Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes

Abstract

Background Many techniques have been described for reconstruction of the vaginal canal for oncologic, traumatic, and congenital indications. An increasing role exists for these procedures within the transgender community. Most often, inverted phallus skin is used to create the neovagina in transwomen. However, not all patients have sufficient tissue to achieve satisfactory depth and those that do must endure cumbersome postoperative dilation routines to prevent contracture. In selected patients, the sigmoid colon can be used to harvest ample tissue while avoiding the limitations of penile inversion techniques. Methods Records were retrospectively reviewed for all transwomen undergoing primary sigmoid vaginoplasty with the University of Miami Gender Reassignment service between 2014 and 2017. Results Average neovaginal depth was 13.9 +/− 2.0 centimeters in 12 patients. 67% were without complications, and all maintained tissue conducive to sexual activity. No incidences of bowel injury, anastomotic leak, sigmoid necrosis, prolapse, diversion neovaginitis, dyspareunia, or excessive secretions had occurred at last follow-up. Conclusions Sigmoid vaginoplasty is a reliable technique for achieving a satisfactory vaginal depth that is sexually functional. Using a collaborative approach, it is now our standard of care to offer this surgery to transwomen with phallus length less than 11.4 centimeters.

Sigmoid Neovagina: A Case Presentation and Pathological Review of Intestinal Transfer

“…6 Although any intestinal segment can be used for this technique, the sigmoid colon has been identified as the optimal bowel segment for this purpose, as it produces less copious secretions, creates a more natural vaginal depth, and results in lower rates of vaginal stenosis. 7…”

Transfeminine Gender Confirmation Surgery with Penile Inversion Vaginoplasty: An Initial Experience

“…However, these are generally recognized as inferior to penile inversion. 17 , 18 In the literature, the overall technical and subjective success rate of penile inversion vaginoplasty is 80%–90%. Complication rate of penile inversion is generally regarded at approximately 20%–30%, while complication rate of alternative procedures is typically 35%–60%.…”

The Use of a Hartmann’s Pouch for Bowel Vaginoplasty: A Case Report

“…The procedure most studied in male-to-female reassignment is the use of inverted phallus skin to create the neovagina. 6 , 7 In some patients, due to anatomical limitations or to penile-scrotal skin hypoplasia as a result of puberty-suppressing hormonal treatment during adolescence, penile skin inversion will not provide sufficient vaginal depth, and bowel vaginoplasty is a valid option. Over the past several years, bowel vaginoplasty in gender affirmation surgery has increased, providing satisfactory results in sexual function and the rate of stenosis.…”

“… 7 A recent systematic review of surgical techniques for vaginoplasty in male-to-female transgender patients showed that bowel vaginoplasty is not inferior to the more commonly performed penial skin inversion technique. 6 …”

“…The literature is scant for the use of a Hartmann’s pouch for vaginal reconstruction; however, our patient had obliteration of her native vagina, and the development of a rectal mucocele allowed for a novel reconstructive approach using reliable techniques of bowel vaginoplasty with a Hartmann’s pouch. 6 …”