[Vaginoplasty to address gender incongruence]

Vaginoplasty is a key genital gender-affirming procedure for transfeminine individuals seeking surgical treatment. Long-term success is determined by surgical, functional, sexual, and psychosocial outcomes.

This article aims to summarize and critically appraise the evidence on indications, techniques, complications, voiding function, pain, sexual function, health-related quality of life, satisfaction, and follow-up.

The article comprises a narrative review based on selected original studies, review articles, and the current German S2k guideline on surgical measures for gender incongruence.

Penile-inversion vaginoplasty is an established technique; alternative tissue options are relevant in cases of tissue shortage and revision surgery but can also be applied in the primary setting. Prospective and retrospective data indicate predominantly high satisfaction and favorable patient-reported outcomes. Neoclitoral sensitivity is important for sexual experience. Voiding symptoms, pain, stenosis, and other complications require structured assessment and treatment.

Vaginoplasty outcomes are multidimensional. Decision-making, counseling, surgical expertise, and needs-based long-term follow-up should integrate anatomical, functional, sexual, and psychosocial aspects.