GENDER AFFIRMATION SURGERY

Colovaginoplasty

A colovaginoplasty, otherwise known as an intestinal or sigmoid vaginoplasty, is a surgical technique that involves using a section of the terminal large intestine (sigmoid colon) to recreate a vagina.

COLOVAGINOPLASTY

GENDER AFFIRMATION SURGERY

A colovaginoplasty, otherwise known as an intestinal or sigmoid vaginoplasty, is a technique in gender affirmation surgery that aims to provide trans women who wish to undergo the procedure with external genitalia that are in harmony with their identity.

Colovaginoplasty results

At IM GENDER we believe that it is important that you know the results we achieve with a colovaginoplasty or vaginoplasty with a pedunculated rectosigmoidal flap. Although all people are different, we can assure you that the result is an aesthetic and functional vagina. Only by knowing cases and testimonies will you be able to have a clear idea of what to expect from your genital affirmation surgery.

BEFORE THE COLOVAGINOPLASTY

Who can undergo a colovaginoplasty?

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 centimetres, 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.

 

The preparations

Abandonment of hormone treatment: Many people who undergo surgery such as vaginoplasty 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 For this reason, oestrogens are withdrawn about one month before the operation.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.

COLOVAGINOPLASTY SURGERY STEP BY STEP

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 the 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 colonised by a wide variety of bacteria.

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 anaesthesia, usually lasts between five and six hours, plus pre-anaesthesia, preparation of the patient and immediate recovery time after surgery.

Colovaginoplasty 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 caesarean 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 centimetres of 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.

THE POST-OPERATIVE PERIOD AFTER A COLOVAGINOPLASTY

Admission to the ward after colovaginoplasty. Post-operative 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 hospitalised, 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 standardised 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.

 

Going home after colovaginoplasty

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.

 

Possible complications

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 post-operative 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.

THE RESULTS OF COLOVAGINOPLASTY

The results

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.

 

Post-operative visits

It is very important not to skip any of the post-operative visits after a pedicled rectosigmoid flap vaginoplasty. Only the medical team will be able to assess the evolution of the recovery from surgery.

As a general rule, once you have been discharged from hospital, you 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 you will have a telephone number for post-operative support as well as a follow-up email address which will be provided to you at the time of discharge.

Follow all recommendations given by the medical team, such as dilations and post-operative visits.

 

Post-operative visits

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 specialised physiotherapy service if desired.

TIPS AFTER COLOVAGINOPLASTY

Diet

You will eat a soft diet for the first 7 days after vaginoplasty.

URINARY CATHETER

You should wear it for approximately 14-21 days. Follow the advice of the medical team to avoid any discomfort.

Postoperative Guide

We offer you a postoperative guide that will include information for your complete recovery. Also about dilations.

we solve your doubts

We are happy to help you and answer any questions. After the surgery, you should go home without doubts about the dilations and the postoperative process.

Sport

You should avoid doing physical exercises during the first month. Afterwards, your surgeon will tell you how and when to start doing sports.

Postpoerative visits

It is very important that you do not miss any of the visits after your surgery.

Do you want to know more experiences and testimonies of IM GENDER?

Frequently Asked Questions about Vaginoplasty

In this section you will be able to answer the most common doubts about colonovaginoplasty. If you have any other question, do not hesitate to contact us either by mail, telephone or with the contact form.

IM GENDER Team

IM GENDER’s medical and human team has been dedicated to the specialized care of trans people for more than 20 years. Two decades adding experience, professionalism, research and training.

Do you need more information about IM GENDER’s Gender Unit? Do you have questions about gender affirmation surgery?

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BARCELONA
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MADRID
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28006 Madrid 

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29601 Marbella (Málaga)

 

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