Life-Threatening Bleeding Following Penile Inversion Vaginoplasty: Case Analysis and Practice Improvement

Gender-affirming surgery is a medically necessary treatment for transgender and gender diverse patients experiencing gender dysphoria. Preliminary data demonstrate an association between gender-affirming surgery and improved mental health outcomes. Penile inversion vaginoplasty is the most frequently performed feminizing bottom surgery in transwomen. Importantly, complications associated with penile inversion vaginoplasty are not uncommon and can be life-threatening. Surgeons and other members of the health care team must be aware of these potential harms. However, there is a paucity of high-quality evidence reported in the literature about the management and breadth of complications regarding feminizing bottom surgery.

A healthy 37-year-old woman who was assigned male at birth underwent gender-affirming orchiectomy, penile inversion vaginoplasty, and vulvar reconstruction. During routine vaginal packing removal in the postoperative period, there was an acute arterial bleed in the neovaginal canal, and hemostasis was achieved in the operating room.

We review the associated periprostatic anatomy and describe several practice improvements to mitigate postoperative complications.