Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male to Female Transsexuals

IntroductionIn the treatment of transgender women, the surgical construction of a neo vagina, or vaginoplasty, is the final stage in the transition to the desired gender. Surgeons aim to create a neovagina that is in function and appearance as close to a biological vagina as possible. However, to date, it is insufficiently clear whether transgender women are satisfied with the functional and cosmetic outcomes of vaginoplasty.AimsOur aim was to assess if penile skin inversion neovaginoplasty performed in transgender women meet the objectives strived for, by determining functional and aesthetic outcomes, as well as the physical and sexual well being and satisfaction.MethodsWe performed a retrospective survey study on 49 transgender women who underwent vaginoplasty using the penile skin inversion technique. Participants were asked to fill out the Female Sexual Function Index (FSFI), a combination of the Amsterdam Hyperactive Pelvic Floor Scale—Women (AHPFS W) and the Female Genital Self Imaging Scale, and a short questionnaire for self evaluation of vaginoplasty. Photographs of the genitalia were taken for objective assessment by an independent panel.Main Outcome MeasuresPrimary outcomes were the functional and aesthetic evaluation as perceived by the trangender women themselves. Secondary outcomes were the aesthetic evaluation of the vaginoplasty by an independent panel.ResultsFunctionality and appearance were both given an average score of 8 out of 10. Despite this high score, 56% is sexually dysfunctional according to the FSFI, mainly because of not being sexually active, or due to problems with lubrication and discomfort. In 75%, the result met the expectation and 70% thinks their genital is feminine enough.ConclusionThis study demonstrates that, despite relatively low FSFI scores, this group of transgender women is very satisfied with both the functional and aesthetic results of neovaginoplasty using penile skin inversion. Buncamper ME, Honselaar JS, Bouman M B, Özer M, Kreukels BPC, and Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male to female transsexuals. J Sex Med 2015;12:1626–1634.     

Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques

IntroductionGender reassignment surgery is the keystone of the treatment of transgender patients. For male-to-female transgenders, this involves the creation of a neovagina. Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most gender surgeons. However, the optimal surgical technique for vaginoplasty in transgender women has not yet been identified, as outcomes of the different techniques have never been compared.AimWith this systematic review, we aim to give a detailed overview of the published outcomes of all currently available techniques for vaginoplasty in male-to-female transgenders.MethodsA PubMed and EMBASE search for relevant publications (1995–present), which provided data on the outcome of techniques for vaginoplasty in male-to-female transgender patients.Main Outcome MeasuresMain outcome measures are complications, neovaginal depth and width, sexual function, patient satisfaction, and improvement in quality of life (QoL).ResultsTwenty-six studies satisfied the inclusion criteria. The majority of these studies were retrospective case series of low to intermediate quality. Outcome of the penile skin inversion technique was reported in 1,461 patients, bowel vaginoplasty in 102 patients. Neovaginal stenosis was the most frequent complication in both techniques. Sexual function and patient satisfaction were overall acceptable, but many different outcome measures were used. QoL was only reported in one study. Comparison between techniques was difficult due to the lack of standardization.ConclusionsThe penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data. Horbach SER, Bouman M-B, Smit JM, Özer M, Buncamper ME, and Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: A systematic review of surgical techniques. J Sex Med 2015;12:1499–1512.     

Rectosigmoid vaginoplasty: clinical experience and outcomes in 86 cases

IntroductionThere are several techniques for creation of a neovagina. However, rectosigmoid segment presents the most natural substitute for vaginal tissue.AimTo evaluate the anatomical and functional results of sigmoid vaginoplasty and long‐term sexual and psychological outcomes in 86 patients with vaginal absence.MethodsBetween April 2000 and February 2009, 86 patients, aged 18 to 57 years (mean 22) underwent rectosigmoid vaginoplasty. Indications were vaginal agenesis (54), female transgenderism (27), and genital trauma (5). Rectosigmoid segments ranging from 8 cm to 11 cm were isolated, to avoid excessive mucus production. Preferably, it should be dissected distally first in order to check its mobility and determine the correct site for its proximal dissection. Stapling device was used for the colorectal anastomosis as the safest procedure. Creation of perineal cavity for vaginal replacement was performed using a simultaneous approach through the abdomen and perineum. Perineal skin flaps were designed for anastomosis with rectosigmoid vagina for the prevention of postoperative introital stenosis.Main Outcome MeasuresSexual and psychosocial outcomes assessment was based on the Female Sexual Function Index, Beck Depression Inventory, and standardized questionnaires.ResultsFollow‐up ranged from 8 to 114 months (mean 47 months). Good aesthetic result was achieved in 77 cases. Neovaginal prolapse (7) and deformity of the introitus (9) were repaired by minor surgery. There was no excessive mucus production, vaginal pain, or diversion colitis. Satisfactory sexual and psychosocial outcome was achieved in 69 patients (80.23%).ConclusionsRectosigmoid colon presents a good choice for vaginoplasty. According to our results, sexual function and psychosocial status of patients who underwent rectosigmoid vaginoplasty were not affected in general, and patients attained complete recovery. Djordjevic ML, Stanojevic DS, and Bizic MR. Rectosigmoid vaginoplasty: Clinical experience and outcomes in 86 cases. J Sex Med **;**:**–**.     

Vaginoplasty for the Transgender Woman

Purpose of Review

The purpose of this review was to describe the most common male-to-female vaginoplasty surgical techniques, and to review important perioperative considerations, outcomes, and complications associated with these surgeries.

Recent Findings

Vaginoplasty for the transgender woman may be performed using a variety of techniques. Most commonly, the penile inversion vaginoplasty technique is used, but in some cases, the intestinal segment vaginoplasty is indicated. Intraoperative complications of vaginoplasty surgery include bleeding and injury to the bladder, urethra, and/or rectum. Immediate postoperative complications include hematoma or seroma formation, infection or abscess, wound dehiscence, flap necrosis, and venous thromboembolism. Delayed postoperative complications include neovaginal stenosis or shortening of the neovagina, rectovaginal or genitourinary fistula formation, urethral meatal stenosis or abnormal urine stream, neuropathy, and sexual dysfunction including dyspareunia and anorgasmia. Most patients are satisfied with the functional and esthetic outcomes of vaginoplasty, but sexual dysfunction may be common. The risk of regret following vaginoplasty seems to be low, and certain risk factors for this unfavorable outcome have been identified.

Summary

Outcomes appear to be satisfactory following vaginoplasty surgery for transgender women, but robust prospective, long-term data are lacking.

     

Laparoscopic technique for secondary vaginoplasty in male to female transsexuals using a modified vascularized pedicled sigmoid

Between 1995 and 2002, 53 primary sex reassignments in male to female transsexuals were performed at our division. The objective of this procedure is to mimic the female external and part of the internal genitalia both esthetically and functionally. In 11 of the 53 patients, a secondary vaginal lengthening had to be performed due to a short neovagina. This was achieved using a pedicled sigmoid segment, with an open approach in the first 2 patients and using a laparoscopic method in the following 9. This paper focuses on the laparoscopic technique, its benefits and potential complications. Where a primary vaginoplasty, combining inversion of the penile and scrotal skin flaps, yields unsatisfactory functional results, a secondary vaginoplasty using the pedicled sigmoid represents an elegant means to achieve functional improvement. Furthermore, we report a modified surgical approach to the conventional sigmoid transition.     

Male-to-Female Gender-Affirming Surgery Using Nile Tilapia Fish Skin as a Biocompatible Graft

Study ObjectiveInsufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth.DesignStepwise demonstration of the procedure with narrated video footage.SettingTransgender health clinic.InterventionsA 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period.ConclusionNile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.     

Genital gender-affirming surgery for transgender women

Transgender women may opt for genital gender-affirming surgery (gGAS), which comprises bilateral orchiectomy, gender-affirming vulvoplasty, or vaginoplasty. Vaginoplasty is chosen most frequently in this population, penile inversion vaginoplasty being the surgical gold standard. In selected cases, skin graft vaginoplasty, intestinal vaginoplasty, or peritoneal vaginoplasty may be indicated. In this article, we discuss the various types of gGAS for transgender women, (contra)-indications, intraoperative considerations, techniques, surgical outcomes, and postoperative patient-reported outcomes.     

A Single-Center Study Comparison of Two Different Male-to-Female Penile Skin Inversion Vaginoplasty Techniques and Their 3.5-Year Outcomes

BackgroundVaginoplasty is a crucial part of genital gender-affirming surgery with the number of trans women undergoing this intervention steadily, however, up to date, there is still no standardized vaginoplasty technique.AimThis retrospective single-center study compares single-stage vs two-stage penile skin inversion vaginoplasty techniques and their long-term outcomes.MethodsMedical records of 63 consecutive patients who underwent single-stage vaginoplasty, as described by Dr Preecha Tiewtranon, and 62 consecutive patients who underwent 2-stage vaginoplasty were reviewed.ResultsThe mean postoperative hospital stay was 7 days for patients who underwent single-stage vaginoplasty vs 16 days for patients who underwent 2-stage vaginoplasty. Neovaginal depth proved constant in patients who underwent single-stage vaginoplasty, whereas a loss of more than 30% was observed in patients who underwent 2-stage vaginoplasty during the first postoperative year. Early complications were more common than late-onset complications in both groups. The most common complication in the single-stage group was wound dehiscence (4.8%). There were significantly more complications in 2-stage collective, among which wound dehiscence (33.9%), unsatisfactory cosmetic outcome (25.8%), and urethral stenosis (14.5%) were the most common. In the single-stage cohort, 4 (6.4%) patients needed one revision surgery, whereas 35 (56.5%) patients in the 2-stage cohort necessitated one or more reoperations with up to 10 quaternary revisions. All patients reported to have sensitivity to neoclitoris in the single-stage group, whereas 3 (4.8%) patients in the 2-stage group were deprived of it because of neoclitoral necrosis.Clinical ImplicationsOptimizing a vaginoplasty surgical technique and its postoperative protocol.Strengths & LimitationsThe present retrospective study with a mean follow-up of more than 3.5 years offers the first ever comparison of 2 different PSI vaginoplasty surgical techniques performed in the same center.ConclusionSignificantly lower complication and revision rates, shorter recovery time, and superior esthetic and functional outcomes were observed in the single-stage than in the two-stage penile skin inversion vaginoplasty surgical technique.Fakin RM, Giovanoli P. A Single-Center Study Comparison of Two Different Male-to-Female Penile Skin Inversion Vaginoplasty Techniques and Their 3.5-Year Outcomes. J Sex Med 2021;18:391–399.     

Intestinal Vaginoplasty Revisited: A Review of Surgical Techniques,Complications, and Sexual Function

IntroductionVaginal (re)construction is essential for the psychological well‐being of biological women with a dysfunctional vagina and male‐to‐female transgender women. However, the preferred method for vagina (re)construction with respect to functional as well as aesthetic outcomes is debated. Regarding intestinal vaginoplasty, despite the asserted advantages, the need for intestinal surgery and subsequent risk of diversion colitis are often‐mentioned concerns. The outcomes of vaginal reconstructive surgery need to be appraised in order to improve understanding of pros and cons.AimsTo review literature on surgical techniques and clinical outcomes of intestinal vaginoplasty.MethodsElectronic databases and reference lists of published articles were searched for primary studies on intestinal vaginoplasty. Studies were included if these included at least five patients and had a minimal follow‐up period of 1 year. No constraints were imposed with regard to patient age, indication for vaginoplasty, or applied surgical technique. Outcome measures were extracted and analyzed.Main Outcome MeasuresMain outcome measures were surgical procedure, clinical outcomes, and outcomes concerning sexual health and quality of life.ResultsTwenty‐one studies on intestinal vaginoplasty were included (including 894 patients in total). All studies had a retrospective design and were of low quality. Prevalence and severity of procedure‐related complications were low. The main postoperative complication was introital stenosis, necessitating surgical correction in 4.1% of sigmoid‐derived and 1.2% of ileum‐derived vaginoplasties. Neither diversion colitis nor cancer was reported. Sexual satisfaction rate was high, but standardized questionnaires were rarely used. Quality of life was not reported.ConclusionBased on evidence presently available, it seems that intestinal vaginoplasty is associated with low complication rates. To substantiate these findings and to obtain information about functional outcomes and quality of life, prospective studies using standardized measures and questionnaires are warranted. Bouman M‐B, van Zeijl MCT, Buncamper ME, Meijerink WJHJ, van Bodegraven AA, and Mullender MG. Intestinal vaginoplasty revisited: A review of surgical techniques, complications, and sexual function. J Sex Med 2014;11:1835–1847.     

Laparoscopic Sacrocolpopexy With a Mesh for Sigmoid Neovaginal Prolapse: A Case Report

BackgroundCreating a functional neovagina is a practical therapeutic intervention for women with congenital vaginal agenesis and sexual needs. Although the incidence of neovaginal prolapse (NP) is low, it is inconvenient for patients and is a challenging problem for gynecologists.CaseA 32-year-old woman who had undergone transabdominal sigmoid vaginoplasty 10 years previously at another hospital visited our clinic for evaluation and treatment of NP. Gynecological examination showed exstrophy of the vaginal apex, 4 cm beyond the hymen. Laparoscopic sacrocolpopexy was performed using a mesh. The mesh was sutured at the anterior wall and apex of the neovagina and suspended in the anterior sacral region without blood vessels.Summary and ConclusionLaparoscopic sacrocolpopexy might be an effective and safe treatment for NP.     

Rectal Lactobacillus Species and Their Influence on the Vaginal Microflora: A Model of Male-to-Female Transsexual Women

IntroductionBased on Lactobacillus species co-colonizing the vagina and rectum, it has been hypothesized that the rectum may be an important reservoir for vaginal colonization by lactobacilli. There are no data on this issue in male-to-female transsexual women.AimWe undertook this observational study to characterize the Lactobacillus species present in the neovagina and rectum of male-to-female transsexual women and to determine the degree of neovaginal-rectal co-colonization in order to gain a better understanding of the potential role of the gut as a reservoir for genital lactobacilli.MethodsSixty-one male-to-female transsexual women with penile skin lined neovagina without clinical signs of infection were recruited on an ongoing basis from among male-to-female transsexual outpatients. Neovaginal and rectal smears were taken for molecular Lactobacillus species profiling by denaturing gradient gel electrophoresis (PCR-DGGE).Main Outcome MeasuresMatching Lactobacillus species between neovagina and rectum.ResultsForty-three of the 61 male-to-female transsexual women (70.5%) simultaneously harbored the same lactobacilli in both the neovagina and rectum. We found 276 neovaginal and 258 rectal DGGE bands representing 11 Lactobacillus species, with 201 matches of the same Lactobacillus species in neovagina and rectum. 37 of the 61 women (61%) had two or more matching Lactobacillus species.ConclusionThese data support the hypothesis that the rectum may play an important role as source of Lactobacillus species that colonies neovagina of male-to-female transsexual women. In view of the specific anatomical circumstances of the study population, these findings may be extended to the general population of women. Petricevic L, Kaufmann U, Domig KJ, Kraler M, Marschalek J, Kneifel W, and Kiss H. Rectal Lactobacillus species and their influence on the vaginal microflora: A model of male-to-female transsexual women. J Sex Med 2014;11:2738–2743.     

Repair of vaginal prolapse following penoscrotal flap vaginoplasty in a male-to-female transsexual

Penis and testicle amputation, vaginoplasty, and clitoroplasty are procedures that help male-to-female transsexuals to accept their body and to increase psychosocial well-being. We describe a successful correction of prolapse of the neovagina with abdominovaginal sacropexy in a male-to-female transsexual who had undergone penoscrotal flap vaginoplasty. Although the reasons for a neovaginal prolapse are not completely known, in our case vaginal sacropexy was successful, with good functional and cosmetic results.     

A case of vaginoplasty without grafting

BackgroundMany techniques have been used to create a neovagina in patients with vaginal agenesis, and several surgical procedures involve the use of a graft. Grafting techniques are associated with intraoperative and postoperative morbidity and complications, at both the donor and the recipient site.CaseA 17-year-old patient with Mayer-Rokitansky-Kuster-Hauser syndrome complicated by unilateral pelvic kidney underwent successful vaginoplasty without the use of a graft, followed by insertion of a vaginal stent for 12 weeks. She had a functional, well-healed, and fully epithelialized neovagina by 6.5 months postoperatively.ConclusionPatients undergoing surgical vaginoplasty may benefit from this simple surgical technique, thereby avoiding the morbidity associated with the alternative grafting techniques commonly used in practice.     

A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program

BackgroundGiven the burgeoning demand for gender affirmation surgery, there are few studies examining both surgical process variables and patient outcome variables. Knowing the learning curve for surgical teams who are beginning to perform this procedure will be important for patient safety and presurgical patient counseling as more institutions open transgender surgical programs.AimThe purpose of this study was to determine the demographics of patients pursuing penoscrotal vaginoplasty, to determine their postoperative course, and to determine a learning curve for the surgical team performing penoscrotal vaginoplasty.MethodsWe retrospectively reviewed charts of all 43 patients who underwent penoscrotal vaginoplasty from the commencement of a new male-to-female penoscrotal vaginoplasty program in March 2018 through July 2019.OutcomesPrimary outcomes included mean hemoglobin decrease from surgery and operative time. Mean time to neoclitoral sensation, length of hospital admission, complication rates, reoperation rates, length of narcotic use after surgery, and demographics were also evaluated. Associations between surgical team experience and outcomes were assessed with Spearman's rho and Cox regression, and curve-fitting procedures were applied to determine the relationship.ResultsThe mean operative time from initial incision to procedure finish was 225 minutes, and the mean decrease in hemoglobin was 3.3 g/dL. The mean time to neoclitoral sensation was 0.72 months. The time until neoclitoral sensation decreased as the surgical cases performed increased (Spearman's rho, −0.577 [P < .001]), with a power function best describing the learning curve. Operative time did not change with case number (Spearman's rho, 0.062 [P = .698]) but overall time in the operating room did (Spearman's rho, 0.631 [P < .001]). Mean length of hospital admission was 2.9 days. There were no intraoperative complications. 18 patients (42%) experienced a postoperative complication. 8 of 43 patients underwent reoperation (20%). Narcotics were used a mean of 9.5 days after surgery.Clinical ImplicationsA learning curve can be demonstrated in penoscrotal vaginoplasty for time to neoclitoral sensation and overall time in the operating room, plateauing between 30 and 40 cases.Strengths and LimitationsStrengths include assessing a learning curve for time to neoclitoral sensation, length of hospital stay, and length of postoperative narcotic use after penoscrotal vaginoplasty, which, to our knowledge, has not been reported elsewhere. Limitations include our overall low number of patients.ConclusionDespite a low number of cases, length of hospital stay was short and the postoperative complication rate was similar to that of long-standing penoscrotal vaginoplasty programs.Whynott RM, Summers K, Mickelsen R, et al. A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program. J Sex Med 2020;17:1787–1794.     

Male‐to‐Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients

BackgroundPatients with male‐to‐female gender dysphoria (GD) require multidisciplinary assessment and management. Nowadays, more and more patients decide to undergo genital reassignment surgery (GRS) to have aesthetic and functional external female genitalia. Different techniques of this procedure have been described. Orchiectomy, penile disassembly, creation of a neovaginal cavity, repositioning of urethral meatus, and clitorolabioplasty may be identified as the five major steps in all of these techniques.MethodsWe conducted a retrospective study of 60 patients who underwent genital reassignment procedure for male‐to‐female GD at our department between November 2008 and August 2013 with a minimum follow‐up of 1 year. Data were collected on surgical technique, postoperative dilations protocol, complications, and functional and aesthetic outcomes. We describe and critically evaluate the surgical technique used in our department.ResultsFollow‐up ranged from 14 to 46 months. Two patients developed late neovaginal stricture, and two patients experienced rectovaginal fistulae (one required surgical revision with dermal porcine graft placement). Minor complications occurred in 13 patients and included urethral stenosis, partial wound dehiscence, and minor bleeding. Secondary aesthetic revision surgery was performed in 13 cases.ConclusionsGRS can provide good functional and aesthetic outcomes in patients with male‐to‐female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina. Raigosa M, Avvedimento S, Yoon TS, Cruz‐ Gimeno J, Rodriguez G, and F ontdevila J. Male‐to‐female genital reassignment surgery: A retrospective review of surgical technique and complications in 60 patients. J Sex Med 2015;12:1837–1845.     

Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome

ObjectiveTo evaluate anatomic and sexual outcomes in women with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome after laparoscopic Davydov (laparoscopic peritoneal vaginoplasty).DesignProspective follow-up study of patients with MRKH syndrome after vaginoplasty (Design classification: II-2).SettingAcademic hospital.PatientsPatients with MRKH syndrome and frequency-matched age-comparable healthy controls.InterventionThirty-one patients with MRKH syndrome underwent surgery with the procedure, and their clinical, surgical, and follow-up data were recorded. A Female Sexual Function Index (FSFI) questionnaire was administrated to evaluate sexual functions of patients who became sexually active and compared them with 50 randomly selected, age-matched healthy women.MeasurementsFSFI scores in women with MRKH syndrome and in control subjects. Clinical and anatomic measurements of neovagina.Main ResultsThe laparoscopic Davydov was successfully completed in all 31 cases, with 24 patients monitored. The mean length of the neovagina was 6.27±1.25 cm. There was no statistical difference in the total FSFI score between the case and control groups. There is indication that shorter neovaginal length, especially of<7 cm, appears to be associated with lower total FSFI scores.ConclusionLaparoscopic Davydov is a safe, effective treatment of Mayer-Rokitansky-Kuster-Hauser syndrome with minimal invasion and a relatively low complication rate.     

Gender-Confirming Vulvoplasty in Transgender Women in the Netherlands: Incidence,Motivation Analysis,and Surgical Outcomes

BackgroundPenile inversion vaginoplasty is the surgical gold standard for genital gender-affirmative surgery in transgender women. However, there is an increase of attention for gender-confirming vulvoplasty (GCV), in which no neovaginal cavity is created.AimTo describe underlying motives and surgical outcomes of GCV in transgender women.MethodsAll transgender women who underwent GCV were retrospectively identified from a departmental database. A retrospective chart study was conducted, recording underlying motives, demographics, perioperative complications, and reoperations.OutcomesUnderlying motives and perioperative complication rate.ResultsIn the period January 1990 to January 2020, 17 transgender women underwent GCV at our center. Most women reported that their motivation to undergo GCV was because they had no wish for postoperative neovaginal penetration (n = 10, 59%). This was due to a sexual preference toward women without the wish for neovaginal penetrative intercourse (n = 6, 35%) or due to a negative sexual experience in the past (n = 4, 24%). Some women desired vaginoplasty with neovaginal cavity creation but were ineligible for this because of their medical history (n = 4, 24%), for example, due to locoregional radiotherapy. The median clinical follow-up was 34 months (range 3-190). The postoperative course was uncomplicated in 11 (65%) women. Postoperative complications comprised the following: meatal stenosis (n = 2, for which surgical correction), remnant corpus spongiosum tissue (n = 1, for which surgical correction), minor wound dehiscence (n = 3, for which conservative management), and postoperative urinary tract infection (n = 1, successfully treated with oral antibiotics). One woman, who developed meatal stenosis, had a history of radiotherapy because of rectal carcinoma and needed 2 surgical procedures under general anesthesia to correct this. Information on self-reported satisfaction was available for 12 women. All were satisfied with the postoperative result and they graded their neovagina an 8.2 ± 0.9 out of 10.Clinical ImplicationsGCV may be added to the surgical repertoire of the gender surgeon. Transgender women with a desire for genital gender-affirmative surgery should be counseled on surgical options and its (dis)advantages.Strengths & LimitationsStrengths of this study comprise that it is from a high-volume center. A weakness of this study is the retrospective design. The absence of a self-reported outcome measure validated for the transgender persons is a well-known problem.ConclusionAn increase is observed in transgender women who opt for GCV; however, the absolute number undergoing this surgery remains small in our center. Postoperative complications do occur but are generally minor and treatable.van der Sluis WB, Steensma TD, Timmermans FW, et al. Gender-Confirming Vulvoplasty in Transgender Women in the Netherlands: Incidence, Motivation Analysis, and Surgical Outcomes. J Sex Med 2020;17:1566–1573.     

Plastie vaginale par technique de Vecchietti cœlioscopique : résultats anatomiques et fonctionnels

ObjectivesTo evaluate vaginoplasty by Vecchietti technique adapted to laparoscopy and the anatomical and functional long term outcomes.Patients and methodsWe retrospectively studied the patients with vaginal agenesis (a Mayer-Rokitansky-Küster-Hauser syndrome for seven of young adults) operated from 1997 to 2011. The data of eight patients with a median age of 18 years old was collected. Surgical complications were analysed. The functional outcomes were compared to a control group with the Female Sexual Function Index (FSFI).ResultsNo major complication occurred during surgery. The postoperative mean vaginal measurement was 7.2 cm (4.4–10). The total FSFI scores did not differ from that of the control group (19.2 versus 18 p = 0.82). Desire, arousal, lubrication, orgasm, satisfaction, and pain of the patients were similar to controls.Discussion and conclusionLaparoscopic Vecchietti technique is a fast, simple and safe procedure to create a neovagina, and guarantees good anatomic and functional results.