Vaginectomy
Vaginectomy is a medical procedure to remove all or part of the vagina. It is usually used as a treatment for vaginal cancer. Vaginectomy is also used as part of bottom surgery on trans men receiving Metoidioplasty or Phalloplasty.
Indications
As cancer treatment
Vaginectomy can be divided into two kinds of operations.[1]
An operation under which the whole vagina is removed is called a radical vaginectomy. If only the upper part of the vagina is removed then the operation is called a partial vaginectomy. The doctor will decide depending the severity of the case and the affected areas.
Usually after a radical vaginoplasty a plastic surgeon will perform reconstructive vaginoplasty, using skin and muscle from other body parts, for aesthetic reasons.
While it is extremely rare for a trans man to become afflicted with vaginal cancer after hormone therapy and hysterectomy, there are documented[2] cases of such happening, necessitating preventive screening until after vaginectomy as part of bottom surgery.
In FTM bottom surgery
In order to complete scrotoplasty, the vaginal vault must be closed, in order to do so demands a skilled surgeon due to the possibility of blood loss (from the midlateral arterial arcades). [3]
- After patient prep, including bowel prep, the patient is catheterized. A midline abdominal incision may be used for exploration and ease of operation.
- The round ligaments are then cut at the pelvic sidewall, and the supporting arteries are ligated. The vaginal tissue is then separated from both the sacrum in the rectal area, and the tendinous arch. The urethra is protected from injury in this step.
- Normal saline and epinephrine are injected into the mucosa, then a circumferential incision to facilitate the separation of the mucosa from the underlying muscle, taking care to not damage the urethra.
- Once the distal (rear) part of the vagina has been removed, the proximal mucosa remaining may be used as part of the urethral extension if the surgeon's technique dictates, otherwise the new perineum is constructed by suturing the skin together.
Complications and aftercare
Complications can include, blood loss; scarring; damage to bladder, urethra or colon; and post-op depression typically associated with prolonged anesthesia. After surgery, use of a neck pillow or inflatable doughnut is recommended to not place pressure on the perineum area for 3 weeks.
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References
- ↑ Surgical Treatment of Vaginal Cancer: eMedicine Obstetrics and Gynecology
- ↑ CASE REPORTS: Vaginal Carcinoma in a Female-to-Male Transsexual by Schenck TL, Holzbach T, Zantl N, Schuhmacher C, Vogel M, Seidl S, Machens H-G, and Giunta RE (Journal of Sexual Medicine: Volume 7, Issue 8, pages 2899–2902, August 2010)
- ↑ Gender Reassigment by Dan Greenwald, MD and Wayne Stadelmann, MD (eMedicine Journal, July 6 2001, Volume 2, Number 7)
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