Vaginoplasty

Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses to restore a normal vaginal structure and function.

[1] Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

[3][4] Vaginoplasty is the description of the following surgical interventions: In some instances, extra tissue is needed to reconstruct or construct the vagina.

[11] Conditions such as congenital adrenal hyperplasia virilize genetic females due to a 21-hydroxylase deficiency.

Specific procedures include: clitoral reduction, labiaplasty, normalizing appearance, vagina creation, initiating vaginal dilation.

[13] Vaginoplasty is used as part of the series of surgeries needed to treat those girls and women born with the bladder located outside of their abdomen.

[12] Vaginoplasties may be performed in children or adolescents with intersex conditions or disorders of sex development.

[3] A canal is surgically constructed between the urinary bladder and urethra in the anterior portion of the pelvic region and the rectum.

Inversion of the penile skin is the method most often selected to create a neovagina by surgeons performing gender-affirming surgery.

However, in bowel vaginoplasty a segment of rectosigmoid colon is grafted into a surgically created canal to form the neovagina.

peritoneal pull-down or pull-through (PPT), is based on neovaginal techniques documented in the 1970s and 80s[25][26][27] for cisgender women born without a vaginal canal due to agenesis/atresia,[28][29] which were referred to as the "Davydov" procedure[29][30] or "Rothman's" method.

[31] A 2022 review states, "In the last 5 years, peritoneal flap vaginoplasty has emerged as a promising technique".

[39][40] The Society of Obstetricians and Gynaecologists of Canada published a policy statement against elective vaginoplasty based upon the risks associated with unnecessary cosmetic surgery in 2013.

In this procedure, a Foley catheter is laparoscopically inserted to the rectouterine pouch whereupon gradual traction and distension are applied to create a neovagina.

[45] The outcomes of Vecchietti technique via the laparoscopic approach are found to be comparable to the procedure using laparotomy.

[46] In vaginal hypoplasia, traction vaginoplasty such as the Vecchietti technique seems to have the highest success rates both anatomically (99%) and functionally (96%) among available treatments.

[48][49] At the end of the procedure the device stays in place to maintain the neovagina against the pelvic wall which also favors the process of microscopic neovascularization and reduces the risks of hematoma.

[50] Solid vaginal dilators can also be used immediately after surgery to keep the passage from attachments, and regularly thereafter to maintain the viability of the neovagina.

Those reporting a negative outcome who experienced loss of bladder control and urinary incontinence were 19%.