Vaginoplasty is the most frequently performed gender-affirming genital surgery for gender-diverse people with genital gender incongruence. The procedure is performed to create an aesthetic and functional vulva and vaginal canal that enables receptive intercourse, erogenous clitoral sensation and a downward-directed urine stream. Penile inversion vaginoplasty (PIV) is a single surgical procedure involving anatomical component rearrangement of the penis and scrotum that enables many patients to meet these anatomical goals. Other options include minimal-depth, peritoneal and intestinal vaginoplasty. Patient quality of life has been shown to improve drastically after vaginoplasty, but complication rates have been documented to be as high as 70%. Fortunately, most complications do not alter long-term postoperative clinical outcomes and can be managed without surgical intervention in the acute perioperative phase. However, major complications, such as rectal injury, rectovaginal fistula, and urethral or introital stenosis can substantially affect the patient experience. Innovations in surgical approaches and techniques have demonstrated promising early results for reducing complications and augmenting vaginal depth, but long-term data are scarce.
Vaginoplasty is the most frequently performed genital gender-affirming surgery for gender-diverse people.
Preoperative management of patients choosing to undergo vaginoplasty includes hormone management, pelvic floor physiotherapy and hair removal, in addition to standard preoperative preparation.
The two types of vaginoplasty most often performed are penile inversion vaginoplasty and intestinal vaginoplasty; peritoneal-based vaginoplasties are also becoming widely used.
Minimal-depth vaginoplasty is an option for patients who do not desire construction of a full-depth vagina.
Postoperative care includes strict dilation regimens, vaginal rinses and pelvic floor physiotherapy.
Clinical and patient-reported outcomes that require monitoring include sensation, urinary divergence, vaginal depth, lubrication and patient satisfaction.
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The authors declare no competing interests.
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Morrison, S.D., Claes, K., Morris, M.P. et al. Principles and outcomes of gender-affirming vaginoplasty. Nat Rev Urol (2023). https://doi.org/10.1038/s41585-022-00705-y