Vaginoplasty

Done By :- Ma’ad Adnan

:- Dr.Ali Al- HussainiSupervised By

What is Vaginoplasty?

Vaginoplasty is a medical procedure that serves to ‘tighten up’ vaginal muscles, which can loosen up with aging and childbirth.

It helps in correcting defects and deformities of vaginal canal, congenital disease, acquired cause – physical trauma, cancer.

Different therapeutic options

Non-operative method Operative methods

A. For Neovagina1. Vecchietti operation

2. Balloon Vaginoplasty

Foreign tissuevaginoplasty

1. free skin graft (McIndoe method)2. Sigmoid vaginostomy3. Buccal mucosa4. Wilson Method(for Intersex pt.)5. Don Flap (labia minora flap)

B. For Vaginal Tightening1. Laser Vaginal Tightening

Non-operative methodA. For Neovagina

1.Vecchietti procedure :-the Vecchietti procedure is a laparoscopic surgical technique that produces a vagina of dimensions (depth and width) comparable to those of a normal vagina (ca. 8.0 cm. deep) A small, plastic sphere (“olive”) is threaded (sutured) against the vaginal area; the threads are drawn though the vaginal skin, up through the abdomen, and through the navel. There, the threads are attached to a traction device

and then daily are drawn tight so that the “olive” is pulled inwards and stretches the vagina, by approximately 1.0 cm. per day, thereby creating a vagina, approximately 7.0 cm. deep by 7.0 cm. wide, in 7 days.

The mean operating room (OR) time for the Vecchietti vaginoplasty is approximately 45 minutes; yet, depending upon the patient and her indications, the procedure might require more time.

plastic sphere (“olive”) in vecchiette procedure

Disadvantages of the Vecchietti procedure

1.It requires specialized teams utilizing sophisticated instrumentation.

2.and it is tedious to perform.

3. It has the drawbacks of requiring daily traction for 8 to 10 days.

4.it lifts the posterior urethrovesical angle, making it more obtuse.

5.possible consequence of causing stress incontinence later on (the posterior traction on the urethral supports also placing the patient at higher risk for stress incontinence).

6. Furthermore, a change in the pelvic floor balance has been suspected .

7.Another problem with the Vecchietti vaginoplasty is the use of a special abdominal traction device for a few days

2.Balloon vaginoplasty

In the balloon vaginoplasty technique, a Foley catheter is laparoscopically inserted to the rectouterine pouch whereupon gradual traction and distension are applied to create a neovagina . Moreover, balloon vaginoplasty also is a new technique for treating vaginal aplasia,

which also is applied as a technically simple, physically safe, and medically effective alternative vaginoplasty for creating a neovagina, especially when conventional laparoscopic surgery is either infeasible or unsafe. Balloon vaginoplasty was introduced by professor Ali El Saman from Egypt as the fastest method for creation of a naturally covered neovagina.

Balloon vaginoplasty is both effective and unique in the ability to manage and control both the depth and the length of the reconstructed neovagina. Interestingly, the balloon vaginoplasty procedure is so simple that it could be conducted under local anesthesia .Furthermore, balloon vaginoplasty is associated with cosmetically appealing vagina especially when it was conducted via single port.

is a non-surgical, vaginal rejuvenation treatment. Using the strong ablative and thermal effect of the CO2 laser . It act by stimulating collagen production, it restructures lax skin and regenerates damaged tissue. LVT provides significant relief for women with post-childbirth loss of sensation, and those suffering from stress incontinence.

B. For Vaginal Tightening1.Laser Vaginal Tightening

Operative methods

• free skin graft (McIndoe method)

The McIndoe vaginoplasty technique used in congenital absence of vagina utilizes split-thickness skin grafts that cover a mold, which is then inserted into a surgically created space between the bladder and the rectum. The principal technical difference between the McIndoe vaginoplasty and the Vecchietti vaginoplasty is which tissue to utilize to line the created neovagina .

Each surgical procedure has positive and negative factors, especially regarding upon whom such a plastic surgical technique can be applied, because the post-operative outcome varies with the patient’s indications.

• Sigmoid vaginostomy :-

The Sigmoid Vaginostomy technique creates a vagina by cutting a segment of the sigmoid colon along with its vascular pedicle and using it to form vaginal lining. This surgery is performed on women with androgen insensitivity syndrome , congenital adrenal hyperplasia , vaginal agenesis, müllerian agenesis,

and other intersex conditions where in non-invasive forms of deepening the vagina cannot be performed (mostly on trans women patients) as an alternative to penile inversion, with or without an accompanying skin graft (usually from the thigh or the abdomen).

Because of the potential complications(e.g. diversion colitis) most surgeons will

recommend a colovaginoplasty procedure only when there is no alternative procedure.

The benefit of this procedure is that it gives good space and length to neo-vagina .

. Buccal (oral) mucosa :-

A relatively novel surgical approach to treating vaginal agenesis is utilizing the buccal mucosa as the tissue for lining the vagina(ca. 8.0 cm. deep).

The medical advantages of this vaginoplasty technique include the biological and healing qualities of the buccal mucosa tissue, minimal scarring, and a short, post-operative recovery for the patient.

The disadvantages include limited vaginal dimensions (depth and width), and the possibility of either intraoral damage, when tissue-harvesting, or of complications.

• Wilson Method ( For Intersex condition ) :-

The penile-inversion technique of the Wilson Method is different from the traditional penile-inversion technique in that it is a three-stage surgery, comprising a two-stage initial vaginoplasty. The Wilson Method surgery is initially performed like a traditional penile inversion, until the vaginal-vault creation step,

in which the vault of the vagina is left unfinished, as a raw surface, and is packed with a sterile stent, which, after 5–7 days, then is lined with a skin graft harvested from the buttocks. The penile skin is used to create the labia minora, clitoral hooding, and the anterior fourchette (frenulum); the glans penis is used to create the clitoris, and the scrotum is used to create the labia majora .

.Don Flap (labia minora flap) :-

The Don Flap correction of vaginal agenesis uses a technique similar to that of penile inversion, that sutures the labia minora together to create a neovagina. A refinement of this vaginoplastic technique is its utilization of the prepucial skin (hood) of the clitoris as a horseshoe-shaped, one-piece flap.

Yet, although the Don Flap technique is a relatively simple surgical procedure, the most obvious disadvantages of the labia minora flap surgery include the need for restorative labiaplasty and cervical dilation to produce a vagina of adequate dimensions (depth and width).

Risks & Recovery of Vaginoplasty

Risks:-1. There may be a permanent increase or decrease in genital sensation after surgery.

2. Ongoing pain can occur if the muscles are Tightened too much during surgery.

3. Scarring of genital area.

5. Bleeding

-Recovery :

1. During the first few days a person feels a bit uncomfortable, full recovery usually takes about 6 weeks.

2. A person can return to work after a week from the surgery.

THE ENDTHANK YOU