VAGINOPLASTY WITH SIGMOID COLON IN A GENDER REASSIGNMENT PATIENT WITH PREVIOUS LOSS OF CUTANEOUS-MUSCULAR FLAP – A CASE REPORT

Case Presentation A 43-year-old transgender woman with a diagnosis of gender dysphoria underwent gender affirmation surgery using inverted penile skin for the creation of the vaginal canal in June 2018. In 2022, she developed dyspareunia and partial loss of the cutaneous flap of the neovagina, which did not improve with topical Promestriene. In November 2022, a revision of the neovagina was performed with dissection of the vaginal canal's fundus and autologous full-thickness skin graft in the suprapubic region. Upon follow-up, a short vaginal canal and persistent granulation tissue were noted, along with continued dyspareunia. The patient was evaluated by the Digestive Surgery team for the use of an intestinal flap and neovagina correction. In January 2024, she underwent sigmoid colon vaginoplasty with a descending-sigmoid anastomosis by videolaparoscopy. She currently has normal bowel habits and no complaints.

Discussion Gender identity disorder is a condition in which individuals strongly identify with the gender opposite to their biological sex, causing social and occupational distress. For transgender women, the most common surgery is vaginoplasty, which involves removal of male genitalia and the creation of a neovagina. There are three main surgical techniques for vaginoplasty: skin grafts, penile-scrotal cutaneous flaps, and pedicled segments of small or large intestine. The intestinal segment technique is most commonly used when there is a lack of penoscrotal skin or when previous vaginoplasty attempts have failed. Intestinal vaginoplasty can present complications, such as intestinal fistulas, urinary retention, bleeding, urethral stenosis, surgical site infection, rectal injuries, and tissue necrosis. Performing the procedure laparoscopically offers advantages, including better visualization and ease in recreating the neovagina. A team of specialists, including a gastrointestinal surgeon with advanced laparoscopic skills, is essential to minimize complications and ensure the success of the procedure.

Conclusion The lack of evidence makes it difficult to choose the ideal technique for vaginoplasty in transgender women. Penile skin inversion is more studied, but vaginoplasty with intestinal segments does not appear to be inferior. Prospective studies with larger groups and long-term follow-up are needed. Until then, the experience of the team and available resources should guide the choice of technique.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025