Labia Minora Redefined: A Nonpenile Inversion Technique in Gender-affirming Vaginoplasty

Aesthetic refinement of labia minora reconstruction remains a challenge with the traditional penile inversion vaginoplasty, which may result in inadequately defined labia minora, a gaping introitus, or redundant labial folds. This study described a refinement based on nonpenile inversion vaginoplasty (NPIV) to address these limitations.

The NPIV technique uses preputial and penile skin exclusively for external labial reconstruction. Labial aesthetic outcomes were assessed using either standardized photographs or patient-submitted images via telemedicine, graded with a 4-point aesthetic scoring system. Patient satisfaction was evaluated using a customized patient-reported outcome measure with Likert-scale scoring (1-5). Clinical outcomes and complication profiles were also analyzed.

Between July 2023 and March 2025, 74 patients underwent primary vaginoplasty using the NPIV technique. Of these, 72 (97.3%) completed a 1-month follow-up. Mid- to long-term data were available in 42 (56.8%) patients, comprising 15 with standardized photographs and 27 with self-taken photographs. Most aesthetic ratings were excellent or good (80.9%). Patient-reported outcome measures data were available in 40 patients, with mean scores of 4.5 for appearance, 4.3 for symmetry, and 4.6 for overall satisfaction. The most frequent complication was introital wound dehiscence with minor labial necrosis (25.7%), followed by significant labia minora necrosis (12.2%), which occurred more often in circumcised patients (30.0% versus 5.6%, P = 0.014).

The NPIV technique offers a predictable and reproducible approach for labia minora reconstruction with improved labial contour and definition. Clinical and patient-reported outcomes demonstrate high satisfaction and favorable aesthetic results.