Vaginoplasty
Encyclopedia
Vaginoplasty is a reconstructive plastic surgery
procedure for correcting the defects and deformities of the vaginal
canal and its mucous membrane, and of vulvo-vaginal structures that might be absent or damaged because of congenital disease (e.g. vaginal atresia
) or because of an acquired cause (e.g. physical trauma
, cancer
). As such, the term vaginoplasty generally describes any such reconstructive and corrective vaginal surgery, whilst the term neovaginoplasty specifically describes the procedures of either partial or total construction or reconstruction of the vulvo-vaginal complex.
The post-operative outcome of vaginoplasty is variable; it usually allows coitus (sexual intercourse), although sensation might not always be present. In biological women, menstruation
and fertilization are assured when the uterus
and the ovaries
have preserved their normal functions; in a few cases, vaginal childbirth is possible. In male-to-female sex reassignment surgery, some trans women patients undergo vaginoplasty as part of their physical (sex) transition
. The physical factors that limit vaginal dimensions are the rectoprostatic Denonvilliers’ Fascia
(depth) and the Levator ani muscle
(diameter); thus, in trans women patients, the narrowness of the male pelvis
can reduce the available area to use for vaginoplasty.
, the creation of an opening in an imperforate hymen, and hymenorrhaphy
, the recreation of a ruptured hymen
.
(patient-derived) tissue
from the patient’s person, to construct areas of vagina and areas of the vulvovaginal complex. The tissues available for surgical correction include the oral mucosa
, skin flaps, skin grafts, the vaginal labia, penile
skin, penile tissue, scrotal
skin, and intestinal mucosa
. In surgical praxis, it is important to electrolytically
remove the follicles from a hair-bearing skin graft, unless the surgeon directs otherwise; usually, the skin graft is depilated intra-operatively, either manually (scraped) or by electrocauterization. Besides the vaginoplastic surgery
techniques herein discussed, earlier plastic surgery procedures do exist, but have been superseded by the more effective results (outcome) of contemporary vaginoplasty.
is laparoscopically
inserted to the recto-vesical space (recto-pubic space), whereupon gradual traction and distension are applied to create a neovagina
. Moreover, balloon vaginoplasty also is a new technique for treating vaginal aplasia
, which also is applied as a technically simple, physically safe, and medically effective alternative vaginoplasty for creating a neovagina, especially when conventional laparoscopic surgery is either infeasible or unsafe.
(ca. 8.0 cm. deep). The medical advantages of this vaginoplasty technique include the biological and healing qualities of the buccal mucosa tissue, minimal scarring, and a short, post-operative recovery for the patient. The disadvantages include limited vaginal dimensions (depth and width), and the possibility of either intraoral
damage, when tissue-harvesting, or of complications.
In surgery, the tissue donor site in the cheek (ca. 2.5 x 8.0 cm.) is marked to avoid damage to the Stensen’s duct
(parotid duct) and to the parotid gland
. To create the vaginal lining, the buccal mucosa tissue graft is micro-perforated to allow shaping it to a larger size of greater area (surface); it then is formed upon a stent
, and afterwards affixed to the vaginal space (created earlier in the operation), with its edge sutured to the minor labia
and to the perineal skin. The vaginal mold of buccal mucosa is then (temporarily) secured to the perineal skin, to allow the patient’s recovery.
by cutting away a section of the sigmoid colon
and using it to form a vaginal lining. This surgery is performed on women with androgen insensitivity syndrome
, congenital adrenal hyperplasia
, vaginal agenesis, müllerian agenesis
, and other intersexual conditions wherein non-invasive forms of deepening the vagina cannot be performed (mostly on trans women patients) as an alternative to penile inversion, with or without an accompanying skin graft (usually from the thigh or the abdomen). Because of the potential complications (e.g. diversion colitis
) most surgeons will recommend a colovaginoplasty procedure only when there is no alternative procedure.
, uses a technique similar to that of penile inversion, that sutures the labia minora
together to create a neovagina
. A refinement of this vaginoplsatic technique is its utilization of the prepucial skin
(hood) of the clitoris
as a horse-shoe-shaped, one-piece flap. Yet, although the Don Flap technique is a relatively simple surgical procedure, the most obvious disadvantages of the labia minora flap surgery include the need for restorative labiaplasty
and cervical dilation
to produce a vagina of adequate dimensions (depth and width).
and the rectum
. The principal, technical difference between the McIndoe vaginoplasty and the Vecchietti vaginoplasty, is which tissue to utilize to line the created neovagina
. Each surgical procedure has positive and negative factors, especially regarding upon whom such a plastic surgical technique can be applied, because the post-operative outcome varies with the patient’s indications.
. Along with the colovaginoplasty procedure, penile inversion is one of the two principal vaginoplasty procedures used for creating a neovagina. Applying a flap technique (first used by Sir Harold Gillies
in 1951), the spongiform erectile tissue of the penis
is removed, and the skin, with its nerves and vascular system (blood supply) still attached, is used to create a vestibule area and labia minora
, which then are inverted into the neovaginal cavity created in the pelvic tissue. Part of the glans penis
tip, with its nerve and vascular systems still connected, becomes the clitoris
; and the urethra
is shortened to end at a place appropriate to the female genital anatomy
. Another common technique for creating a neoclitoris
utilizes the urethral spongiform tissue. This was the most common penile inversion technique, and was so used by Dr. Burou and Dr. Stanley Biber; however, some surgeons do not create a neoclitoris as part of a penile inversion.
, the Vecchietti procedure is a laparoscopic
surgical technique that produces a vagina
of dimensions (depth and width) comparable to those of a normal vagina (ca. 8.0 cm. deep). A small, plastic sphere (“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 1.0 cm. per day, thereby creating a vagina, approximately 7.0 cm. deep by 7.0 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.
, which, after 5–7 days, then is lined with a skin graft harvested from the buttocks
. The penile
skin is used to create the labia minora
, clitoral hooding
, and the anterior fourchette (frenulum); the glans penis
is used to create the clitoris
, and the scrotum
is used to create the labia majora
.
is a vaginoplastic surgery technique for reducing the size the genital labia — either the majora
or the minora
— which are any of the four folds of tissue of the vulva
. It can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.
, by removing excess tissues and tightening the supportive structures of the vulvovaginal complex, in effort either to reduce or to reverse the effects of aging and parturition (childbearing). The advantages are a physically comfortable health and an improved self-image (mental health); the potential disadvantages are decreased clitoral
and genital sensation, and complications, such as infection
, tissue adhesions, and scarring
.
of labiaplasty, and associated vaginoplastic procedures, as medically “accepted and routine surgical practices”. The ACOG doubted the medical safety and the therapeutic efficacy of the surgical techniques and procedures for performing labiaplasty, vaginal rejuvenation
, the designer vagina, revirgination, and Gräfenberg Spot
amplification, and recommended that women seeking such genitoplastic surgeries must be fully informed, with the available surgical-safety statistics, of the potential health risks of surgical-wound infection
, of pudendal nerve
damage (resulting in either an insensitive or an over-sensitive vulva), of dyspareunia
(painful coitus), of tissue adhesions (epidermoid cysts
), and of painful scars.
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
procedure for correcting the defects and deformities of the vaginal
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
canal and its mucous membrane, and of vulvo-vaginal structures that might be absent or damaged because of congenital disease (e.g. vaginal atresia
Vaginal atresia
Vaginal Atresia is a birth defect or congenital abnormality of the female genitourinary system that manifests itself in the absence of a vagina , or a deformed and nonfunctional vagina ....
) or because of an acquired cause (e.g. physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
). As such, the term vaginoplasty generally describes any such reconstructive and corrective vaginal surgery, whilst the term neovaginoplasty specifically describes the procedures of either partial or total construction or reconstruction of the vulvo-vaginal complex.
The post-operative outcome of vaginoplasty is variable; it usually allows coitus (sexual intercourse), although sensation might not always be present. In biological women, menstruation
Menstruation
Menstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
and fertilization are assured when the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
and the ovaries
Ovary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
have preserved their normal functions; in a few cases, vaginal childbirth is possible. In male-to-female sex reassignment surgery, some trans women patients undergo vaginoplasty as part of their physical (sex) transition
Transitioning (transgender)
Transitioning is the process of changing one's gender presentation to accord with one's internal sense of one's gender - the idea of what it means to be a man or woman...
. The physical factors that limit vaginal dimensions are the rectoprostatic Denonvilliers’ Fascia
Rectoprostatic fascia
The rectoprostatic fascia is a membranous partition at the lowest part of the rectovesical pouch. It separates the prostate and urinary bladder from the rectum. It consists of a single fibromuscular structure with several layers that are fused together and covering the seminal vesicles...
(depth) and the Levator ani muscle
Levator ani
The levator ani is a broad, thin muscle, situated on the side of the pelvis.It is attached to the inner surface of the side of the lesser pelvis, and unites with its fellow of the opposite side to form the greater part of the floor of the pelvic cavity....
(diameter); thus, in trans women patients, the narrowness of the male pelvis
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
can reduce the available area to use for vaginoplasty.
Terminology
The term "vaginoplasty" also is applied to hymenotomyHymenotomy
A hymenotomy is a minor medical procedure involving the surgical removal or opening of the hymen. It is often performed on patients with imperforate hymens or septate hymens, or other situations where the hymen is unusually thick or rigid. In the case of a female with a hymen without any opening,...
, the creation of an opening in an imperforate hymen, and hymenorrhaphy
Hymenorrhaphy
Hymenorrhaphy or hymenoplasty or hymen reconstruction surgery is the surgical restoration of the hymen. The term comes from the Greek words hymen meaning membrane, and raphe meaning suture...
, the recreation of a ruptured hymen
Hymen
The hymen is a membrane that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia. The size of the hymenal opening increases with age. Although an often practiced method, it is not possible to confirm with certainty that a girl or woman is a...
.
Vaginoplastic procedures
Vaginoplasty utilizes autologousAutotransplantation
Autotransplantation is the transplantation of organs, tissues or even proteins from one part of the body to another in the same individual. Tissue transplanted by such "autologous" procedure is referred to as an autograft or autotransplant. It is contrasted with xenotransplantation and...
(patient-derived) tissue
Tissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
from the patient’s person, to construct areas of vagina and areas of the vulvovaginal complex. The tissues available for surgical correction include the oral mucosa
Oral mucosa
The oral mucosa is the mucous membrane epithelium of the mouth. It can be divided into three categories.*Masticatory mucosa, para-keratinized stratified squamous epithelium, found on the dorsum of the tongue, hard palate and attached gingiva....
, skin flaps, skin grafts, the vaginal labia, penile
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
skin, penile tissue, scrotal
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
skin, and intestinal mucosa
Intestine
In human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
. In surgical praxis, it is important to electrolytically
Electrolysis
In chemistry and manufacturing, electrolysis is a method of using a direct electric current to drive an otherwise non-spontaneous chemical reaction...
remove the follicles from a hair-bearing skin graft, unless the surgeon directs otherwise; usually, the skin graft is depilated intra-operatively, either manually (scraped) or by electrocauterization. Besides the vaginoplastic surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
techniques herein discussed, earlier plastic surgery procedures do exist, but have been superseded by the more effective results (outcome) of contemporary vaginoplasty.
Balloon vaginoplasty
In the balloon vaginoplasty technique, a foley catheterFoley catheter
A Foley catheter is a flexible tube that is often passed through the urethra and into the bladder. The tube has two separated channels, or lumens, running down its length. One lumen is open at both ends, and allows urine to drain out into a collection bag...
is laparoscopically
Laparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
inserted to the recto-vesical space (recto-pubic space), whereupon gradual traction and distension are applied to create a neovagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
. Moreover, balloon vaginoplasty also is a new technique for treating vaginal aplasia
Aplasia
Aplasia is defined in general as "defective development or congenital absence of an organ or tissue." In the field of hematology, the term refers to "incomplete, retarded, or defective development, or cessation of the usual regenerative process."-Examples:*Acquired pure red cell aplasia*Aplasia...
, which also is applied as a technically simple, physically safe, and medically effective alternative vaginoplasty for creating a neovagina, especially when conventional laparoscopic surgery is either infeasible or unsafe.
Buccal (oral) mucosa
A relatively novel surgical approach to treating vaginal agenesis is utilizing the buccal mucosa as the tissue for lining the vaginaVagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
(ca. 8.0 cm. deep). The medical advantages of this vaginoplasty technique include the biological and healing qualities of the buccal mucosa tissue, minimal scarring, and a short, post-operative recovery for the patient. The disadvantages include limited vaginal dimensions (depth and width), and the possibility of either intraoral
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
damage, when tissue-harvesting, or of complications.
In surgery, the tissue donor site in the cheek (ca. 2.5 x 8.0 cm.) is marked to avoid damage to the Stensen’s duct
Parotid duct
The parotid duct, also known as Stensen's duct, is the route that saliva takes from the parotid gland into the mouth.It passes through the buccal fat, buccopharyngeal fascia, and buccinator muscle then opens into the vestibule of the mouth next to the maxillary second molar tooth. The buccinator...
(parotid duct) and to the parotid gland
Parotid gland
The paired parotid glands are the largest of the salivary glands. They are each found wrapped around the mandibular ramus, and secrete saliva through Stensen's ducts into the oral cavity, to facilitate mastication and swallowing and to begin the digestion of starches.-Location:The parotid glands...
. To create the vaginal lining, the buccal mucosa tissue graft is micro-perforated to allow shaping it to a larger size of greater area (surface); it then is formed upon a stent
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
, and afterwards affixed to the vaginal space (created earlier in the operation), with its edge sutured to the minor labia
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
and to the perineal skin. The vaginal mold of buccal mucosa is then (temporarily) secured to the perineal skin, to allow the patient’s recovery.
Colovaginoplasty
The colovaginoplasty (colon section) technique creates a vaginaVagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
by cutting away a section of the sigmoid colon
Sigmoid colon
The sigmoid colon is the part of the large intestine that is closest to the rectum and anus. It forms a loop that averages about 40 cm...
and using it to form a vaginal lining. This surgery is performed on women with androgen insensitivity syndrome
Androgen insensitivity syndrome
Androgen insensitivity syndrome is a condition that results in the partial or complete inability of the cell to respond to androgens. The unresponsiveness of the cell to the presence of androgenic hormones can impair or prevent the masculinization of male genitalia in the developing fetus, as...
, congenital adrenal hyperplasia
Congenital adrenal hyperplasia
Congenital adrenal hyperplasia refers to any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands ....
, vaginal agenesis, müllerian agenesis
Mullerian agenesis
Müllerian agenesis is a congenital malformation in women characterised by a failure of the müllerian ducts to develop, resulting in a missing uterus and fallopian tubes and variable malformations of the upper portion of the vagina. It is the second most common cause of primary amenorrhea after...
, and other intersexual conditions wherein non-invasive forms of deepening the vagina cannot be performed (mostly on trans women patients) as an alternative to penile inversion, with or without an accompanying skin graft (usually from the thigh or the abdomen). Because of the potential complications (e.g. diversion colitis
Colitis
In medicine, colitis refers to an inflammation of the colon and is often used to describe an inflammation of the large intestine .Colitides may be acute and self-limited or chronic, i.e...
) most surgeons will recommend a colovaginoplasty procedure only when there is no alternative procedure.
Don Flap (labia minora flap)
The Don Flap correction of vaginal agenesisAgenesis
In medicine, agenesis refers to the failure of an organ to develop during embryonic growth and development due to the absence of primordial tissue...
, uses a technique similar to that of penile inversion, that sutures the labia minora
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
together to create a neovagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
. A refinement of this vaginoplsatic technique is its utilization of the prepucial skin
Clitoral hood
In female human anatomy, the clitoral hood, , is a fold of skin that surrounds and protects the clitoral glans. It develops as part of the labia minora and is homologous with the foreskin in male genitals.-Variation:This is a protective hood of skin that covers the clitoral glans...
(hood) of the clitoris
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
as a horse-shoe-shaped, one-piece flap. Yet, although the Don Flap technique is a relatively simple surgical procedure, the most obvious disadvantages of the labia minora flap surgery include the need for restorative labiaplasty
Labiaplasty
Labiaplasty is a plastic surgery procedure for altering the labia minora and the labia majora, the paired tissue structures bounding the vestibule of the vulva. The indications for the correction of labial hypertrophy are two-fold: the correction of defect and deformity, and the cosmetic...
and cervical dilation
Cervical dilation
Cervical dilation is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery...
to produce a vagina of adequate dimensions (depth and width).
McIndoe technique
The McIndoe vaginoplasty technique utilizes split-thickness skin grafts that cover a mold, which then is inserted to a surgically created space, between the bladderBladder
Bladder usually refers to an anatomical hollow organBladder may also refer to:-Biology:* Urinary bladder in humans** Urinary bladder ** Bladder control; see Urinary incontinence** Artificial urinary bladder, in humans...
and the rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
. The principal, technical difference between the McIndoe vaginoplasty and the Vecchietti vaginoplasty, is which tissue to utilize to line the created neovagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
. Each surgical procedure has positive and negative factors, especially regarding upon whom such a plastic surgical technique can be applied, because the post-operative outcome varies with the patient’s indications.
Penile inversion
In genital reassignment, penile inversion is the most common plastic surgical technique for creating a neovagina for trans women patients; it also is used for the genital corrections for people born intersexIntersex
Intersex, in humans and other animals, is the presence of intermediate or atypical combinations of physical features that usually distinguish female from male...
. Along with the colovaginoplasty procedure, penile inversion is one of the two principal vaginoplasty procedures used for creating a neovagina. Applying a flap technique (first used by Sir Harold Gillies
Harold Gillies
Sir Harold Delf Gillies was a New Zealand-born, and later London based, otolaryngologist who is widely considered as the father of plastic surgery.-Personal life:Gillies was born in Dunedin, New Zealand...
in 1951), the spongiform erectile tissue of the penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
is removed, and the skin, with its nerves and vascular system (blood supply) still attached, is used to create a vestibule area and labia minora
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
, which then are inverted into the neovaginal cavity created in the pelvic tissue. Part of the glans penis
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
tip, with its nerve and vascular systems still connected, becomes the clitoris
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
; and the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
is shortened to end at a place appropriate to the female genital anatomy
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
. Another common technique for creating a neoclitoris
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
utilizes the urethral spongiform tissue. This was the most common penile inversion technique, and was so used by Dr. Burou and Dr. Stanley Biber; however, some surgeons do not create a neoclitoris as part of a penile inversion.
Vecchietti procedure
In treating müllerian agenesisMullerian agenesis
Müllerian agenesis is a congenital malformation in women characterised by a failure of the müllerian ducts to develop, resulting in a missing uterus and fallopian tubes and variable malformations of the upper portion of the vagina. It is the second most common cause of primary amenorrhea after...
, the Vecchietti procedure is a laparoscopic
Laparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
surgical technique that produces a vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
of dimensions (depth and width) comparable to those of a normal vagina (ca. 8.0 cm. deep). A small, plastic sphere (“olive”) is threaded (sutured) against the vaginal area; the threads are drawn though the vaginal skin, up through the abdomen
Abdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
, and through the navel
Navel
The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...
. 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 1.0 cm. per day, thereby creating a vagina, approximately 7.0 cm. deep by 7.0 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.
Wilson Method
The penile-inversion technique of the Wilson Method is different from the traditional penile-inversion technique in that it is a three-stage surgery, comprising a two-stage initial vaginoplasty. The Wilson Method surgery is initially performed like a traditional penile inversion, until the vaginal-vault creation step, in which the vault of the vagina is left unfinished, as a raw surface, and is packed with a sterile stentStent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
, which, after 5–7 days, then is lined with a skin graft harvested from the buttocks
Buttocks
The buttocks are two rounded portions of the anatomy, located on the posterior of the pelvic region of apes and humans, and many other bipeds or quadrupeds, and comprise a layer of fat superimposed on the gluteus maximus and gluteus medius muscles. Physiologically, the buttocks enable weight to...
. The penile
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
skin is used to create the labia minora
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
, clitoral hooding
Clitoral hood
In female human anatomy, the clitoral hood, , is a fold of skin that surrounds and protects the clitoral glans. It develops as part of the labia minora and is homologous with the foreskin in male genitals.-Variation:This is a protective hood of skin that covers the clitoral glans...
, and the anterior fourchette (frenulum); the glans penis
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
is used to create the clitoris
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
, and the scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
is used to create the labia majora
Labia majora
The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the...
.
Labiaplasty
LabiaplastyLabiaplasty
Labiaplasty is a plastic surgery procedure for altering the labia minora and the labia majora, the paired tissue structures bounding the vestibule of the vulva. The indications for the correction of labial hypertrophy are two-fold: the correction of defect and deformity, and the cosmetic...
is a vaginoplastic surgery technique for reducing the size the genital labia — either the majora
Labia majora
The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the...
or the minora
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
— which are any of the four folds of tissue of the vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
. It can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.
Vaginal rejuvenation
A “vaginal rejuvenation” is a non-reconstructive vaginoplasty that restores the muscle tone and the æsthetics of the vaginaVagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
, by removing excess tissues and tightening the supportive structures of the vulvovaginal complex, in effort either to reduce or to reverse the effects of aging and parturition (childbearing). The advantages are a physically comfortable health and an improved self-image (mental health); the potential disadvantages are decreased clitoral
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
and genital sensation, and complications, such as infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, tissue adhesions, and scarring
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
.
Criticism
The American College of Obstetricians and Gynecologists (ACOG) published Committee Opinion No. 378: Vaginal “Rejuvenation” and Cosmetic Vaginal Procedures (2007), the college’s formal policy statement of opposition to the commercial misrepresentationsAdvertising
Advertising is a form of communication used to persuade an audience to take some action with respect to products, ideas, or services. Most commonly, the desired result is to drive consumer behavior with respect to a commercial offering, although political and ideological advertising is also common...
of labiaplasty, and associated vaginoplastic procedures, as medically “accepted and routine surgical practices”. The ACOG doubted the medical safety and the therapeutic efficacy of the surgical techniques and procedures for performing labiaplasty, vaginal rejuvenation
Vaginoplasty
thumb|right|300px|Vaginoplasty: the pre-operative aspect , and the post-operative aspect of a [[Labiaplasty|labial reduction]].Vaginoplasty is a reconstructive plastic surgery procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal...
, the designer vagina, revirgination, and Gräfenberg Spot
G-spot
The Gräfenberg Spot, often called the G-Spot, is a bean-shaped area of the vagina. Many women report that it is an erogenous zone which, when stimulated, can lead to strong sexual arousal, powerful orgasms and female ejaculation...
amplification, and recommended that women seeking such genitoplastic surgeries must be fully informed, with the available surgical-safety statistics, of the potential health risks of surgical-wound infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, of pudendal nerve
Pudendal nerve
The pudendal nerve is a sensory and somatic nerve in the pelvic region which is a large branch of the sacral plexus that innervates the external genitalia of both sexes, as well as sphincters for the bladder and the rectum...
damage (resulting in either an insensitive or an over-sensitive vulva), of dyspareunia
Dyspareunia
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original...
(painful coitus), of tissue adhesions (epidermoid cysts
Epidermoid cyst
An epidermoid cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.-Terminology:...
), and of painful scars.
See also
- ClitoroplastyClitoroplastyClitoroplasty is a term for the surgical creation of a clitoris , or restoration, in the case of procedures reversing the damage caused by female genital cutting....
- Gender reassignment therapy
- Genital modification and mutilationGenital modification and mutilationThe terms genital modification and genital mutilation can refer to permanent or temporary changes to human sex organs. Some forms of genital alteration are performed at the behest of an adult, with their informed consent. Others are performed on infants or children...
- HymenorrhaphyHymenorrhaphyHymenorrhaphy or hymenoplasty or hymen reconstruction surgery is the surgical restoration of the hymen. The term comes from the Greek words hymen meaning membrane, and raphe meaning suture...
- HymenotomyHymenotomyA hymenotomy is a minor medical procedure involving the surgical removal or opening of the hymen. It is often performed on patients with imperforate hymens or septate hymens, or other situations where the hymen is unusually thick or rigid. In the case of a female with a hymen without any opening,...
- Intersex surgeryIntersex surgeryIntersex surgery is one of several terms referring to surgery performed to correct birth defects or early injuries of the genitalia, primarily for the purposes of making the appearance more normal and to reduce the likelihood of future problems...
- Intersexuality
- LabiaplastyLabiaplastyLabiaplasty is a plastic surgery procedure for altering the labia minora and the labia majora, the paired tissue structures bounding the vestibule of the vulva. The indications for the correction of labial hypertrophy are two-fold: the correction of defect and deformity, and the cosmetic...
- Sex reassignment surgery male-to-femaleSex reassignment surgery male-to-femaleSex reassignment surgery from male to female involves reshaping the male genitals into a form with the appearance of and, as far as possible, the function of female genitalia. Prior to any surgeries, trans women usually undergo hormone replacement therapy and facial hair removal...
- Sex reassignment surgery female-to-maleSex reassignment surgery female-to-maleSex reassignment surgery from female to male includes a variety of surgical procedures for transsexual men that alter female anatomical traits to provide physical traits more appropriate to the trans man's male identity and functioning....
- Vulvovaginal healthVulvovaginal healthVulvovaginal health is the health and sanitation of the human female vulva and vagina.-Conditions:Problems affecting this area include:*Infection with Candida albicans...
- List of transgender-related topics
Further reading
- Karim RB, Hage JJ, Dekker JJ, Schoot CM. Evolution of the Methods of Neovaginoplasty for Vaginal Aplasia. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1995 January;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. Annals of Plastic Surgery. 1996 Dec;37(6):669–675. Review. PMID 8988784