Skip to main content
SpringerLink
Log in

Vaginoplasty for the Transgender Woman

  • Care for the Transgender Patient (C Unger, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review was to describe the most common male-to-female vaginoplasty surgical techniques, and to review important perioperative considerations, outcomes, and complications associated with these surgeries.

Recent Findings

Vaginoplasty for the transgender woman may be performed using a variety of techniques. Most commonly, the penile inversion vaginoplasty technique is used, but in some cases, the intestinal segment vaginoplasty is indicated. Intraoperative complications of vaginoplasty surgery include bleeding and injury to the bladder, urethra, and/or rectum. Immediate postoperative complications include hematoma or seroma formation, infection or abscess, wound dehiscence, flap necrosis, and venous thromboembolism. Delayed postoperative complications include neovaginal stenosis or shortening of the neovagina, rectovaginal or genitourinary fistula formation, urethral meatal stenosis or abnormal urine stream, neuropathy, and sexual dysfunction including dyspareunia and anorgasmia. Most patients are satisfied with the functional and esthetic outcomes of vaginoplasty, but sexual dysfunction may be common. The risk of regret following vaginoplasty seems to be low, and certain risk factors for this unfavorable outcome have been identified.

Summary

Outcomes appear to be satisfactory following vaginoplasty surgery for transgender women, but robust prospective, long-term data are lacking.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• The World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender nonconforming people. 2011; Available at: http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=3926. Accessed Jan 30, 2017. Provides expert consensus and evidence-based clinical guidelines for healthcare providers participating in the care of transgender people

  2. Unger CA. Care of the transgender patient: the role of the gynecologist. American Journal of Obstetrics & Gynecology. 2014;210(1):16–26.

    Article  Google Scholar 

  3. • Horbach SE, Bouman MB, Smit JM, Ozer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med. 2015;12(6):1499–512. A systematic review of currently available male-to-female vaginoplasty techniques and complications

    Article  PubMed  Google Scholar 

  4. Hage JJ, Karim RB. Abdominoplastic secondary full-thickness skin graft vaginoplasty for male-to-female transsexuals. Plast Reconstr Surg. 1998;101(6):1512–5.

    Article  CAS  PubMed  Google Scholar 

  5. Huang TT. Twenty years of experience in managing gender dysphoric patients: I. Surgical management of male transsexuals. Plast Reconstr Surg. 1995;96(4):921–30. discussion 931-4

    Article  CAS  PubMed  Google Scholar 

  6. Siemssen PA, Matzen SH. Neovaginal construction in vaginal aplasia and sex-reassignment surgery. Scand J Plast Reconstr Surg Hand Surg. 1997;31(1):47–50.

    Article  CAS  PubMed  Google Scholar 

  7. Bouman MB, van der Sluis WB, Buncamper ME, Ozer M, Mullender MG, Meijerink WJ. Primary total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia: a prospective cohort study of surgical outcomes and follow-up of 42 patients. Plast Reconstr Surg. 2016;138(4):614e–23e.

    Article  CAS  PubMed  Google Scholar 

  8. Wangjiraniran B, Selvaggi G, Chokrungvaranont P, Jindarak S, Khobunsongserm S, Tiewtranon P. Male-to-female vaginoplasty: Preecha’s surgical technique. J Plast Surg Hand Surg. 2015;49(3):153–9.

    Article  PubMed  Google Scholar 

  9. Selvaggi G, Ceulemans P, De Cuypere G, VanLanduyt K, Blondeel P, Hamdi M, et al. Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals. Plast Reconstr Surg. 2005;116(6):135e–45e.

    Article  PubMed  Google Scholar 

  10. Perovic SV, Stanojevic DS, Djordjevic ML. Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU Int. 2000;86(7):843–50.

    Article  CAS  PubMed  Google Scholar 

  11. Bizic M, Kojovic V, Duisin D, Stanojevic D, Vujovic S, Milosevic A, et al. An overview of neovaginal reconstruction options in male to female transsexuals. Sci World J. 2014;2014:638919.

    Article  Google Scholar 

  12. Bouman MB, Buncamper ME, van der Sluis WB, Meijerink WJ. Total laparoscopic sigmoid vaginoplasty. Fertil Steril. 2016;106(7):e22–3.

    Article  PubMed  Google Scholar 

  13. • Bouman M, van Zeijl MCT, Buncamper ME, Meijerink WJHJ, van Bodegraven AA, Mullender MG. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function. Journal of Sexual Medicine. 2014;11(7):1835–47. A review of intestinal vaginoplasty techniques and outcomes

    Article  PubMed  Google Scholar 

  14. Buncamper ME, Honselaar JS, Bouman MB, Ozer M, Kreukels BP, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. J Sex Med. 2015;12(7):1626–34.

    Article  PubMed  Google Scholar 

  15. Sigurjonsson H, Mollermark C, Rinder J, Farnebo F, Lundgren TK. Long-term sensitivity and patient-reported functionality of the neoclitoris after gender reassignment surgery. J Sex Med. 2017;10

  16. Pfäfflin F, Junge A. Sex Reassignment. Thirty years of international follow-up studies after sex reassignment surgery: a comprehensive review, 1961–1991. 1997; Available at: https://web.archive.org/web/20070503090247/http://www.symposion.com/ijt/pfaefflin/1000.htm. Accessed Feb 2, 2017.

  17. Lawrence AA. Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Arch Sex Behav. 2003;32(4):299–315.

    Article  PubMed  Google Scholar 

  18. Wanitphakdeedecha R, Alster TS. Physical means of treating unwanted hair. Dermatol Ther. 2008;21(5):392–401.

    Article  PubMed  Google Scholar 

  19. Elamin MB, Garcia MZ, Murad MH, Erwin PJ, Montori VM. Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses. Clin Endocrinol. 2010;72(1):1–10.

    Article  CAS  Google Scholar 

  20. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer 3rd WJ, Spack NP, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.

    Article  CAS  PubMed  Google Scholar 

  21. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195–283.

    Article  CAS  PubMed  Google Scholar 

  22. Deutsch MB. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2016; Available at: http://transhealth.ucsf.edu/pdf/Transgender-PGACG-6-17-16.pdf. Accessed Feb 8, 2017.

  23. Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T’Sjoen G, Weyers S, et al. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol. 2005 Mar;47(3):398–402.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Urogynecology and Pelvic Reconstructive Surgery, Center for LGBT Care, Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic, 9500 Euclid Avenue/A81, Cleveland, OH, 44195, USA

    Tonya N. Thomas & Cecile A. Unger

Authors
  1. Tonya N. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cecile A. Unger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tonya N. Thomas.

Ethics declarations

Conflict of Interest

Tonya N. Thomas and Cecile A. Unger declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Care for the Transgender Patient

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thomas, T.N., Unger, C.A. Vaginoplasty for the Transgender Woman. Curr Obstet Gynecol Rep 6, 133–139 (2017). https://doi.org/10.1007/s13669-017-0203-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-017-0203-5

Keywords

Search

Navigation