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Gender-affirming Vaginectomy-Transperineal Approach
Helen Y Hougen1, Poone S Shoureshi1, Kamran P Sajadi1
1Department of Urology, Oregon Health and Science University, Portland, OR.
Urology
|July 10, 2020
Summary
This study details a transperineal gender-affirming vaginectomy for transgender males, demonstrating a safe and effective surgical approach with low complication rates. The procedure is efficient, with an average operative time of approximately two hours.
Area of Science:
- Surgical techniques in gender affirmation
- Genitourinary reconstructive surgery
Background:
- Gender-affirming vaginectomy addresses gender dysphoria in transgender males.
- Various surgical approaches exist, including transperineal, mucosal fulguration, and robotic-assisted methods.
Purpose of the Study:
- To present the key surgical steps of a transperineal gender-affirming vaginectomy.
- To detail the procedure in a 39-year-old transgender male patient.
Main Methods:
- Transperineal vaginectomy performed in high lithotomy Tredelenberg position.
- Vaginal mucosa excised, preserving anterior wall for urethral lengthening flap.
- Paravaginal space closure with purse-string sutures; cystoscopy for ureteral patency.
Main Results:
- Procedure completed in 110 minutes with 75 mL estimated blood loss.
- No vaginectomy-specific complications (e.g., mucocele, fistula, visceral injury).
- Anterior vaginal wall flap incorporated in 83% of cases.
Conclusions:
- Transperineal vaginectomy is associated with low periprocedural complications.
- The procedure requires approximately two hours after a learning curve.
- This technique offers a viable option for gender-affirming care.
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