Vaginoplasty - penile inversion technique

Vaginoplasty (neovaginoplasty) is a reconstructive surgical procedure to create a neovagina. Among the leading indications is trans-feminine gender-affirming surgery (GAS), where the goal is a functional, sensate vulva and vaginal canal aligned with the patient's affirmed gender.

Many techniques have been described worldwide. The choice depends on available tissue, anatomy, prior surgery, and individual goals. For many transgender women, approaches based on genital skin and urethral tissue - including penile inversion - remain a well-established option when planning depth, sensation, and aesthetics.

A wide variety of operative methods exists for neovagina creation. Two broad categories of tissue are used for vaginal replacement: skin and bowel. Each has specific indications, advantages, and trade-offs; selection is individualized in consultation.

For many transgender patients, penile-inverted skin flaps represent a strong option: they allow use of hairless genital skin with predictable blood supply and can be combined with urethral tissue to line part of the canal and support sensitivity and moisture. When penile skin is insufficient or revision is needed, bowel-based techniques (for example sigmoid) may be considered - those pathways are discussed separately when they apply to your case.

The penile inversion technique aims to create a fully sensate neovagina from an inverted pedicled island penile skin flap together with a vascularized urethral flap. A major advance is complete penile disassembly, which allows use of nearly all penile components (except the corpora cavernosa) in constructing the new vulva, clitoris, and vagina.

The operation commonly begins with bilateral orchidectomy. The penis is dissected into its anatomical components; the corpora cavernosa are fully removed. The glans is reduced and shaped into a conical clitoris, preserving the neurovascular bundle for sensation. Penile skin is inverted as a pedicled flap, maintaining blood supply and innervation to form a sensate vaginal canal.

The urethra is spatulated and used to contribute mucosal lining to the neovagina, which can add sensitivity and wetting. Fixation to the sacrospinous ligament is performed to place the neovagina deeply in the perineal space and to help reduce the risk of prolapse. Remaining penile and scrotal tissue is used to fashion the clitoral hood, labia minora, and labia majora.

After surgery, vaginal stenting and a structured dilation program are typically required to maintain depth and caliber of the neovagina. Your team will provide detailed instructions and follow-up to support safe, consistent dilation over time.

With appropriate technique and aftercare, many patients achieve a sensate, functional neovagina suitable for penetrative intercourse with preserved erogenous sensation, consistent with the goals of modern gender-affirming vaginoplasty. Individual results vary; risks, benefits, and alternatives are reviewed in person before surgery.