Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

VAGINAL RECONSTRUCTION WITH PEDICLE SIGMOID COLON FLAP IN TRANSGENDER WOMEN

Fahri Yetişir1
Serdar Nasır2

1A Life Private Hospital, Department of General Surgery, Ankara, Türkiye
2Hacettepe University, Faculty of Medicine, Department of Plastic Surgery, Ankara, Türkiye

Yetişir F, Nasır S. Vaginal Reconstruction with Pedicle Sigmoid Colon flap in Transgender Women. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.59-71.

ABSTRACT

Sigmoid colon vaginoplasty is an effective method of vaginal reconstruction, performed in cisgender women with congenital vaginal agenesis and transgender individuals undergoing gender-affirming surgery. This procedure is favored for its ability to maintain vaginal depth and width, provide natural lubrication through mucosal secretions, and achieve aesthetically satisfactory outcomes. The anatomical features of the sigmoid colon, including its long mesentery, robust structure, and mucosal surface resembling natural vaginal tissue, are critical to its success. The surgical process involves several key steps, including preoperative preparation, mobilization of the sigmoid colon, preservation of mesenteric vascular structures, and colorectal anastomosis. Techniques such as end-to-side anastomosis using an intraluminal stapler and side-to-side anastomosis with a tri-stapler are commonly employed. The increasing use of laparoscopic techniques offers less invasiveness, reduced recovery time, and superior cosmetic results. Postoperative care is crucial to sustaining surgical success. Patients undergo detailed management protocols, including positioning, gradual resumption of oral intake, perineal wound care, and the use of vaginal dilators. Complications, though relatively rare, include anastomotic leakage, infections, flap necrosis, rectovaginal fistulas, and vaginal narrowing. These risks can be minimized through careful patient selection, meticulous surgical technique, and a multidisciplinary approach. Sigmoid colon vaginoplasty significantly improves both the quality of life and psychological well-being of patients, offering superior functional and aesthetic outcomes. With advancements in technology and surgical expertise, this procedure has become safer, more efficient, and more patient-friendly, establishing itself as a gold-standard technique in the field of vaginal reconstruction.

Keywords: Sigmoid colon vaginoplasty; Vaginal reconstruction; Gender-affirming surgery; Gender reassignment surgery

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