Colovaginoplasty Surgery

Colovaginoplasty or vaginoplasty by pedicled rectosigmoid flap requires a minimum stay of seven days, so that the medical team can properly monitor the patient’s evolution after surgery. The procedure, which is always performed under general anesthesia, usually lasts between five and six hours, plus pre-anaesthesia, preparation of the patient and immediate recovery time after surgery.

Colovaginoplasty surgery is performed in two surgical stages:

• • • Vaginal time: The surgeon will make a tunnel from the perineum to the peritoneum, where the vagina will be opened, i.e. at the anatomical location between the rectum and the bladder.
    • Abdominal time: Subsequently, a Pfannenstiel incision deviated to the left (the same as used during a cesarean section, but more lateral to the left) is made in the abdomen, allowing the surgeon to operate in the abdominal cavity. The 18 to 20 centimeters of the sigmoid colon, provided with a vascular pedicle, is separated and sectioned and moved towards the perineal area, where the vaginal tunnel had been created. The rest of the sectioned colon is joined so that it can continue to function after the operation is completed (end-to-end anastomosis).

The rest of the procedure (testicular, urethral shortening and vaginal aesthetics) is identical to the penile inversion vaginoplasty.

Who can undergo colovaginoplasty surgery?

The technique of intestinal or sigmoid vaginoplasty, or colovaginoplasty, is usually performed in cases where the penile inversion procedure is not feasible. This is usually the case when the penis with stretched skin measures less than 12 centimeters, when there is a circumcision or when it has already been operated upon previously, but insufficient vaginal depth has been attained.

The surgeon, together with his or her medical team, will decide on the most appropriate technique for each patient based on their physical characteristics and medical history.

Should hormonal treatment be stopped before a colovaginoplasty surgery?

Yes, hormonal treatment should be stopped approximately one month before.. Many people who undergo surgery such as colovaginoplasty follow treatment with oestrogens and anti-testosterone drugs. Taking oestrogens carries a risk of deep vein thrombosis during surgery. For this reason, oestrogens are withdrawn about one month before the operation. As for anti-testosterone drugs such as Androcur or Decapeptyl, experience has shown that it is not necessary to withdraw them. They can be maintained until the operation. Their total withdrawal will be one or two weeks after the vaginoplasty. IT IS ESSENTIAL THAT YOU MAKE AN APPOINTMENT WITH YOUR ENDOCRINOLOGIST before and after surgery and that you follow his or her instructions.

Does colovaginoplasty surgery require admission?

In pedicled rectosigmoid vaginoplasty, colon cleansing is very important. Therefore, a few days before the procedure, the medical team will prescribe a diet that will facilitate colon cleansing. The patient must follow it scrupulously to facilitate gender affirmation surgery.

The day before your colovaginoplasty surgery, you will be admitted to IM CLINIC. Throughout the day of admission, the relevant monitoring will be carried out and the colon (large intestine) will be cleaned so that it is clean and as free of bacteria as possible. The aim of colon cleansings is to reduce the risk of infection from handling a viscera that is commonly colonized by a wide variety of bacteria.

How is the colovaginoplasty postoperative period?

You will be admitted for seven days after surgery, so that the Gender Unit’s medical team at IM Gender can monitor you on a daily basis. But also, so that, after such complex surgery, you and your companions will have greater comfort and peace of mind.

In the case of colovaginoplasty or vaginoplasty by pedicled rectosigmoid flap, the intestine needs two or three days to recover its motility. It is then that oral intake is started. From then on, your diet will be gradually increased. During the days you are hospitalized, you will receive subcutaneous enoxaparin.

On the last day of admission, the first dilation of the vagina will be performed. A member of the IM Gender Unit will perform it following a standardized protocol. You will also be taught how to perform the recommended dilations at home, as well as douching. You will be given a care guide by our IM GENDER team. Your post-operative visits after surgery will also be scheduled.

When will I be able to go home after colovaginoplasty surgery?

You will wear the bladder catheter for the first 10–14 days or until the periurethral swelling is minimal. For this reason, you will be discharged from hospital while still wearing the catheter. Once at home, you will have to continue with the dilations, lavage protocols, analgesia and antibiotic treatment that the medical team will have indicated. In addition, you should contact your endocrinologist to restart hormone treatment (after about four weeks) and readjust the dose. It is important to stress that you should not readjust your treatment on your own, as doing so could put your health at risk. Contact your endocrinologist.

What are the postoperative risks of inversion vaginoplasty?

Any surgical procedure carries a risk of complications. The most common complications of colovaginoplasty are infection, bleeding or haematoma and urinary retention.
Although rare, late postoperative complications such as vaginal or introitus stenosis, urethral or meatal stenosis, recto-vaginal fistula, clitoral distress, venous thrombosis or embolism are also possible.
Although remote, there is a possibility of colonic suture failure, which would require timely diagnosis and early reoperation. Rarely, the vagina may necrose due to lack of blood supply through the vascular pedicle.
In order to avoid possible complications and to know how to act in the event that they should arise, we will provide you with a follow-up email address, as well as a 24-hour telephone number for any queries or anomalies after the operation.

Will I be able to have sexual intercourse after colovaginoplasty surgery?

After colovaginoplasty and recovery, you will have a functional, anatomical vagina, aesthetically similar to that of any other woman. This vagina will be suitable for full sexual activity, free of painful scars, with sufficient sensitivity to receive satisfactory erogenous stimulation during sexual intercourse. It is important that you follow all the recommendations given to you by the medical team, such as dilations and post-operative visits.

Will I have to attend visits after the colovaginoplasty postoperative period?

It is very important not to skip any of the post-operative visits with a member of the IM Gender team. Only they will be able to assess the progress of your vaginoplasty recovery.

As a general rule, once the patient has been discharged from hospital, she will be scheduled for the next visit, which will take place approximately three weeks after discharge from hospital (one month after the operation). The next medical check-ups will be approximately three months, six months and one year after the operation.

At all times, the patient will have a post-operative support telephone number available to answer any questions that may arise, as well as a specialized physiotherapy service if desired.