V01-03: Gender-Affirming Vaginoplasty
We describe the operative technique for Gender-Affirming Vaginoplasty performed at Oregon Health and Science University (OHSU). We follow the World Professional Association for Transgender Health (WPATH) Guidelines.
Preoperative pelvic floor physical therapy, genital skin electrolysis, and nicotine cessation is confirmed. In lithotomy position, a full-thickness scrotal skin graft is harvested and later used to create the neovagina. Bilateral orchiectomy is performed. Creation of the neovaginal canal requires meticulous dissection and frequent manual palpation to avoid injury to the bulbospongiosum, external urinary sphincter, rectum, and neurovascular structures. The space is carried through Denonvilliers' fascia and into the retroperitoneum. A custom neovaginal mold aids in blunt dissection to a typical depth of 14 cm. The penis is disassembled in preparation of the clitorourethral complex. The tunica albuginia is opened sharply and the erectile tissue is cleared, leaving the neurovascular bundle intact. The glans penis is marked, incised, and reconstructed to create the neoclitoris. The neomeatus is created by dividing and ventrally spatulating the bulbar urethra. Ventral penile skin is divided to surround the clitororethral complex. The neovagina is constructed by anastomosing the tubularized scrotal skin graft with the native penile skin flap. A custom vaginal packing is created to provide gentle pressure between the penile flap and scrotal skin flap with the neovaginal canal. The perineal and penile skin flaps are anchored to the perineal body, creating the posterior introitus. The skin incisions are closed.
Patient and surgeon satisfaction with cosmetic and functional outcomes remains high for this procedure.
We present the current operative technique for Gender-Affirming Vaginoplasty at Oregon Health and Science University. Demand for gender-affirming surgical care is growing internationally. This procedure provides a challenging opportunity to use many reconstructive principles.