Vaginoplasty

Vaginoplasty (neovaginoplasty) is a reconstructive procedure to create a neovagina. Neovaginal reconstruction is indicated in congenital absence of the vagina (e.g. Mayer-Rokitansky-Küster-Hauser syndrome), certain intersex conditions, and after pelvic exenterative surgery for malignancy or major pelvic trauma.

Vaginal absence can have a profound impact on quality of life. In such cases, creating a functional neovagina is often a central treatment goal. Reconstruction is considered in vaginal agenesis, disorders of sexual development, gender-affirming genital surgery, defects after oncologic or other genital surgery, and severe trauma.

Many techniques have been described, with differing rates of complications, anatomical results, and functional outcomes. Commonly reported approaches include split- and full-thickness skin grafts, bladder or buccal mucosa grafts, penile or penoscrotal skin flaps, local genital flaps, and intestinal segments. These methods can have drawbacks such as visible scarring, contracture, inadequate cavity length or caliber, hair-bearing mucosa internally, need for long-term lubrication with intercourse, and prolonged dilation programs.

In patients with an insufficient neovaginal cavity or after failed prior surgery, sigmoid colon is often favored as donor tissue because of proximity to the pelvis and reliable mobilization of its vascular pedicle. Advances in anesthesia, antibiotics, and colorectal anastomotic technique have made the pedicled sigmoid flap a first-line option in many children and adults.

Compared with several alternatives, rectosigmoid vaginoplasty can provide a self-lubricating, well-caliber neovagina without the same need for indefinite postoperative dilation. The sigmoid segment is thick-walled, of generous diameter, and tolerates trauma better than many skin or small bowel constructs; blood supply from the pedicle may reduce problems such as stricture or shrinkage. Mucous secretion typically decreases substantially over the first three to six months, often remaining sufficient for comfort without being excessive. Short-term calibration or dilation at the introital anastomosis is usually temporary and well tolerated.

Successful sexual intercourse is a primary endpoint when choosing a vaginal substitution technique and a key measure when judging results. Intestinal-based reconstruction can yield a neovagina that is both functional and aesthetically acceptable for many patients. Psychological and psychosocial wellbeing belong in any discussion of outcomes and quality of life after surgery.