Vaginoplasty - laparoscopically assisted peritoneal pull-through

Reconstruction of the neovagina is central to gender-affirming care for many trans women. For some patients it is the first major genital procedure, while for others it may be planned as a later step in a longer transition journey. Timing is individualized after consultation, medical evaluation, and discussion of goals.

Internationally, penile inversion vaginoplasty is widely regarded as a long-standing standard for neovagina creation, with durable outcomes in experienced centers. Bowel vaginoplasty has historically been considered when penile and scrotal skin are insufficient for a satisfactory vulvovaginal complex, or in certain redo (RE-DO) situations.

Over the last decade, an older gynaecological technique attributed to Russian surgeon Davydov has re-emerged in gender-affirming surgery as another option for vaginal lining using the peritoneum. The laparoscopically assisted peritoneal pull-through approach can add depth and may support a degree of natural lubrication, in addition to the external genital reconstruction.

The operation may be offered as a primary vaginoplasty in trans women, or in selected redo cases when anatomy and goals allow.

Surgery is performed under general anesthesia. The patient is positioned in an exaggerated lithotomy position. A complete penectomy is carried out to the level of attachment of the corpora cavernosa to the pubic bones, together with bilateral orchidectomy in the standard manner. A cavity is created between the urethra, bladder, and rectum to receive the vaginal lining.

Using three laparoscopic ports and pneumoperitoneum, the camera is introduced and peritoneal flaps are mobilized from the bladder and urethra above and from the rectum below. An anastomosis with the skin flaps is performed inside the channel. In this way, additional depth of the vagina is achieved, together with natural lubrication to a meaningful degree (individual variation applies).

Vulvoplasty - including the clitoris, labia, and urethral meatus - is performed in the same conceptual manner as in penile inversion vaginoplasty, so that the external appearance and anatomy align with the neovaginal canal created by the peritoneal approach.

Vaginal packing with antibiotic ointment remains in place for 7 days. A urinary catheter is typically left in place for 12 days after surgery. Your team will give you written instructions for wound care, catheter management, and warning signs that should prompt contact.

Dilation of the neovagina begins after removal of vaginal packing, following the plan provided by your therapist or surgical team. In typical protocols, dilation is continued for at least 12 months in a regular schedule - for example twice daily for 45 minutes per session, adjusted to your healing and individual plan.

Vaginal flushing may be advised to help clear lubricant gel from the neovagina. Long-term follow-up ensures depth is maintained, and any concerns (granulation, stenosis, or other issues) are addressed promptly.