Vaginoplasty Procedures

Vaginoplasty is a term of plastic and construction surgery which aims to construct, reconstruct, or reshape vagina, both in cis women and trans women. There are many kinds of vaginoplasty procedures that current surgeons use. Some of them including:

Balloon vaginoplasty

Balloon vaginoplasty is a new technique of vaginoplasty. It is simple by technic, physically safe, and a good alternative of vaginoplasty, especially in creating a new vagina, if the common laparoscopic surgery is unsafe. Balloon vaginoplasty is mostly used to treat vaginal aplasia. Balloon vaginoplasty is done by inserting a foley catheter into rectouterine pouch, where gradual traction and distension are placed to create new vagina.

Buccal (oral) mucosa

Still a relatively new technique, buccal or oral mucosa is used in treating vaginal agenesis. Buccal or oral mucosa is used as a tissue for the vagina lining (or 8 cm deep). Its advantages includes the good qualities, biological and from recovery process, of the patient. Meanwhile, the downside of this technique is regarding to the very limited size of vaginal (both in depth and width), and the potent of intraoral damage and complications.

Colovaginoplasty

Also known as colon section surgery, colovaginoplasty uses a part of the sigmoid colon to shape a vaginal lining. Usually, colovaginoplasty is preferred as vaginoplastic in women with some specific conditions, including androgen hormone insensitivity, vaginal and mullerian agenesis, congenital adrenal hyperplasia, and other genital conditions which makes it unable to do vaginal deepening to be an alternative way to inverse penile—both with and without any accompanying graft skin (sometimes from the stomach and upper thigh). Colovaginoplasty is often recommended by most surgeons to trans women patient who wants to undergo a vaginal plastic and reconstruction surgery.

Don Flap (labia minora flap)

Just like penile inversion, the Don Flap or labia minora flap correction in vaginoplasty joins the labia minora altogeher to shape a new vagina. This is an improvement of vaginoplasty surgery which utilizes the hood skin (prepucial skin) of clitoris as a horse-shoe shaped piece flap. Many surgeons find that the Don Flap technique is easier and simpler, but it also comes with a downside, including the necessity to do labiaplasty and cervical dilation restoratively to create a vagina with a good size, both in depth and width.

McIndoe technique

The McIndoe vaginoplasty technique utilizes split-thickness skin grafts that cover a mold, which then is inserted to a surgically created space, between the bladder and the rectum. The principal, technical difference between the McIndoe vaginoplasty and the Vecchietti vaginoplasty, is which tissue to utilize to line the created neovagina. Each surgical procedure has positive and negative factors, especially regarding upon whom such a plastic surgical technique can be applied, because the post-operative outcome varies with the patient’s indications.

Penile inversion

This is actually more common for a sex reassignment surgery, especially in trans women. Penile inversion is a vaginoplasty method that creates a new vagina. It is one of the two most common and important procedure in vaginoplasty. It removes the spongiform erectile tissue of the penis and the skin, together with the nerves and blood system, is utilized to make a vestibule and labia minora area. Some parts of the head of the penis is used to shape the clitoris, while the urethra is cut short to end at the proper place like in normal vagina. Sometimes, to make the clitoris, urethral spongiform tissue is used. Although this is the most common part of a vaginoplasty, some surgeons prefer not to shape a new clitoris in this method but choosing a separate procedure instead.

Vecchietti procedure

Vecchietti method is a method of laparoscopic surgery to treat mullerian agenesis. It results in a new vagina with sizes similar or comparable to normal vagina). “Olive”, a small plastical sphere is used as a thread against vagina. The “olive” is then drawn from the vaginal skin to the abdomen, via the navel. It is then placed on a traction device. Every day, the “olive” is tighten up so that it pulls and strecthes the vagina by about a centimeter in a day. So, in seven days, the thread will shape a 7 x 7 (width and shape) cm of vagina. Depending on the condition of the patient, Vecchietti method could take at least 45 minutes.

Wilson Method

This method is different from any other common penile-inversion method. Wilson method uses a three stages surgery, including two stages of beginning vaginoplasty. This method is started like common penile inversion. Then, after the creation of vaginal-vault step, it is then left as a raw tissue and packed with a sterile stent. In five until seven days, it is lined with a graft skin from bottoms. The penile skin itself is utilized to shape a labia minora, frenulum, and clitoral hooding, while the glans penis is utilized to make a clitoris. The scrotum is also used to make a labia majora.  

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