Vaginoplasty in male transsexuals using penile skin and a urethral flap

Abstract

Objectives To describe and present the results of a onestage vaginoplasty in male-to-female sex reassignment surgery. Patients and methods The present technique is based on penile disassembly and the use of all penile components for vaginoplasty (except the corpora cavernosa). The neovagina consists of two parts; a long vascularized urethral¯ap and a pedicled island tube skin¯ap created from the penile skin. The urethral¯ap is embedded into the skin tube. The tube, consisting of skin and the urethral¯ap, is inverted, thus forming the neovagina. The new vagina is inserted into the previously prepared perineal cavity between the urethra, bladder and rectum. The neovagina is then ®xed to the sacrospinous ligament. The labia minora and majora are formed from remaining penile and scrotal skin. The new method was used in 89 patients (mean age 28 years, range 18±56) with a mean (range) follow-up of 4.6 (0.25±6) years.Results Good cosmetic and functional results were obtained in 77 of the 89 patients (87%). Importantly, the neovagina produced in most patients was of satisfactory depth and width. There was only one major complication, a rectovaginal ®stula caused by intraoperative injury to the rectum. Conclusions The technique produces a vagina with more normal anatomical and physiological characteristics than those produced by other methods, as all the penile components are used (except for the corpora cavernosa) to form almost normal external female genitalia. Vaginoplasty using pedicled penile skin with a urethral¯ap is a good alternative to other methods of vaginoplasty in male-to-female sex reassignment surgery.

Genital Sensitivity After Sex Reassignment Surgery in Transsexual Patients

“…Contrary to the opinion of Perovic et al, 41 who believe that engorgement of the bulbar urethra is moderate and does not present a barrier to intercourse, we agree with Karim et al, 42 preferring to remove this structure to avoid its swelling during sex arousal: this swelling may reduce the diameter of the vagina, making penetration more difficult and painful.…”

Genitoplasty in male-to-female transsexuals

“…Perovic et al [8,9] presented improvements in male-tofemale SRS regarding the creation of hooded neoclitoris using preputium attached to the glans. Urethra is divided 4-5 cm proximally from the meatus and glans is opened ventrally.…”

Sex reassignment surgery for transsexuals

“…In order to increase the neovaginal length, some authors [6,7] spatulate and position the urethra to form the closing top of the neovagina. They also describe [8] the use of sutures to anchor the neovagina to the sacrospinal ligament in an effort to prevent prolapse.…”