Vaginoplasty

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Vaginoplasty is any surgical procedure whose purpose is to address vaginal structural defects, or to partially or totally construct or reconstruct a vagina. The term vaginoplasty is used to describe any such vaginal surgery, while the term neovaginoplasty is more specifically used to refer to procedures of partial or total construction or reconstruction of the vulvovaginal complex.

There are many different vaginoplasty techniques. Some involve the use of autologous biological tissue from other parts of the body of the patient to construct areas of vagina. Areas that may be used include oral mucosa, skin flaps, skin grafts, the vaginal labia, penile skin and/or tissue, testicular skin, intestinal mucosa, and others.

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[edit] Neovaginoplasty

Neovaginoplasty is a reconstructive surgery procedure used to construct or reconstruct a vaginal canal and mucous membrane. These may be absent in a woman, due either to congenital disease such as vaginal atresia, or to an acquired cause, such as trauma or cancer. Neovaginoplasty is also used to create the vagina in transwomen.

The outcome of neovaginoplasty is variable. It usually allows sexual intercourse, although sensation is not always present. In genetic women, menstruation and fertilization are assured when the uterus and ovaries have preserved a normal function. In a few cases, vaginal childbirth is possible.

[edit] Techniques

Various surgical techniques exist for creating a neovagina. The Vecchietti procedure is a laparoscopic procedure that has been shown to result in a vagina that is comparable to a normal vagina in patients with Mullerian agenesis.[1].[2]

[edit] Male-to female transsexual patients

Most neovaginoplasty procedures are performed on transsexual women. The penile inversion techniques were evolved by the Biber and Granato during the 1960s through the 1980s.[citation needed]

For the creation of the male-to-female neovagina, there is also the possibility of using penile skin flaps (so-called penile inversion), as well as the "Suporn technique" and "Wilson method".

In the 1990s and continuing to the present, neovaginal construction has been futher advanced by Toby R. Meltzer, M.D., whose technique involves the use of both penile and scrotal tissue to form the vaginal vault, and has yielded more reliable sexual sensation, maintenance of vaginal depth, and a stronger pelvic floor by maintaining a nearly intact levitor ani muscle complex.[3]

Meltzer creates a neurologically sensate clitoris, constructed from a penile glans pedicle, with its attached blood supply and nerves. During a secondary procedure using Meltzer's technique, he forms a labia hood for the clitoris using the inverted Y plasty suturing method, leaving only a single midline incision scar.[4][5]

[edit] Penile inversion

Penile inversion is a surgical technique for genital reassignment (sex change) used to construct a neo-vagina from a penis for transwomen, sometimes also for intersex people. It is one of two main sorts of vaginoplasty, along with colovaginoplasty.

The erectile tissue of the penis is removed, and the skin, with its blood and nerve supplies still attached (a flap technique first used by Sir Harold Gillies in 1951), is used to create a vestibule area and labia minora, and inverted into a cavity created in the pelvic tissue. Part of the tip (glans) of the penis, still connected to its blood and nerve supplies, is usually used to construct a clitoris, the urethra is shortened to end at a place that is appropriate for a female anatomy.

[edit] Colovaginoplasty

With colovaginoplasty, sometimes called a colon section, a vagina is created by cutting away a section of the sigmoid colon and using it to form a vaginal lining.

This surgery is performed on females with androgen insensitivity syndrome, congenital adrenal hyperplasia, vaginal agenesis, Mayer-Rokitansky syndrome, and other intersexed conditions, where non-invasive forms of lengthening the vagina cannot be done and, mostly, on male-to-female transsexuals as an alternative to penile inversion with or without an accompanying skin graft (usually from either the thigh or abdomen).

Due to numerous potential complications (such as diversion colitis) most surgeons will recommend a colovaginoplasty only when there is no alternative.

[edit] Other forms

There are several forms of non-reconstructive vaginoplasty, including laser surgery and labiaplasty.

Vaginal childbirth can cause a decrease in a woman's vaginal muscle tone, which can lead to orgasmic difficulties or a lack of orgasm in her or her sex partner(s). Some women opt for laser surgery to constrict the size of the vaginal canal. Kegel exercises are a method of strengthening the pubococcygeus muscle, which surrounds the vaginal opening in women. In many cases, regular exercise of the PC muscle can resolve the issue without surgery.[citation needed]

Labiaplasty is a plastic surgery procedure involving the labia, any of four folds of tissue of the vulva. Labiaplasty may be performed alone or as part of vaginoplasty.

The term vaginoplasty has also been applied to surgical procedures that create an opening in an imperforate hymen, or recreate a ruptured hymen.

[edit] Notes

[edit] References

  1. ^ Vecchietti G.Creation of an artificial vagina in Rokitansky-Kuster-Hauser syndrome. Attual Ostet Ginecol 1965;11:131-47
  2. ^ Fedele L, Bianchi S, Tozzi L, Borruto F, Vignali M, A new laparoscopic procedure for creation of a neovagina in Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril 1996;66:854-7
  3. ^ Anne Lawrence, MD Vaginoplasty: Dr. Meltzer Multipage photographic surgical presentation Note Surgical Photos
  4. ^ Anne Lawrence, MD Labiaplasty: Dr. Meltzer Performs Labiaplasty - Multipage photographic surgical presentation Note Surgical Photos
  5. ^ Toby R. Meltzer, M.D. - Aesthetic Refinements to the Secondary Labiaplasty - XVII Harry Benjamin International Gender Dysphoria Association Symposium (abstract)

[edit] Sources

  • Karim RB, Hage JJ, Dekker JJ, Schoot CM. Evolution of the methods of neovaginoplasty for vaginal aplasia. Eur J Obstet Gynecol Reprod Biol. 1995 Jan;58(1):19-27. Review. PMID 7758640
  • Karim RB, Hage JJ, Mulder JW. Neovaginoplasty in male transsexuals: review of surgical techniques and recommendations regarding eligibility. Ann Plast Surg. 1996 Dec;37(6):669-75. Review. PMID 8988784

[edit] See also

[edit] External links

[edit] Vaginoplasty

[edit] Colovaginoplasty

[edit] Penile inversion

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