Penile inversion vaginoplasty is possible if there is sufficient penile skin length and diameter. If you have ‘normally’ formed genitals and are not circumcised, you will probably qualify for this technique.
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Click on the first image to view the image gallery and read the captions for further information on the operation.
This surgery is performed by the plastic surgeon and his/her assistant. The first thing they do is 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 penile skin is dissected off the penile shaft. This skin still has nerves and is vascularized. Next the testicles and the spermatic cords 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 the top is closed with stitches. This skin is pushed into the vaginal cavity and used to make the inner lining of the new vagina.
The remaining part of the scrotal skin is used for the outer labia. A tampon consisting of a condom filled with foam rubber will be inserted, to allow the skin inside the vaginal cavity to heal properly and stay in place. The tampon is anchored in place and remains inside for 5 days. Several tubes (drains) are placed inside to drain possible wound fluid or blood. When little or no fluid comes out, these drains will be removed.
Illustrations by Dana Hamers, scientific illustrator
The urinary catheter and the tampon are removed after 5 days. If you feel good, are sufficiently independent and the doctor has given you permission to do so, you may go home. We will see you again at the outpatient clinic.