Gender Confirmation Surgical Techniques
Penile Inversion Vaginoplasty (PIV)
As described this style of surgery involves the Inversion of the outer dermal tissue of the Penis, the inner tissue excluding urethra is utilized elsewhere in the Vulva. It can employ a variation to employ the use of a scrotal graft primarily to increase depth of Vaginal Canal.
Non Penile Inversion
This is the Non-Penile Inversion form of Vaginoplasty, where the Scrotal tissue (in toto) is used in the creation of the Vaginal Canal. Additional depth and some moisture is achieved with urethral tissue and/or Tunica Vaginalis (Tunica Vaginalis is the Pouch of Serous Membrane that surrounds the Testes and is analogous to the Peritoneum.)
Sigmoid Colon Vaginoplasty – OPEN
The term OPEN refers to the external method of accessing and harvesting the Sigmoid Colon. This leaves significant external scarring that are evident. This style of surgery utilizes a section of the Sigmoid Colon is detached then rotated down to become the Vaginal lining. It has had a history of continuous seeping, manifesting as Vaginal discharge and increased odour issues This has now been largely rectified. It has been considered a revision of last resort when other methods have failed.
Laparoscopic Sigmoid Colon for Vaginoplasty
Laparoscopic sigmoid colon vaginoplasty is performed internally (laparascopically) hence leaving no external scarring. It is a surgical procedure that uses a portion of the sigmoid colon to create a new vagina. It is typically performed on transgender women who were assigned male at birth and desire a functional vagina.
The Surgical Technique: the procedure involves laparoscopically harvesting a segment of the sigmoid colon and then fashioning it into a neovagina. The neovagina is then connected to the urethra and the vaginal opening is created. The Success Rate for Laparoscopic sigmoid colon vaginoplasty is high, with most patients reporting satisfactory vaginal depth and sexual function. The procedure is also associated with a low complication rate.
Peritoneal Pull-Through Vaginoplasty (PPV/PPT)
Is based around a surgical procedure known as the Davydov Procedure ( initially targetted at women suffering from MKRH) and created in the mid 80’s. It is becoming popular. It requires harvesting of Peritoneal tissue and this leaves abdominal scarring, but the Vaginal lining is considered to be much moister and less dilation issues Compared with PIV surgery.
Jejunal Vaginoplasty
Is not a new technique at all but has been used to treat CIS women who may have a malformed Vagina or Agenesis. Is used mainly as a revisionary procedure. A technique for vaginal reconstruction is described that uses a pedicled jejunal flap. A neovagina was constructed using a segment of jejunum based on the fourth branch of the superior mesenteric artery. This provided an excellent result with adequate length, without the need for a lubricator or stent. Hypersecretion has not been observed.
Zero Depth Vaginoplasty
Has become more popular amongst older women and for those where Depth is not a concern. It removes the issue of dilation all together but does have similar vulval cosmetic value as a fully formed Vagina.
Nicola Summers
Transworldcare.com