Different Types of Vaginoplasty

Types of Surgery to Create a Vagina

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Vaginoplasty is surgical procedure used to create a vagina. The surgery may be performed after a woman has had a vaginectomy for vaginal cancer. It may also be used to create a vagina for a woman born without one because of vaginal agenesis. In addition, vaginoplasty can be used to create a vagina for transgender women as a type of gender-affirming surgery. Sometimes when a vagina is created through vaginoplasty it is referred to as a neovagina. This literally means "new vagina."

For a woman who needs a vaginoplasty, there are several different types that may be offered. The type of vaginoplasty that is most appropriate depends on a number of factors. In particular, the type of vaginoplasty may be limited by the woman's age and the indication for the vaginoplasty. The surgery appropriate for an adult transgender woman would not be the same one indicated for a young cisgender girl. The main types of vaginoplasty are intestinal, peritoneal, McIndoe, buccal mucosa, and penile-inversion.

Intestinal or Sigmoid Vaginoplasty

Intestinal vaginoplasty uses a section of the sigmoid colon to create the neovagina. This is usually done as a laproscopic surgery. Laproscopic surgery is also often referred to as minimally invasive or keyhole surgery because there is only a small incision through the skin. For this surgery, a small piece of colon is detached and then rotated down to become the lining of the vagina. Then the surrounding colon is stitched together to restore its function.

There have been some criticisms that intestinal vaginoplasty can lead to excess mucus in the vagina and mucus with an unpleasant smell. However, these side effects have not been consistently reported.

Some people see the mucus production by the intestinal tissue as an advantage. The healthy vaginal lining is also mucus producing and self lubricating. The colon segment is also stretchy in a way that is more similar to the regular vaginal lining than other tissue options used to line the neovagina.

Peritoneal Vaginoplasty

Peritoneal vaginoplasty is also referred to as the Luohu operation. It uses the lining of the abdominal cavity, the peritoneum, to create the vagina. Like intestinal vaginoplasty, peritoneal vaginoplasty is usually a laproscopic procedure.

Women who have this procedure do not necessarily need to use dilation to maintain their vaginal opening. That is particularly true if they are having regular sexual intercourse.

There is a risk of rectovaginal fistula with this procedure and with other types of vaginoplasty. A rectovaginal fistula is when the rectum and vagina have a hole between them. Fistulas are usually treatable with surgery.

McIndoe Vaginoplasty

The McIndoe technique, McIndoe procedure, or McIndoe vaginoplasty are quite different from the peritoneal and intestinal vaginoplasty procedures. Unlike with peritoneal and intestinal vaginoplasties, the McIndoe technique does not require abdominal surgery to create the lining.

Instead, McIndoe vaginoplasty lines the vagina with a skin graft. That skin graft is placed on a vaginal mold and then placed into the space that has been opened to become the vagina. In peritoneal and intestinal vaginoplasty, no such mold is used. The mold is used consistently for the first several months after surgery (removing it for regular cleaning) in order to promote healing of the vagina into an open cavity suitable for intercourse.

Unlike the peritoneum and the intestine, skin is not a mucosal tissue. Therefore, it does not self lubricate. This also increases the risk that the vaginal opening will close. Because of that, women who have a McIndoe procedure, and do not have regular sexual intercourse, will need to commit to dilating their vaginas for the rest of their lives.

Buccal Mucosa Vaginoplasty

Buccal mucosa is the tissue lining the mouth. It is quite similar to the lining of the vagina. Both tissues are hairless and create mucus. Therefore, in some ways it is an ideal lining for a neovagina created during vaginoplasty.

However, buccal vaginoplasties are not as common as other vaginoplasty procedures for several reasons. Only a relatively small area of tissue is available. People may be concerned about side effects in the mouth and cheek. In addition, the inside of the mouth is not an area most gynecologists are used to working on. Therefore, they may have to collaborate with facial surgeons in order to harvest tissue appropriately.

Penile Inversion Vaginoplasty

Penile inversion vaginoplasty is only used in transgender women. In this procedure, the skin from the outside of the penis is removed and inverted to create the lining of the vagina. The head of the penis is also reshaped to create a clitoris. Finally, scrotal skin is used to create the labia majora and minora.

The disadvantages of this procedure are similar to those when skin is used for a McIndoe vaginoplasty. Hair must be fully removed to make certain there is no hair growing on the inside of the vagina. The vagina requires a lifetime of dilation for maintenance. It is also not self lubricating.

Although only transgender women can get a penile inversion vaginoplasty, that is not the only type of vaginoplasty they can get. Transgender women may also be offered an intestinal vaginoplasty either as a primary surgery or if they need a surgical revision. At least one transgender woman has also had a peritoneal vaginoplasty, but they are not widely available for this population.

Dilation After Vaginoplasty

Depending on the technique used, women may or may not need to dilate their neovagina for the rest of their lives. Dilation involves inserting a silicone dilator—a rod with a curved end—into the vagina and leaving it in place for a short period of time (usually around 10-15 minutes).

Dilation can be used to increase the depth and width of the vagina through gentle stretching. This can help women who have difficulty with intercourse after vaginoplasty. Dilation is also necessary to maintain the vaginal opening when skin is used to line the neovagina, such as in penile inversion or McIndoe vaginoplasty. The frequency of dilation needed depends on the type of procedure and how long it has been since the surgery was completed.

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