Comparing Penile Inversion and Rectosigmoid Vaginoplasty

The goal of Male-to-Female Vaginoplasty is to create a vagina that is functional, feminine looking, with normal voiding function, satisfactory sexual function, and minimal scarring. Ideally, the neovagina should be moist, flexible and hairless, and a minimum of 10 cm in depth and about 3-4 cm in diameter.

While a variety of surgical approaches exist for MTF Vaginoplasty, the two most widespread techniques are the Penile Inversion and Rectosigmoid methods. Penile Inversion Vaginoplasty is widely regarded as the “gold standard” method of male-to-female gender reassignment surgery.

Dr. Rumer performs a One-Stage Modified Penile Inversion Vaginoplasty which results in an authentic appearance with excellent depth, function and sensation. In addition, Dr. Rumer’s Vaginoplasty technique does not require electrolysis or laser hair removal of the genital area before surgery, and there is NO regrowth.

During the Penile Inversion procedure, the penile skin is turned inside out like a sock, and used to line a vaginal cavity created in the perineal area. The penis and testes are removed. Clitoroplasty and Labiaplasty are performed to create small but sensitive clitoris and the labia minora and majora. The urethra is shortened and the urethral meatus is relocated to an appropriate female position.

The Penile Inversion technique offers several advantages:

• Less tendency for vagina to contract. (Postoperative use of vaginal dilators for at least 6 months is required after surgery.)
• Excellent sensation
• Excellent depth, provided there is sufficient penile skin. (If insufficient, scrotal skin flaps can also be used.)
• Absence of hair on donor flap
• Reduced risk of vaginal prolapse

Rectosigmoid Vaginoplasty uses a section of the Sigmoid colon to create the vaginal lining. Because this method doesn’t rely on penis size for vaginal depth, it’s often used for patients who lack sufficient penile skin for the Penile Inversion method.

However with a second major surgery site, Rectosigmoid Vaginoplasty is a much more invasive surgery that is more expensive, requires longer recovery and carries the heightened risk of serious complications like rectal fistula. Proponents of this method often cite the self-lubricating quality of the Sigmoid colon graft, but this benefit is typically outweighed by too much lubrication and an unpleasant smell that can persist for months. Furthermore, the Rectosigmoid graft lining the vagina is unlikely to provide the quality of sensation obtained with Penile Inversion. Lower risk complications can include colitis, vaginal atrophy, and constipation. For these reasons, Dr. Rumer does not offer Rectosigmoid Vaginoplasty.

In the hands of Dr. Rumer, Penile Inversion Vaginoplasty more than satisfies the goals of her patients by providing a sexually functional and aesthetically pleasing vagina with excellent depth and sensation but without the higher risk of complications that the more invasive Rectosigmoid Vaginoplasty carries. During your consultation, Dr. Rumer will perform a full evaluation and together you will decide on a plan to meet your goals and maximize your surgery outcome.