Penile inversion technique

VAGINOPLASTY – PENILE INVERSION TECHNIQUE

Vaginoplasty (neovaginoplasty) is a reconstructive surgical procedure for creating a neovagina.
Male to female transgenderism is among the principal indications for vaginoplasty.

Treatment

Great variety of operative techniques for creation of neovagina is reported. There are two substantial tissues for vaginal replacement: skin and bowel. For transgender patients penile inverted skin flap presents the best option.

Penile inversion technique includes creation of fully sensate neovagina from an inverted pedicled island penile skin flap and vascularized urethral flap. The important advance in this technique is complete penile disassembly, which ideally enables the use of all penile components (except the corpora cavernosa) in the construction of the new vulva, clitoris and vagina. Ordinarily, procedure is started with bilateral orchidectomy. The penis is dissected into its anatomical components and corpora cavernosa are completely removed. Glans is reduced and fashioned to create a conically shaped clitoris, with fully preserved neurovascular bundle. The skin of the penis is inverted, as a pedicled flap preserving blood and nerve supplies to form a fully sensate vagina. The urethra is then spatulated and used to create the mucosal part of the neovagina that provides additional sensitivity and wetting. Fixation of the vagina to the sacrospinous ligament is performed to achieve deep placement of the neovagina in the perineal cavity and to prevent prolapse. Clitoral hood, labia minora, and labia majora is finally created by fashioning remaining penile and scrotal tissue. Postoperative vaginal stenting and periodic dilatation is necessary. This way fully sensate and sufficient vagina is created, enabling regular sexual intercourses with erogenous sensation.