Rectoneovaginal Fistula After Gender-Affirming Surgery in Transgender Women

Gender incongruence is defined as a conflict between a person's gender and the gender they were assigned at birth. With gender-affirming surgery, being a trans woman is possible. In this study, we aimed to investigate rectoneovaginal fistula repair and describe the creation of a new neovagina for gender-affirming surgery in trans women. The design of this study was observational, and the data were obtained retrospectively from electronic databases. The effectiveness of the treatments that were applied was evaluated by observation. Although 2 of the 3 patients in this study had undergone neovagina construction by the penile inversion method, 1 had undergone neovagina construction by skin graft vaginoplasty. All 3 patients were suffering from rectoneovaginal fistulae, and they were on the seventh and eighth postoperative days. Lavage, rectoneovaginal fistula dressing, and vaginal tamponade were applied to the patients for 6 weeks. At the end of the 6-week period, granulation tissue and epithelialization were observed in the entire tissue up to the outer boundary of the neovagina. At the end of 1 year, a new neovaginal pouch was opened 1 cm above the fistula site. In the conservative repair of rectoneovaginal fistulae, daily dressing replacement and careful patient monitoring are highly important. For patients who have developed rectoneovaginal fistulae, we recommend the opening of a new neovaginal pouch 1 cm above the healed fistula site. Level of Evidence: 5 (Therapeutic).