Vaginoplasty for the Transgender Woman

The purpose of this review was to describe the most common male-to-female vaginoplasty surgical techniques, and to review important perioperative considerations, outcomes, and complications associated with these surgeries.

Vaginoplasty for the transgender woman may be performed using a variety of techniques. Most commonly, the penile inversion vaginoplasty technique is used, but in some cases, the intestinal segment vaginoplasty is indicated. Intraoperative complications of vaginoplasty surgery include bleeding and injury to the bladder, urethra, and/or rectum. Immediate postoperative complications include hematoma or seroma formation, infection or abscess, wound dehiscence, flap necrosis, and venous thromboembolism. Delayed postoperative complications include neovaginal stenosis or shortening of the neovagina, rectovaginal or genitourinary fistula formation, urethral meatal stenosis or abnormal urine stream, neuropathy, and sexual dysfunction including dyspareunia and anorgasmia. Most patients are satisfied with the functional and esthetic outcomes of vaginoplasty, but sexual dysfunction may be common. The risk of regret following vaginoplasty seems to be low, and certain risk factors for this unfavorable outcome have been identified.

Outcomes appear to be satisfactory following vaginoplasty surgery for transgender women, but robust prospective, long-term data are lacking.