Primary sigmoid vaginoplasty in gender affirmation surgery: technique and outcomes

Vaginal canal reconstruction is critical for transgender and gender-diverse individuals assigned male at birth, seeking gender affirmation, but conventional techniques often have limitations in depth and tissue quality.

The aim was to evaluate outcomes of primary sigmoid vaginoplasty as a gender-affirming surgical option for transgender women at a tertiary center.

A prospective review included transgender women operated for primary sigmoid vaginoplasty from 2023 to 2025, with data collected on demographics, perioperative details, complications, and postoperative neovaginal depth; assessment relied on physical examination, preoperative screening, standardized surgical technique, and postoperative follow-up with dilation routines.

Primary outcomes were neovaginal depth, maintenance of sexual function, and postoperative complications.

Thirty patients achieved a mean neovaginal depth of 16 ± 2.0 cm intraoperatively; all maintained sexually functional tissue. There were 2 major complications-1 bowel injury and 1 anastomotic leak-requiring reoperation, with no mortality. Introital stenosis occurred in 10% and was successfully treated with dilation. Average hospital stay was 8 ± 2.1 days, and long-term follow-up confirmed satisfaction with sexual function and depth, without significant odor or excessive secretions.

Sigmoid vaginoplasty offers a reliable approach for achieving functional vaginal depth and patient satisfaction, particularly in individuals with limited penile tissue. Bowel Complications can set in, requiring adequate evaluation, motivation and understanding of the procedure.

Strengths include the prospective design and standardized surgical technique, while limitations are the small sample size, single-center scope, and limited follow-up duration for some patients due to geographic constraints.

Primary sigmoid vaginoplasty is an effective and dependable surgical option for transgender women, yielding satisfactory depth, appearance, and sexual function but can come with associated bowel complications.