Background The ideal vaginoplasty must be successful functionally as well as have a natural
appearance, and also must retain its functionality and appearance over the long term.
Conventional vaginoplasty techniques have functional limitations and are associated
with recurrent complications, but rectosigmoid vaginoplasty is known to have a high
satisfaction rate due to its functional similarity with the vagina. We conducted the
present study to assess the usability of rectosigmoid vaginoplasty over the course
of long-term follow-up.
Methods From March 1992 to February 2014, 84 patients were treated with rectosigmoid vaginoplasty;
44 had gender identity disorder, 29 had vaginal agenesis, 8 had female pseudohermaphroditism,
and 3 had gynecologic malignancies after radical pelvic surgery. This retrospective
study was based on a review of the patients' records, clinical examinations, complications,
and questionnaires about appearance, function, and sexual intercourse.
Results All patients who underwent rectosigmoid vaginoplasty were discharged within 2 weeks
without surgical flap loss. The early complications were partial flap necrosis, difficulty
in defecation, mucous hypersecretion, and postoperative ileus. The late complications
were vaginal introitus contracture, vaginal prolapse, and difficulty in urination.
The mean length and diameter of the neovagina 3.4 years after rectosigmoid vaginoplasty
were 13.2 cm and 3.8 cm, respectively. On questionnaires about satisfaction, 70% of
patients reported excellent satisfaction, 11% good, 12% fair, and 7% poor.
Conclusions Rectosigmoid vaginoplasty is useful, safe, and well-accepted operative method with
good functional and cosmetic results, such as natural lubrication and adequate vaginal
length and width obtained without requiring the use of a dilator.
Keywords
Gender identity - Vagina - Surgical flap
