A colovaginoplasty (also known as colon section) is an operation where a vagina is created by cutting away a section of the sigmoid colon or ascending colon and using it to form a vaginal lining.
Candidates for surgery
This surgery is performed on females with androgen insensitivity syndrome, congenital adrenal hyperplasia, vaginal agenesis, MÃ¼llerian agenesis, and other intersexed conditions, where non-invasive forms of lengthening the vagina cannot be done and, mostly, on male-to-female transsexuals as an alternative to penile inversion with or without an accompanying skin graft for greater depth with the donor skin taken from the thigh, abdomen, or scrotum.
There appears to be little evidence that genital surgery on children/infants is successful. In the case of females with Androgen Insensitivity Syndrome (AIS) if any vaginal opening is present at all, it is preferable to increase depth via dilation than surgery, if possible.
Due to numerous potential complications most surgeons will recommend a colovaginoplasty only when there is no alternative. Persons with ulcerative colitis or crohn's disease may be contraindicated for colovaginoplasty because of complications inherent with the disease process which will affect the vagina's properties.
Colovaginoplasty is best viewed literally, as two separate operations taking place simultaneously. The first, a general surgery team, performs laparotomy (keyhole surgery) on the abdomen, harvesting a 15 to 20 centimetre colon interposition flap. During this time, the reassignment team performs many of the duties also done in a penile inversion, such as removal of the gonads, and corpora cavernosae. (if either are present) At this point, the general surgery team will internally hand off the colon segment to the reassignment team and secure it in place in the perineal body. And finally, the urethra is put in place, external genitalia are formed, and the patient is prepared for recovery.
The advantages to this procedure include:
- Natural vaginal lubricesant properties and feel to a biological male partner
- More natural appearance (this is subjective and depending on the surgeons ability and available resources)
- Less need to dilate but still required to maintain opening width
- Skin grafts from thigh or abdomen rarely needed for additional depth
- May reduce the need for electrolysis or laser hair reduction
The disadvantages to this procedure include:
- Higher out of pocket costs
- Longer amount of time spent in the operating theatre (with resulting compilations from increased anaesthesia times)
- Higher chance of post surgical infection and complications
- Possibility of necrosis (death) of the graft
- Foul smelling excretions during recovery and when regular cleaning is not performed
- Permanent reduction in nutrient absorption
- May have the appearance of being constantly inflamed (diversion colitis)
- Vaginal secretions at inappropriate times (necessitating the use of a tampon and/or sanitary pad at all times)
- Higher risk of yeast infection
- Possibility of complications such as chronic pain and cramping
If the harvesting of the colon segment was not performed using laparoscopic techniques, there will be a scar on the abdomen.
- Gender Reassigment by Dan Greenwald, MD and Wayne Stadelmann, MD (eMedicine Journal, July 6 2001, Volume 2, Number 7)
- Vaginal reconstruction using bowel segments in male-to-female transsexual patients by Colin Markland and Donald Hastings (Archives of Sexual Behavior, Volume 7, Number 4, July 1978)
- Long-term results of sigmoid vaginoplasty in a consecutive series of 62 patients by Emilio Imparato, Alessandro Alfei, Giovanni Aspesi, Anton Livio Meus and Arsenio Spinillo (International Urogynecology Journal, Volume 18 Number 12, December 2007)
- Laparoscopic sigmoid vaginoplasty in women with Mayer-Rokitansky-Kuster-Hauser syndrome by Yi Shen, Guobin Wang, Zhoufang Xiong, Kaixiong Tao and Zehua Wang (Frontiers of Medicine in China, Volume 3 Number 3, September 2009)
- Intestinal vaginoplasty: is it optimal treatment of vaginal agenesis? A pilot study by Ates Karateke, Ayse Gurbuz, Berna Haliloglu, Canan Kabaca and Neset Koksal (International Urogynecology Journal, Volume 17 Number 1, January 2006)
- Laparoscopic Technique for Secondary Vaginoplasty in Male to Female Transsexuals Using a Modified Vascularized Pedicled Sigmoid by V. Wedler, C. Meuli-Simmen, M. Guggenheim, M. Schneller-Gustafsson, W. KÃ¼nzia (Gynecologic and Obstetric Investigation, Vol. 57, No. 4, 2004)
- Total anorectal and partial vaginal reconstruction with dynamic graciloplasty and colonic vaginoplasty after extended abdominoperineal resection by Eric Rullier, Tarun McBride, Frank Zerbib, Michel Caudry and Jean Saric (Diseases of the Colon & Rectum, Volume 42 Number 8, August 1999)
- Long-term outcome after laparoscopic creation of a neovagina in patients with Mayer-Rokitansky-KÃ¼ster-Hauser syndrome by a modified Vecchietti procedure by J. Keckstein, O. Kandolf, G. Rauter and G. Hudelist (Gynecological Surgery, Volume 5 Number 1, February 2008)
- Robot-assisted vaginal construction using ileum in a case of Mayerâ€“Rokitanskyâ€“KÃ¼sterâ€“Hauser syndrome by Tristan Berry, Christopher Tepera, Uri Gur, Michael Fabrizio and Gerald Jordan (Journal of Robotic Surgery, Volume 2 Number 4, December 2008)
- Robotic Sigmoid Vaginoplasty: A Novel Technique by Christina Kim, Brendan Campbell and Fernendo Ferrer (SociÃ©tÃ© Internationale d'Urologie, Volume 72, Issue 4, Pages 847-849 (October 2008))
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