Vaginoplasty

Vaginoplasty (neovaginoplasty) is a reconstructive surgical procedure for creating a neovagina. Neovaginal reconstruction is indicated in the congenital absence of the vagina (Mayer-Rokitansky-Kuster-Hauser Syndrome), intersex conditions, conditions after pelvic exonerative procedures for tumors or trauma.

 

Vaginal absence has a devastating impact on a young woman’s life. Thus, in such cases, creation of a functioning neovagina is an imperative. Vaginal reconstruction is inevitable in the case of vaginal agenesis, disorders of sexual development, transsexualism, defects resulting from genital cancer surgeries, and trauma.

Treatment

There are many reports on different surgical procedures, their outcomes following postoperative complications and anatomical and functional results. Some popular methods include split- and full-thickness skin grafts, bladder or buccal mucosa grafts, penile or penoscrotal skin flaps, local genital flaps, and intestinal flaps. However, these methods have certain disadvantages, such as scarring, shrinkage, insufficient vaginal cavity, intravaginal hair growth, as well as a need for lubrication during intercourse and permanent dilation.

In patients with either insufficient vaginal cavity or previously failed surgery, sigmoid colon presents the material of choice for vaginal reconstruction. Use of a sigmoid colon loop seems a most favorable choice, due to anatomical proximity and easy mobilization of the vascular pedicle of this part of the bowel. In recent decades, due to progress in anesthesiology, antibiotics, and reduced risks associated with colorectal anastomosis, the sigmoid pedicled flap has become a first-line option in both children and adults.

Contrary to other techniques, rectosigmoid vaginoplasty results in a self-lubricating and goodsized neovagina, which does not require postoperative dilatation for extended periods of time. Use of rectosigmoid colon as a pedicled flap for the creation of a neovagina is effective since sufficient length may be obtained with excellent blood supply that could prevent complications such as contractions, shrinkage, or narrowing. This segment is thick-walled, large in diameter, and can tolerate trauma better than small bowel, bladder, or skin grafts. Postoperative management is simple and easy. Mucous production decreases dramatically after 3-6 months regardless of length of sigmoid segment. Although sufficient to provide adequate lubrication, it was neither excessive nor irritating to our patients. Dilation or calibration of the introital anastomosis is temporary and well tolerated.

As successful sexual intercourse should be the primary end point when choosing the method for vaginal substitution, it should also be the starting point when evaluating surgical outcome. Reconstructing the vagina using intestinal segments creates an aesthetically pleasing vagina, which seems to be more compatible with sexual activity. Psychological and psychosocial recovery should definitely be considered in evaluating these patients’ quality of life.