Genital reassignment surgery for transgender women: vaginoplasty, vulvoplasty

The number of transgender people seeking medical and/or surgical care is increasing worldwide. At our center, over 80% of transgender women opt for penile inversion vaginoplasty (VIP). Gender-affirming genital surgery includes bilateral orchiectomy, clitoridectomy, vestibuloplasty, urethral reimplantation, and the creation of a vaginal canal (or not), defining either vulvoplasty (without a canal) or vaginoplasty (with a canal). Vaginoplasty is the most frequent choice among this population.The term "penile inversion vaginoplasty" (PIV) refers to the technique of inverting the penile skin and covering the neovagina. Reassignment vaginoplasty, strictly speaking, is a procedure reported in 1931 by Dr. Felix Abraham, assistant to Dr. Magnus Hischfield (director of the Berlin Institute of Sexology). It was performed in two stages (orchidectomy – vaginoplasty) at different times (1922-1931) on two patients, one German and the other Danish (Dora Richter and Lily Elbe).These vaginoplasties were performed by a general surgeon, Dr. Erwin Gohrbandt, and a gynecological surgeon, Professor Kurt Warnekros, in Berlin and Dresden, respectively. Since 1931, the procedure has undergone numerous modifications or "adjustments" to arrive at the definitive form described below. The VIP (Vaginal Vulvoplasty), which involves lining the neocavity with penile skin, was developed by Dr. Harold Gillies (UK) and Dr. Ralph Millard (US) (plastic surgeons) in 1957, and later popularized by Dr. Georges Burou of Casablanca (France) (Gynecologist-Obstetrician). This article will describe the technical variations and modifications of VIP. Some transgender women opt for vulvoplasty. Vulvoplasty, or zero-depth vaginoplasty, is the same procedure as vaginoplasty, but without the creation of a canal or the use of skin lining.
This presentation will discuss the techniques of vaginoplasty with penile inversion and vulvoplasty, which are offered as first-line treatments at our center. We will cover indications, contraindications, intraoperative considerations, surgical outcomes, and postoperative results reported by patients. Second-line treatments (peritoneal or digestive implants) will be mentioned but not discussed in detail.
Professor Bruno Deval
Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France.