Vaginoplasty in gender identity disorder male-to-female transsexuals

Worldwide, most vaginoplasties in male-to-female transsexual patients utilize either a reversed penile flap or a penoscrotal flap. In cases in which the preoperative penis is short in length, neither of these methods results in adequate vaginal depth, because the proximal aspects of both penile flaps are utilized not only to construct the vaginal cavity, but also to cover the perineal area. Thus, in such cases, it is the standard to add a skin graft to resurface the depths of the vaginal cavity, although the grafted skin may constrict, resulting in a narrowed and shortened vaginal canal. Ideally, a reconstructed vagina should be fully lined with a hairless flap without a skin graft. The pudendal-thigh flap vaginoplasty was first reported by Joseph and Wee. It is commonly known that this flap contains the posterior pudendal vessels and can be elevated safely. In our pudendal groin flap vaginoplasty, we modified this flap, creating an M-shaped perineal scrotal flap and a more advanced pudendal groin flap. In doing so, this flap is adequate to line the entire cavity of the vagina, while the penile flap is only utilized to cover the perineal region and in creation of the labia minor. Recently, laparo-scopically assisted rectosigmoid colon vaginoplasty was introduced, and its utility has been documented with regard to appearance, lubrication, and sense of touch. Operative time is comparable and duration of hospitalization is less than with the conventional open method. Colon vaginoplasty as a salvage operation for complicated cases could become a first-choice protocol with the use of the laparoscope.