Combined vaginoplasty technique for male-to-female sex reassignment surgery: Operative approach and outcomes

J Plast Reconstr Aesthet Surg. 2017 Oct;70(10):1483-1492. doi: 10.1016/j.bjps.2017.05.040. Epub 2017 May 27.

Abstract

Background: Several therapy options exist for male-to-female (MTF) transgenders desiring sex reassignment. Surgery includes numerous different procedures. Of those, vaginoplasty is predominant and aims at providing attractive esthetics and fully functional genitals. This study aimed to present the surgical results of our modified combined vaginoplasty technique in a consecutive patient cohort.

Methods: We included 40 MTF transgender patients who underwent a two-stage sex reassignment surgery (SRS) in an observational prospective study between September 2012 and January 2014. Demographic characteristics, medical and surgical history, operative details, and outcomes after surgery were documented. Postoperatively, 23 patients received a pelvic examination following the standardized protocol.

Results: Measured vaginal depth was 11.77-14.99 cm depending on the size of the dilator used (25-40 mm). Vaginal, clitoral, and labial sensitivities were intact and favorable in all examined patients. Nineteen women (47.5%) opted for breast augmentations to achieve a feminine cosmesis, making it the most common nongenital operation. Complications were mostly minor and temporary. Severe adverse events, such as wound infections (n = 3), colon injuries (3), short (1) or narrow (1) vaginas, or partial clitoral necroses (1), were rare and immediately addressed by the surgical team. No vaginal construction was lost, and no secondary reconstructive approaches were required.

Conclusion: Satisfactory physical results and favorable low rates of complications endorse our combined technique for MTF SRS. These findings, however, need to be confirmed by other research groups as well. Therefore, in our opinion, MTF SRS remains an evolving area of development, whose research is aiming to establish a state-of-the-art surgical technique.

Keywords: Combined technique; Gender dysphoria; Male-to-female; Outcomes; Sex reassignment surgery; Vaginoplasty.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Cohort Studies
  • Demography
  • Esthetics
  • Female
  • Humans
  • Male
  • Patient Outcome Assessment
  • Plastic Surgery Procedures* / adverse effects
  • Plastic Surgery Procedures* / methods
  • Postoperative Complications* / classification
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Prospective Studies
  • Sex Reassignment Surgery* / adverse effects
  • Sex Reassignment Surgery* / methods
  • Vagina / surgery*