Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Vaginoplasty in Male to Female transgenders: single center experience and a narrative review

International Journal of Impotence Research volume 33, pages 726–732 (2021)Cite this article

Subjects

Abstract

Vaginoplasty in Male to Female (M to F) transgenders is a challenging procedure, often accompanied by numerous complications. Nowadays the most commonly used technique involves inverted penile and scrotal flaps. In this paper the data of 47 M to F patients who have undergone sex affirmation surgery at the Department of Urology of the University of Trieste, Italy since 2014, using our modified vaginoplasty technique with the “Y” shaped urethral flap, have been retrospectively reviewed. Moreover, a non structured review of the literature with regards to short and long-term complications of vaginoplasty has been provided. All patients followed a standardized neo-vaginal dilation protocol. At follow up 2 patients were lost. At 12 months 88.9% of patients (40/45) were able to reach climax, 75.6% (34/45) were having neo-vaginal intercourses and median neo-vaginal depth was 11 cm (IQR 9–13.25): no statistically significant decrease in depth was found at follow up. Only one patient was dissatisfied with aesthetic appearance at 12 months. Our technique provided excellent cosmetic and functional results without severe complications (Clavien–Dindo ≥ 3). The review of the literature has highlighted the need to standardize a postoperative follow up protocol with particular regard to postoperative dilatation regimen. Further, larger randomized clinical trials are pending to draw definitive conclusions.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2017;102:3869–903.

    Article  Google Scholar 

  2. Sutcliffe PA, Dixon S, Akehurst RL, Wilkinson A, Shippam A, White S, et al. Evaluation of surgical procedures for sex reassignment: a systematic review. J Plast Reconstr Aesthet Surg. 2009;62:294–306.

    Article  CAS  Google Scholar 

  3. Goddard JC, Vickery RM, Terry TR. Development of feminizing genitoplasty for gender dysphoria. J Sex Med. 2007;4:981–9.

    Article  Google Scholar 

  4. Eldh J. Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals. Plast Reconstr Surg. 1993;91:895–900.

    Article  CAS  Google Scholar 

  5. Giraldo F, Esteva I, Bergero T, Cano G, González C, Salinas P, et al. Corona glans clitoroplasty and urethropreputial vestibuloplasty in male-to-female transsexuals: the vulval aesthetic refinement by the andalusia gender team. Plast Reconstr Surg. 2004;114:1543–50.

    Article  Google Scholar 

  6. Wagner S, Greco F, Hoda MR, Inferrera A, Lupo A, Hamza A, et al. Male-to-female transsexualism: technique, results and 3-year follow-up in 50 patients. Urol Int. 2010;84:330–3.

    Article  Google Scholar 

  7. Buncamper ME, van der Sluis WB, van der Pas RSD, Özer M, Smit JM, Witte BI, et al. Surgical outcome after penile inversion vaginoplasty: a retrospective study of 475 transgender women. Plast Reconstr Surg. 2016;138:999–1007.

    Article  CAS  Google Scholar 

  8. Jones HW Jr, Schirmer HK, Hoopes JE. A sex conversion operation for males with transsexualism. Am J Obstet Gynecol. 1968;100:101–9.

    Article  Google Scholar 

  9. Trombetta C, Liguori G, Benvenuto S, Petrovic M, Napoli R, Umari P, et al. La neouretroclitoridoplastica secondo Petrovic [Neo-urethroclitoroplasty according to Petrovic]. Urologia. 2011;78:267–73.

    Article  Google Scholar 

  10. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.

    CAS  PubMed  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  12. Ferrando CA. Vaginoplasty complications. Clin Plast Surg. 2018;45:361–8.

    Article  Google Scholar 

  13. Zavlin D, Schaff J, Lellé JD, Jubbal KT, Herschbach P, Henrich G, et al. Male-to-female sex reassignment surgery using the combined vaginoplasty technique: satisfaction of transgender patients with aesthetic, functional, and sexual outcomes. Aesthetic Plast Surg. 2018;42:178–87.

    Article  Google Scholar 

  14. Krege S, Bex A, Lümmen G, Rübben H. Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients. BJU Int. 2001;88:396–402.

    Article  CAS  Google Scholar 

  15. Amend B, Seibold J, Toomey P, Stenzl A, Sievert KD. Surgical reconstruction for male-to-female sex reassignment. Eur Urol. 2013;64:141–9.

    Article  Google Scholar 

  16. Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med. 2015;12:1499–512.

    Article  Google Scholar 

  17. Shoureshi P, Dy GW, Dugi D 3rd. Neovaginal canal dissection in gender-affirming vaginoplasty. J Urol. 2021;205:1110–8.

    Article  Google Scholar 

  18. Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol. 2011;8:274–82.

    Article  Google Scholar 

  19. Lawrence AA. Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Arch Sex Behav. 2006;35:717–27.

    Article  Google Scholar 

  20. Reed HM. Aesthetic and functional male to female genital and perineal surgery: feminizing vaginoplasty. Semin Plast Surg. 2011;25:163–74.

    Article  Google Scholar 

  21. Jarolím L, Šedý J, Schmidt M, Naňka O, Foltán R, Kawaciuk I. Gender reassignment surgery in male-to-female transsexualism: a retrospective 3-month follow-up study with anatomical remarks. J Sex Med. 2009;6:1635–44.

    Article  Google Scholar 

  22. Dreher PC, Edwards D, Hager S, Dennis M, Belkoff A, Mora J, et al. Complications of the neovagina in male-to-female transgender surgery: a systematic review and meta-analysis with discussion of management. Clin Anat. 2018;31:191–9.

    Article  Google Scholar 

  23. Rossi Neto R, Hintz F, Krege S, Rubben H, Vom, Dorp F. Gender reassignment surgery-a 13 year review of surgical outcomes. Int Braz J Urol. 2012;38:97–107.

    Article  CAS  Google Scholar 

  24. Jarolím L. Surgical conversion of genitalia in transsexual patients. BJU Int. 2000;85:851–6.

    Article  Google Scholar 

  25. Raigosa M, Avvedimento S, Yoon TS, Cruz-Gimeno J, Rodriguez G, Fontdevila J. Male-to-female genital reassignment surgery: a retrospective review of surgical technique and complications in 60 patients. J Sex Med. 2015;12:1837–45.

    Article  Google Scholar 

  26. Cristofari S, Bertrand B, Leuzzi S, Rem K, Rausky J, Revol M, et al. Postoperative complications of male to female sex reassignment surgery: a 10-year French retrospective study. Ann Chir Plast Esthet. 2019;64:24–32.

    Article  CAS  Google Scholar 

  27. Schardein JN, Zhao LC, Nikolavsky D. Management of vaginoplasty and phalloplasty complications. Urol Clin North Am. 2019;46:605–18.

    Article  Google Scholar 

  28. Li JS, Crane CN, Santucci RA. Vaginoplasty tips and tricks. Int Braz J Urol. 2021;47:263–73.

    Article  Google Scholar 

  29. van der Sluis WB, Pavan N, Liguori G, Bucci S, Bizic MR, Kojovic V, et al. Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes. BJU Int. 2018;121:952–8.

    Article  Google Scholar 

  30. Liguori G, Trombetta C, Bucci S, Salamè L, Bortul M, Siracusano S, et al. Laparoscopic mobilization of neovagina to assist secondary ileal vaginoplasty in male-to-female transsexuals. Urology. 2005;66:293–8.

    Article  CAS  Google Scholar 

  31. Perovic SV, Stanojevic DS, Djordjevic ML. Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU Int. 2000;86:843–50.

    Article  CAS  Google Scholar 

  32. Bertolotto M, Liguori G, Bucci S, Iannelli M, Vedovo F, Pavan N, et al. MR imaging in patients with male-to-female sex reassignment surgery: postoperative anatomy and complications. Br J Radiol. 2017;90:20170062.

    Article  Google Scholar 

  33. Bucci S, Mazzon G, Liguori G, Napoli R, Pavan N, Bormioli S, et al. Neovaginal prolapse in male-to-female transsexuals: an 18-year-long experience. Biomed Res Int. 2014;2014:240761.

    Article  Google Scholar 

  34. Papadopulos NA, Zavlin D, Lellé JD, Herschbach P, Henrich G, Kovacs L, et al. Combined vaginoplasty technique for male-to-female sex reassignment surgery: operative approach and outcomes. J Plast Reconstr Aesthet Surg. 2017;70:1483–92.

    Article  Google Scholar 

  35. Cocci A, Rosi F, Frediani D, Rizzo M, Cito G, Trombetta C, et al. Male-to-Female (MtoF) gender affirming surgery: modified surgical approach for the glans reconfiguration in the neoclitoris (M-shape neoclitorolabioplasty). Arch Ital Urol Androl. 2019;91:119–24.

  36. Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T’Sjoen G, Weyers S, et al. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol. 2005;47:398–402.

    Article  Google Scholar 

  37. Trombetta C, Liguori G, Bucci S, Salamè L, Garaffa G, Cova M, et al. Radiological evaluation of vaginal width and depth in male-to-female transsexuals by the use of magnetic resonance imaging. World J Urol. 2004;22:405–8.

    Article  CAS  Google Scholar 

  38. Brunocilla E, Soli M, Franceschelli A, Schiavina R, Borghesi M, Gentile G, et al. Radiological evaluation by magnetic resonance of the ‘new anatomy’ of transsexual patients undergoing male to female sex reassignment surgery. Int J Impot Res. 2012;2:206–9.

    Article  Google Scholar 

  39. Dunford C, Bell K, Rashid T. Genital reconstructive surgery in male to female transgender patients: a systematic review of primary surgical techniques, complication profiles, and functional outcomes from 1950 to present day. Eur Urol Focus. 2021;7:464–71.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy

    Luca Ongaro, Francesca Migliozzi, Michele Rizzo, Fabio Traunero, Stefano Bucci, Carlo Trombetta & Giovanni Liguori

  2. Department of Urology, University College London Hospitals, London, UK

    Giulio Garaffa

  3. Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy

    Marco Falcone

  4. Department of Urology, Santa Chiara Hospital, Trento, Italy

    Tommaso Cai

  5. Urology Unit, Department of Neurosciences, Reproductive Sciences, Odontostomatology, University of Naples “Federico II”, Naples, Italy

    Alessandro Palmieri

Authors
  1. Luca Ongaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giulio Garaffa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesca Migliozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabio Traunero
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Falcone
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefano Bucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tommaso Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alessandro Palmieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carlo Trombetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Giovanni Liguori
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LO: project design, data acquisition and interpretation, manuscript drafting, final approval. GG: data acquisition and interpretation, manuscript revising, final approval. FM: data acquisition, manuscript revising, final approval. MR: data acquisition and interpretation, manuscript revising, final approval. FT: data acquisition, manuscript revising, final approval. MF: manuscript revising, final approval. SB: manuscript revising, final approval. TC: manuscript revising, final approval. AP: manuscript revising, final approval. CT: manuscript revising, supervision, final approval. GL: project design, data acquisition and interpretation, manuscript revising, supervision, final approval

Corresponding author

Correspondence to Luca Ongaro.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ongaro, L., Garaffa, G., Migliozzi, F. et al. Vaginoplasty in Male to Female transgenders: single center experience and a narrative review. Int J Impot Res 33, 726–732 (2021). https://doi.org/10.1038/s41443-021-00470-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-021-00470-3

Search

Advanced search

Quick links