Aesthetic Refinements to the Secondary Labiaplasty - XVII Harry Benjamin International Gender Dysphoria Association Symposium (abstract)
  4. Vecchietti G. Creation of an artificial vagina in Rokitansky-Kuster-Hauser syndrome. Attual Ostet Ginecol 1965;11:131-47
  5. Fedele L, Bianchi S, Tozzi L, Borruto F, Vignali M, A new laparoscopic procedure for creation of a neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril 1996;66:854-7
  6. University College University Hospitals > Vecchietti Procedure Retrieved on April 3, 2010
  7. 7.0 7.1 El Saman AM, Fathalla MM, Nasr AM, Youssef MA (August 2007). Laparoscopically assisted balloon vaginoplasty for management of vaginal aplasia. Int J Gynaecol Obstet 98 (2): 134–7.
  8. 8.0 8.1 8.2 El Saman AM (April 2010). Retropubic balloon vaginoplasty for management of Mayer-Rokitansky-Küster-Hauser syndrome. Fertil. Steril. 93 (6): 2016–9.
  9. ACOG (2007). Committee Opinion No. 378: Vaginal "rejuvenation" and cosmetic vaginal procedures.. Obstet Gynecol (2007) 110(3):737-8 110 (3): 737–8.
  10. http://womenshealthnews.wordpress.com/2007/08/31/vaginal-rejuvenation-not-proven-safe-or-necessary/

Further readingEdit

  • Karim RB, Hage JJ, Dekker JJ, Schoot CM. Evolution of the methods of neovaginoplasty for vaginal aplasia. Eur J Obstet Gynecol Reprod Biol. 1995 Jan;58(1):19-27. Review. PMID 7758640
  • Karim RB, Hage JJ, Mulder JW. Neovaginoplasty in male transsexuals: review of surgical techniques and recommendations regarding eligibility. Ann Plast Surg. 1996 Dec;37(6):669-75. Review. PMID 8988784
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