Abstract
Objectives Vaginoplasty as a part of feminizing genitoplasty (FG) in transwomen helps alleviate
gender dysphoria and improves mental health, sexual and psychosocial functioning,
and quality of life in these individuals. Penile inversion technique (PSFV) remains
the gold standard procedure for FG with least morbidity but has inherent limitations
often resulting in inadequate depth and incorrect (posteroinferior) vaginal axis,
precluding sexual intercourse.
Material and Methods Over the past 27 years, the senior author has refined his technique considerably
incorporating several modifications penile perineo-scrotal flap vaginoplasty (PPSFV)
to overcome the limitations in PSFV. Most of these modifications were in place by
March 2015. Out of 630 primary FGs, retrospective review of all PPSFV with minimum
6 months follow-up operated during the period March 2015 to July 2020 was done for
intra and postoperative complications.
Results There were 183 patients who underwent PPSFV during the study period. Average follow-up
was 31 (6–62) months. There were no cases of injury to bladder, rectum, urethral stenosis,
or neovaginal prolapse. Average operative time was 4 hours and eight (4.37%) patients
required blood transfusion. The vaginal depth was 13 to 14 cm or more in 159 (86.88%),
10 to 12 cm in 17 (9.29%), and 7.5 to 9 cm in seven (3.82%) patients. Ten (5.46%)
patients complained of intravaginal hair growth. Touch up procedures in the form of
anterior commissure and labia plasty were required in 13 (7.10%) patients. All (100%)
patients had good clitoral sensitivity and preserved posterosuperior vaginal axis.
One-hundred thirty nine (75.96%) patients were able to have satisfactory penetrative
sexual intercourse, while 39 (21.31%) had not attempted intercourse and five (2.73%)
complained of poor sexual experience on account of inadequate vaginal dimensions.
Conclusion PPSFV addresses the limitations in PSFV and results in good vaginal depth and posterosuperior
axis, which facilitates penetrative sexual intercourse, at the same time, avoiding
potential complications of procedures such as intestinal vaginoplasties.
Keywords
vaginoplasty - penile inversion vaginoplasty - feminizing genitoplasty - gender affirmation
surgery - gender incongruence - gender dysphoria
