Do Histologic Changes in the Skin-Lined Neovagina of Male-to-Female Transsexuals Really Occur?

Abstract

Controversy exists on whether or not the epidermal keratinizing squamous epithelium of skin grafts and flaps applied to line a neovagina changes histologically to a nonkeratinizing mucosal type squamous epithelium after vaginoplasty in male-to-female transsexuals. To end this discussion, the aim of this study was to objectify the short-term and long-term histologic aspect of this neovaginal epithelial lining. Biopsies were taken from the epithelium lining of the neovagina of 9 male-to-female transsexuals, from the moment of vaginoplasty up to 14 years after. These were stained with hematoxylin-eosin and periodic acid-Schiff stain for histologic comparison to normal vaginal biopsies. Because no changes that might have been induced by local influences or hormonal therapy were found, we concluded that short-term and long-term changes in the histologic aspect of inverted skin flaps do not occur after penile and scrotal skin vaginoplasty in male-to-female transsexuals.

Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina

“…While a certain amount of anucleated squamous cells is commonly encountered in normal cervical/vaginal smears as a result of chronic irritation, inflammation, cauterisation, pessary usage or uterine prolapse, the presence of abundant anucleated squamous cells is a constant finding of cytological samples from (penile) skin‐lined neovaginas. In (penile) skin‐lined neovaginas there is usually a considerable amount of cellular debris and sebaceous matter because the transplanted tissue reportedly retains certain characteristics of the original skin such as keratinisation and the presence of sebaceous glands . On the other hand, bowel neovaginas may contain abundant covering mucus.…”

Genitoplasty in male-to-female transsexuals

“…Dekker et al [14] studied short-acting and long-term histological aspects of neovaginal epithelial lining in transsexuals after combined penile and scrotal skin inversion vaginoplasty. Biopsies were taken from the neovaginal epithelium in nine patients, from the moment of vaginoplasty up to 14 years after.…”

Condylomata acuminata of the neovagina in a transgender woman treated with trichloroacetic acid

“…However, the neovaginal lining can lose some keratinization, which may portend increased success on neovaginal warts compared to other lesions for treatment of keratinized tissue. 23 TCA may also be suitable if the neovagina is fashioned from other tissue, such as colonic mucosa or peritoneum.…”