In the case of an underdeveloped penis (e.g. due to the use of puberty blockers) or a small circumcised penis, there is such a great lack of skin that it is often impossible to make a sufficiently deep and wide vagina with the penile inversion vaginoplasty and/or a skin graft.
In this case, you will qualify for colovaginoplasty. With the help of exploratory surgery part of the intestine is used to make the inner lining of the vagina. This surgery is done in collaboration with a gastrointestinal surgeon specialized in exploratory surgeries.
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This surgery is performed by two operators and their assistants.
It starts with a small incision below the navel through which a viewing tube (trocar) is inserted and the abdominal cavity is filled with gas. This creates space in the abdominal cavity so the surgeon will be able to operate. Next a camera is inserted through the same incision and two additional incisions are made to insert surgical tools.
At the same time the plastic surgeon starts to place a urinary catheter, a soft tube that is inserted through the urethra for the purpose of draining. Next the skin of the penis is cut lengthwise from the glans down to the scrotum. Part of the skin of the perineum (the area between the anus and the scrotum) remains attached on the side of the anus. The cut is used to obtain access to the pelvic floor.
While the urethra and the rectum are continuously monitored, an opening is made between the rectum and the urethra/bladder.
The gastrointestinal surgeon clears a section of the intestine. The blood vessels that supply and drain this intestinal section are saved and can be used to move the intestinal portion.
The isolated intestinal section, with a length of about 15 centimeters, is brought to the pelvic floor. Afterwards the extremities of the intestine are carefully attached to one another again.
The skin is dissected off the penile shaft but remains attached to the mons pubis. This skin still has nerves and a vascular system. Next the testicles and the vas deferens are removed (castration).
The penile skin is dissected off the penile shaft but remains attached to the mons pubis.
Part of the glans of the penis and the foreskin are used to create the new clitoris with hood and inner labia. The nerves and blood vessels responsible for a large part of the sensation and blood flow are carefully dissected off the back of the penis. In addition the urethra is dissected and shortened. A large part of the spongiform erectile tissue that surrounds the urethra is also removed. The two large erectile tissues that remain are also removed.
The location of the clitoris and the urethra is determined and grafted. The hood of the clitoris and inner labia are shaped and attached. The perineum skin flap is attached to the trunk skin of the penile shaft and pushed into the vaginal cavity where it will be attached to the intestine.
The remaining part of the scrotal skin is used for the outer labia. No tampon will be used during this surgery. One or two tubes (drains) are used to drain wound fluid or blood. The final result of the colovaginoplasty is the same as that of the penile inversion technique. The only difference is the type of tissue used for the vagina.
Illustrations by Dana Hamers, scientific illustrator