American Educational Gender Information Service, Inc. (AEGIS)
P.O. Box 33724
Decatur, GA 30033-0724
Medical Advisory Bulletin -- January, 1995
The Controversial Nature of Vaginoplasty Using Bowel Segments

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 theEuropean 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 neocolporraphy. Paper presented at the 13th International Symposium on Gender Dysphoria, New York City, 21-24 October.