Vaginoplasty

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Vaginoplasty
ICD-9-CM70.64, 70.62, 70.64, 70.94, 70.6, 70.95
MeSHD013509

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the

urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina.[1]
Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

Congenital disorders such as adrenal hyperplasia can affect the structure and function of the vagina and sometimes the vagina is absent; these can be reconstructed or formed, using a vaginoplasty.[2] Other candidates for the surgery include babies born with a microphallus, people with Müllerian agenesis resulting in vaginal hypoplasia, trans women, and women who have had a vaginectomy after malignancy or trauma.[3][4]

Medical uses

Vaginoplasty is the description of the following surgical interventions:

In some instances, extra tissue is needed to reconstruct or construct the vagina. These grafts used in vaginoplasty can be an

autologous material.[9][10] A woman can use an autologous in vitro cultured tissue taken from her vaginal vestibule as transplanted tissue to form the lining of the reconstructed vagina.[9] A reconstructed or newly constructed vagina is called a neovagina.[11]

Vaginoplasties in children

See also: Intersex medical interventions

Conditions such as

21-hydroxylase deficiency. Specific procedures include: clitoral reduction, labiaplasty, normalizing appearance, vagina creation, initiating vaginal dilation.[12] Vaginal atresia, or congenital absence of the vagina, can be another reason for surgery to construct a normal and functional vagina.[13] Vaginoplasty is used as part of the series of surgeries needed to treat those girls and women born with the bladder located outside of their abdomen. After the repairs, women have been able to give birth but are at risk of prolapse.[1]

There are human rights concerns about vaginoplasties and other genital surgeries in children who are not old enough to consent,[14][15] including concern with post-surgical sexual function,[16] and assumptions of cisnormativity.[17] There is no consensus attitude among clinicians about their necessity, timing, method or evaluation.[12] Vaginoplasties may be performed in children or adolescents with intersex conditions or disorders of sex development.[18]

Techniques

Non-surgical vagina creation was used in the past to treat the

dilators. The procedure took several months and was sometimes painful. It was not effective in every instance.[2] Uncommon growths, cysts, septums in the vagina can also require vaginoplasty.[19]

Reconstructive surgery after cancer treatment

Radiological cancer treatment can result in the destruction or alteration of vaginal tissues. Vaginoplasty is often performed to reconstruct the vagina and other genital structures. In some cases, normal sexual function can be restored.[3]

McIndoe surgical technique

A canal is surgically constructed between the

buccal mucosa.[3][9]

Gender-affirming surgery

Several techniques may be used in gender-affirming surgery to create a neovagina.

A close-up image of a neovagina's outer labia
A close-up image of a neovagina, held open to reveal inner labia
The results of a penile inversion vaginoplasty, two years after surgery. Inner labia vary aesthetically based on surgeon; here, they are very minimal. The clitoris is tactile rather than visual, another aesthetic difference by surgeon. A faded surgical scar comes up from the perineum and follows the outer labia in a curved Y.

Penile inversion

Inversion of the penile skin is the method most often selected to create a neovagina by surgeons performing gender-affirming surgery. The inverted penile skin uses inferior pedicle skin or abdominal skin for the lining of the neovagina. The skin is cut to form an appropriate-sized flap. The skin flap is sometimes combined with a scrotal or urethral flap.[4]

The penile inversion technique was pioneered by Georges Burou in his Morocco clinic in the 1950s.[20] By the 1970s he had performed hundreds of them, and gave his first public presentation of his technique to a conference at Stanford University in 1973,[21] after which it gradually became the predominant technique worldwide.

Bowel vaginoplasty

Bowel vaginoplasty is another commonly used method to create a neovagina in gender-affirming surgery.[4]

Other methods

Penile-

scrotal skin flaps are also used. Nongenital full-thickness graft (FTG) or split-thickness skin grafts from other parts of the body have been used.[citation needed
]

Elective vaginoplasty

Critics have labeled such surgery as the "designer vagina". The

British Medical Journal strongly criticized the "designer vagina" in 2009.[23][24] The Society of Obstetricians and Gynaecologists of Canada published a policy statement against elective vaginoplasty based upon the risks associated with unnecessary cosmetic surgery in 2013.[25]

The World Health Organization describes any medically unnecessary surgery to the vaginal tissue and organs as female genital mutilation.[26]

Vaginal rejuvenation is a form of elective plastic surgery. Its purpose is to restore or enhance the vagina's cosmetic appearance.[24]

Hymen surgical procedures

Further information: Hymenorrhaphy

An imperforate hymen is the presence of tissue that completely covers the vaginal opening. It is cut to allow menstrual flow to exit during a short surgical procedure.[1] A hymenorrhaphy is the surgical procedure that reconstructs the hymen.

Balloon vaginoplasty

In this procedure, a

laparoscopically inserted to the rectouterine pouch whereupon gradual traction and distension are applied to create a neovagina.[citation needed
]

Pull through or Vecchietti procedure

In treating

laparoscopic surgical technique that produces a vagina of dimensions (depth and width) comparable to those of a normal vagina (ca. 8 cm deep).[27][28] A small, plastic sphere called an olive is threaded (sutured) against the vaginal area; the threads are drawn though the vaginal skin, up through the abdomen, and through the navel. There, the threads are attached to a traction device, and then daily are drawn tight so that the olive is pulled inwards and stretches the vagina, by approximately 1 cm per day, thereby creating a vagina, approximately 7 cm deep by 7 cm wide, in 7 days. The mean operating room (OR) time for the Vecchietti vaginoplasty is approximately 45 minutes; yet, depending upon the patient and her indications, the procedure might require more time.[29] The outcomes of Vecchietti technique via the laparoscopic approach are found to be comparable to the procedure using laparotomy.[30] In vaginal hypoplasia, traction vaginoplasty such as the Vecchietti technique seems to have the highest success rates both anatomically (99%) and functionally (96%) among available treatments.[31][19]

Other surgical techniques that have been developed include ileal neovagina (Monti's technique), Creatsas vaginoplasty, Wharton–Sheares–George neovaginoplasty, or the Davydov procedure. The most widely used is the Vecchietti laparoscopic procedure. Sometimes sexual intercourse can result in the dilation of a newly constructed vagina.[9]

Vaginal dilators and expanders

Vaginal expander ZSI 200 NS
ZSI 200 NS vaginal expander stretching the female vagina
Main article: Vaginal dilator

The most techniques of vaginoplasty are using inflatable vaginal expanders or vaginal stents to design the vaginal diameter and length.[32][33] At the end of the procedure the device stays in place to maintain the neovagina against the pelvic wall which also favors the process of microscopic neovascularization and reduces the risks of hematoma. In post-operative setting the expander can be used regularly to prevent post-operative vaginal retraction.[34] Solid vaginal dilators can also be used immediately after surgery to keep the passage from attachments, and regularly thereafter to maintain the viability of the neovagina. The frequency required to use decreases over time, however remains obligatory lifelong.[35][36]

Risks and complications

Reconstructive vaginoplasty in children and adolescents carries the risk of superinfection.[19]

In adults, rates and types of

Genital pain was reported in 4–9%. Rectovaginal fistula is also rare with only 1% documented. Vaginal prolapse was seen in 1–2% of people assigned male at birth undergoing this procedure.[4]

The ability of emptying the

voiding got worse. Those reporting a negative outcome who experienced loss of bladder control and urinary incontinence were 19%. Urinary tract infections occurred in 32% of those treated.[4]

History

Reports of people seeking vaginoplasty go back to the 2nd century.[37][38] The first modern vaginoplasty was performed in 1931 on Dora Richter.[37][39][40] Lili Elbe also underwent a vaginoplasty the same year.[41]

See also

References

  1. ^ a b c Baggish, p. 779-798.
  2. ^
    ISBN 9781444335538
    .
  3. ^
    ISBN 9780071716727
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  4. ^
    PMID 25817066
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  5. ^
    ISBN 9783318025590;]{{cite book}}: CS1 maint: postscript (link
    )
  6. ^ a b c d e f g "2016 ICD-10-PCS Procedure Code 0UQG0ZZ : Repair Vagina, Open Approach". ICD10Data.com. Retrieved 3 March 2016.
  7. ^ Baggish, p. 467-474.
  8. ^ Baggish, p. 409-412.
  9. ^
    PMID 26537987
    .
  10. ^ "Online ICD9/ICD9CM codes". World Health Organization. Retrieved 1 March 2016.
  11. OCLC 941369411
    . Retrieved 31 May 2018.
  12. ^
    PMID 26820577
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  13. ^ "Müllerian Agenesis: Diagnosis, Management, and Treatment – ACOG". www.acog.org. Archived from the original on 13 December 2017. Retrieved 26 December 2017.
  14. ^ Office of the High Commissioner for Human Rights (24 October 2016), End violence and harmful medical practices on intersex children and adults, UN and regional experts urge
  15. ^ "The Social Construction of Female Circumcision: Gender, Equality, and Culture". femalecircumcision. 2 February 2018. Archived from the original on 12 February 2018. Retrieved 11 February 2018.
  16. S2CID 20580500
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  17. Office of the UN High Commissioner for Human Rights
    , February 2013.
  18. PMID 16882788
    .
  19. ^ a b c Emans.
  20. S2CID 25373951
    . In 1956, the gynecologist Dr Georges Burou (1910–1987) independently developed the anteriorly pedicled penile skin flap inversion vaginoplasty in his Clinique du Parc in Casablanca. This technique was to become the gold standard of skin-lined vaginoplasty in transsexuals.
  21. PMID 17451484
    .
  22. ^ Zimmerman, Rachel (31 August 2007). "Genital Procedure Draws Warning". Wall Street Journal.
  23. ^ a b Bourke, Emily (12 November 2009). "Designer vagina craze worries doctors". Australian Broadcasting Corporation. Retrieved 5 March 2016.
  24. ^
    PMID 17525451
    .
  25. PMID 24405879. Archived from the original
    (PDF) on 10 March 2016. Retrieved 7 March 2016.
  26. ^ "Female genital mutilation". World Health Organization. 2016. Retrieved 7 March 2016.
  27. PMID 5319813
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  28. PMID 8893702
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  29. PMID 10686221
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  30. S2CID 2851401
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  31. PMID 24899229
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  32. PMID 17623058
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  33. PMID 9827964
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  34. doi:10.4321/S0376-78922011000100010
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  35. ISBN 978-1-4381-2702-6
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  36. ISBN 978-0-683-03454-7
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  37. ^
    S2CID 149966616
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  38. S2CID 242422061
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  39. OCLC 696313936
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  40. ^ Kaye, Hugh (16 November 2021). "The incredible story of the first known trans woman to undergo gender confirmation surgery". Attitude. Retrieved 31 January 2022.
  41. ISBN 978-0-19-088003-3
    . Retrieved 20 June 2023.

Bibliography
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