Colovaginoplasty

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A colovaginoplasty (also known as colon section) is an operation where a vagina is created by cutting away a section of the sigmoid colon or ascending colon and using it to form a vaginal lining.

[edit] Candidates for surgery

This surgery is performed on females with androgen insensitivity syndrome, congenital adrenal hyperplasia, vaginal agenesis, Müllerian agenesis, and other intersexed conditions, where non-invasive forms of lengthening the vagina cannot be done and, mostly, on male-to-female transsexuals as an alternative to penile inversion with or without an accompanying skin graft for greater depth with the donor skin taken from the thigh, abdomen, or scrotum.

There appears to be little evidence that genital surgery on children/infants is successful. In the case of females with Androgen Insensitivity Syndrome (AIS) if any vaginal opening is present at all, it is preferable to increase depth via dilation than surgery, if possible.

Due to numerous potential complications most surgeons will recommend a colovaginoplasty only when there is no alternative.

[edit] The operation

Colovaginoplasty is best viewed literally, as two separate operations taking place simultaneously. The first, a general surgery team, performs laparotomy (keyhole surgery) on the abdomen, harvesting a 15 to 20 centimetre colon interposition flap. During this time, the reassignment team performs many of the duties also done in a penile inversion, such as removal of the gonads, and corpora cavernosae. (if either are present) At this point, the general surgery team will internally hand off the colon segment to the reassignment team and secure it in place in the perineal body. And finally, the urethra is put in place, external genitalia are formed, and the patient is prepared for recovery.

[edit] Advantages

The advantages to this procedure include:

Natural vaginal lubricesant properties and feel to a biological male partner
More natural appearance (this is subjective and depending on the surgeons ability and available resources)
Less need to dilate but still required to maintain opening width
Skin grafts from thigh or abdomen rarely needed for additional depth
May reduce the need for electrolysis or laser hair reduction

[edit] Disadvantages

The disadvantages to this procedure include:

Higher out of pocket costs
Longer amount of time spent in the operating theatre (with resulting compilations from increased anaesthesia times)
Higher chance of post surgical infection and complications
Foul smelling excretions during recovery and when regular cleaning is not performed
Permanent reduction in nutrient absorption
May have the appearance of being constantly inflamed (diversion colitis)
Vaginal secretions at inappropriate times (necessitating the use of a tampon and/or sanitary pad at all times)
Higher risk of yeast infection
Possibility of complications such as chronic pain and cramping

[edit] See also

[edit] Referances

Gender Reassigment by Dan Greenwald, MD and Wayne Stadelmann, MD (eMedicine Journal, July 6 2001, Volume 2, Number 7)
Vaginal reconstruction using bowel segments in male-to-female transsexual patients by Colin Markland and Donald Hastings (Archives of Sexual Behavior, Volume 7, Number 4, July 1978)

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