Advisory



AEGIS recommends that for primary neovaginal construction in male-to-female transsexual
persons, penile inversion, with or without use of a skin graft, should be considered
the procedure of choice. We suggest that vaginoplasty using sections of large or
small intestine not be considered as a primary procedure, but only as a secondary
procedure in cases in which the primary surgery produces a vagina which does not
meet the needs of the patient. The wishes of patients who insist on surgery using
bowel segments should be honored, but because of its intrusiveness and high rate
of complications, the procedure should not be advocated as a primary procedure by
surgeons or other members of the treatment team.





The Problem



Currently, there is ongoing debate among surgeons as to the desirability of using
rectosigmoid surgery for primary vaginoplasty. Hage, et al. (1994) have found a variety
of long-term complications, including introitus stenosis, painful introital suture
line, abundant mucosal discharge, and painful contractions, and have furthermore
noted that the distal end of the vagina can become detached and lost in the abdominal
cavity (Karim, et al., 1994). Some surgeons have not reported such extensive problems
(cf Laub, et al., 1993).



Hage & Karim (1994) concluded penile skin inversion is the method of choice for
vaginoplasty in male-to-female transsexuals. Only when the penile skin inversion
technique is impossible or has not led to satisfactory results should a rectosigmoid
neocolpopoiesis be considered.





Discussion



There are a number of techniques for creating neovaginas in male-to-female transsexual
persons. The most popular procedure is penile skin inversion, in which the inverted
skin of the penis is used to line the vagina. Sometimes, penile inversion is used
in conjunction with split-skin or full-skin grafts (Hage & Karim, 1994).



Another procedure is rectosigmoid transplantation, in which a section of the rectosigmoid
colon is used to provide a lining for the neovagina. Hage & Karim (1994) note
that due to the use of antibiotics and stapler devices, this procedure is less dangerous
than it once was. However, it is more intrusive than penile inversion, as the abdominal
cavity is entered, requires a longer healing period, is more expensive than penile
inversion, and has a variety of long-term complications not associated with penile
inversion (Hage & Karim, 1994).



We believe that there is significant evidence that the advantages of rectosigmoid
vaginoplasty are more than offset by its disadvantages.







References



Hage, J.J., & Karim, R.B. (1994). Vaginoplasty in male transsexuals:
(Dis-) advantages of various procedures. Paper presented at The Conference of
the European Network of Professionals on Transsexualism, Manchester, England, 31
August, 1994.



Hage, J.J., Karim, R.B., Asscheman, H., Bloemena, E., & Cuesta, M.A. (1994).
Unfavorable longterm results of rectosigmoid neocolpopoiesis. Paper presented
at The Conference of the European Network of Professionals on Transsexualism, Manchester,
England, 31 August, 1994.



Karim, R.B., Hage, J.J., Questa, M.A, Eggink, W.F., Nicolai, J.P.A., & Reuvers,
C.B. (1994). The vanished vagina. Paper presented at The Conference of
the European Network of Professionals on Transsexualism, Manchester, England, 31
August, 1994.



Laub, D.R., Laub, D.R., II, Lebovic, G.S., & van Maasdam, J. (1993). Follow-up
on the safety, efficacy, and erotic aspects of the rectosigmoid necolporraphy.
Paper presented at the 13th International Symposium on Gender Dysphoria, New York
City, 21-24 October.





Medical Advisory Bulletin

January, 1995

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