Table of ContentsView AllTable of ContentsPeritonealMcIndoeBuccal MucosaPenile InversionPost-Surgery DilationNext in Vaginoplasty GuideVaginoplasty: Long-Term Care
Table of ContentsView All
View All
Table of Contents
Peritoneal
McIndoe
Buccal Mucosa
Penile Inversion
Post-Surgery Dilation
Next in Vaginoplasty Guide
Neovagina surgery, orvaginoplasty, is a surgical procedure used to create a vagina. The surgery may be performed after a cisgender woman has had a vaginectomy forvaginal cancer.It may also be used to create a vagina for a woman born without one (called vaginalagenesis). In addition, vaginoplasty can be used to create a vagina for transgender women or individuals as a type ofgender-affirming surgery.
Jessica Lia / DigialVision / Getty Images
This article will explain the different surgical procedures that can be used to create a neovagina, which means a “new vagina.” It will also discuss possible complications and side effects.
Intestinal or Sigmoid Vaginoplasty
Intestinal vaginoplasty uses a section of thesigmoid colonto create the neovagina. This is usually done aslaparoscopic surgery. Laparoscopic surgery is also often referred to as minimally invasive or keyhole surgery because there is only a small incision through the skin. For this surgery, a small piece of colon is detached and then rotated down to become the lining of the vagina. Then the surrounding colon is stitched together to restore its function.
There have been some criticisms that intestinal vaginoplasty can lead to excess mucus in the vagina and mucus with an unpleasant smell. However, these side effects have not been consistently reported.
Peritoneal Vaginoplasty
Peritoneal vaginoplasty is also referred to as theLuohuoperation. It uses the lining of the abdominal cavity, theperitoneum,to create the vagina. Like intestinal vaginoplasty, peritoneal vaginoplasty is usually a laparoscopic procedure.
Patients who have this procedure do not necessarily need to use dilation (a practice to stretch the vagina) to maintain their vaginal opening. That is particularly true if they are having regular sexual intercourse.
There is a risk of rectovaginalfistulawith peritoneal vaginoplasty and with other types of vaginoplasty. A rectovaginal fistula occurs when a hole forms between the rectum and vagina. Fistulas are usually treatable with surgery.
McIndoe Vaginoplasty
The McIndoe technique, McIndoe procedure, or McIndoe vaginoplasty are quite different from the peritoneal and intestinal vaginoplasty procedures. Unlike peritoneal and intestinal vaginoplasties, the McIndoe technique does not require abdominal surgery to create the lining.
Instead, McIndoe vaginoplasty lines the vagina with a skin graft.That skin graft is put on a vaginal mold and then placed into the space that has been opened to become the vagina. (In peritoneal and intestinal vaginoplasty, no such mold is used.) The mold is used consistently for the first several months after surgery (removing it for regular cleaning) in order to promote healing of the vagina into an open cavity suitable for intercourse.
Unlike the peritoneum and the intestine, the skin is not a mucosal tissue. Therefore, it does not self-lubricate. This also increases the risk that the vaginal opening will close. Because of that, those who have a McIndoe procedure, and do not have regular sexual intercourse, will need to commit to dilating their vaginas for the rest of their lives.
Buccal Mucosa Vaginoplasty
Buccalmucosa is the tissue lining the mouth. It is quite similar to the lining of the vagina. Both tissues are hairless and create mucus.Therefore, in some ways, it is an ideal lining for a neovagina created during vaginoplasty.
However, buccal vaginoplasties are not as common as other vaginoplasty procedures for several reasons. Only a relatively small area of tissue is available. People may be concerned about side effects in the mouth and cheek. And in addition, the inside of the mouth is not an area most gynecologists are used to working on. Therefore, they may have to collaborate with facial surgeons to harvest tissue appropriately.
Penile Inversion Vaginoplasty
Penile inversion vaginoplasty is only used in transgender women.In this procedure, the skin from the outside of the penis is removed and inverted to create the lining of the vagina. The head of the penis is also reshaped to create a clitoris. Finally, scrotal skin is used to create the labia majora and minora.
The disadvantages of this procedure are similar to those when the skin is used for a McIndoe vaginoplasty. Hair must be fully removed to make certain there is no hair growing on the inside of the vagina. The vagina requires a lifetime of dilation for maintenance. And, it is also not self-lubricating.
Although only transgender women or individuals can get a penile inversion vaginoplasty, that is not the only type of vaginoplasty available. These patients may also be offered an intestinal vaginoplasty either as a primary surgery or if they need a surgical revision. At least one transgender woman or individual has also had a peritoneal vaginoplasty, but they are not widely available for this population.
Dilation After Vaginoplasty
Depending on the technique used, patients may or may not need to dilate their neovagina for the rest of their lives.
Dilation involves inserting a silicone dilator—a rod with a curved end—into the vagina and leaving it in place for a short period of time (usually around 10-15 minutes).
Dilation can be used to increase the depth and width of the vagina through gentle stretching. This can help those who have difficulty with intercourse after vaginoplasty. Dilation is also necessary to maintain the vaginal opening when the skin is used to line the neovagina, such as in penile inversion or McIndoe vaginoplasty. The frequency of dilation needed depends on the type of procedure and how long it has been since the surgery was completed.
Summary
Neovagina surgery, or vaginoplasty, is surgery used to create a vagina. Reasons for vaginoplasty include vaginal cancer, being born without a vagina, and being a transgender woman (i.e. “bottom surgery”).
There are numerous different surgical techniques used to create a vagina with varying levels of success. Often, the neovagina must be regularly dilated to avoid closing up.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhaskar V, Sinha RJ, Mehrotra S, Mehrotra CN, Singh V.Long-term outcomes of sigmoid vaginoplasty in patients with disorder of sexual development - our experience.Urol Ann. 2018;10(2):185-190. doi:10.4103/UA.UA_88_17Mhatre P, Mhatre J, Sahu R.New laparoscopic peritoneal pull-through vaginoplasty technique.J Hum Reprod Sci. 2014;7(3):181-6. doi:10.4103/0974-1208.142478Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA.Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: a review.Int J STD AIDS. 2022 Feb;33(2):106-113. doi: 10.1177/09564624211046997Chan JL, Levin PJ, Ford BP, Stanton DC, Pfeifer SM.Vaginoplasty with an autologous buccal mucosa fenestrated graft in two patients with vaginal agenesis: a multidisciplinary approach and literature review.J Minim Invasive Gynecol. 2017;24(4):670-676. doi:10.1016/j.jmig.2016.12.030Linder BJ, Gebhart JB.McIndoe neovagina creation for the management of vaginal agenesis.Int Urogynecol J. 2021 Feb;32(2):453-455. doi:10.1007/s00192-020-04425-ySalim A, Poh M.Gender-affirming penile inversion vaginoplasty.Clin Plast Surg. 2018;45(3):343-350. doi:10.1016/j.cps.2018.04.001Johns Hopkins Medicine.Vaginoplasty for gender affirmation.Additional ReadingBouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG.Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.J Sex Med. 2014 Jul;11(7):1835-47. doi:10.1111/jsm.12538Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG.Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques.J Sex Med. 2015 Jun;12(6):1499-512. doi: 10.1111/jsm.12868.Li FY, Xu YS, Zhou CD, Zhou Y, Li SK, Li Q.Long-term outcomes of vaginoplasty with autologous buccal micromucosa.Obstet Gynecol. 2014 May;123(5):951-6. doi:10.1097/AOG.0000000000000161Qin C, Luo G, Du M, Liao S, Wang C, Xu K, Tang J, Li B, Zhang J, Pan H, Ball TW, Fang Y.The clinical application of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital absence of vagina.Int J Gynaecol Obstet. 2016 Jun;133(3):320-4. doi:10.1016/j.ijgo.2015.11.015
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhaskar V, Sinha RJ, Mehrotra S, Mehrotra CN, Singh V.Long-term outcomes of sigmoid vaginoplasty in patients with disorder of sexual development - our experience.Urol Ann. 2018;10(2):185-190. doi:10.4103/UA.UA_88_17Mhatre P, Mhatre J, Sahu R.New laparoscopic peritoneal pull-through vaginoplasty technique.J Hum Reprod Sci. 2014;7(3):181-6. doi:10.4103/0974-1208.142478Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA.Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: a review.Int J STD AIDS. 2022 Feb;33(2):106-113. doi: 10.1177/09564624211046997Chan JL, Levin PJ, Ford BP, Stanton DC, Pfeifer SM.Vaginoplasty with an autologous buccal mucosa fenestrated graft in two patients with vaginal agenesis: a multidisciplinary approach and literature review.J Minim Invasive Gynecol. 2017;24(4):670-676. doi:10.1016/j.jmig.2016.12.030Linder BJ, Gebhart JB.McIndoe neovagina creation for the management of vaginal agenesis.Int Urogynecol J. 2021 Feb;32(2):453-455. doi:10.1007/s00192-020-04425-ySalim A, Poh M.Gender-affirming penile inversion vaginoplasty.Clin Plast Surg. 2018;45(3):343-350. doi:10.1016/j.cps.2018.04.001Johns Hopkins Medicine.Vaginoplasty for gender affirmation.Additional ReadingBouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG.Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.J Sex Med. 2014 Jul;11(7):1835-47. doi:10.1111/jsm.12538Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG.Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques.J Sex Med. 2015 Jun;12(6):1499-512. doi: 10.1111/jsm.12868.Li FY, Xu YS, Zhou CD, Zhou Y, Li SK, Li Q.Long-term outcomes of vaginoplasty with autologous buccal micromucosa.Obstet Gynecol. 2014 May;123(5):951-6. doi:10.1097/AOG.0000000000000161Qin C, Luo G, Du M, Liao S, Wang C, Xu K, Tang J, Li B, Zhang J, Pan H, Ball TW, Fang Y.The clinical application of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital absence of vagina.Int J Gynaecol Obstet. 2016 Jun;133(3):320-4. doi:10.1016/j.ijgo.2015.11.015
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bhaskar V, Sinha RJ, Mehrotra S, Mehrotra CN, Singh V.Long-term outcomes of sigmoid vaginoplasty in patients with disorder of sexual development - our experience.Urol Ann. 2018;10(2):185-190. doi:10.4103/UA.UA_88_17Mhatre P, Mhatre J, Sahu R.New laparoscopic peritoneal pull-through vaginoplasty technique.J Hum Reprod Sci. 2014;7(3):181-6. doi:10.4103/0974-1208.142478Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA.Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: a review.Int J STD AIDS. 2022 Feb;33(2):106-113. doi: 10.1177/09564624211046997Chan JL, Levin PJ, Ford BP, Stanton DC, Pfeifer SM.Vaginoplasty with an autologous buccal mucosa fenestrated graft in two patients with vaginal agenesis: a multidisciplinary approach and literature review.J Minim Invasive Gynecol. 2017;24(4):670-676. doi:10.1016/j.jmig.2016.12.030Linder BJ, Gebhart JB.McIndoe neovagina creation for the management of vaginal agenesis.Int Urogynecol J. 2021 Feb;32(2):453-455. doi:10.1007/s00192-020-04425-ySalim A, Poh M.Gender-affirming penile inversion vaginoplasty.Clin Plast Surg. 2018;45(3):343-350. doi:10.1016/j.cps.2018.04.001Johns Hopkins Medicine.Vaginoplasty for gender affirmation.
Bhaskar V, Sinha RJ, Mehrotra S, Mehrotra CN, Singh V.Long-term outcomes of sigmoid vaginoplasty in patients with disorder of sexual development - our experience.Urol Ann. 2018;10(2):185-190. doi:10.4103/UA.UA_88_17
Mhatre P, Mhatre J, Sahu R.New laparoscopic peritoneal pull-through vaginoplasty technique.J Hum Reprod Sci. 2014;7(3):181-6. doi:10.4103/0974-1208.142478
Van Gerwen OT, Aryanpour Z, Selph JP, Muzny CA.Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: a review.Int J STD AIDS. 2022 Feb;33(2):106-113. doi: 10.1177/09564624211046997
Chan JL, Levin PJ, Ford BP, Stanton DC, Pfeifer SM.Vaginoplasty with an autologous buccal mucosa fenestrated graft in two patients with vaginal agenesis: a multidisciplinary approach and literature review.J Minim Invasive Gynecol. 2017;24(4):670-676. doi:10.1016/j.jmig.2016.12.030
Linder BJ, Gebhart JB.McIndoe neovagina creation for the management of vaginal agenesis.Int Urogynecol J. 2021 Feb;32(2):453-455. doi:10.1007/s00192-020-04425-y
Salim A, Poh M.Gender-affirming penile inversion vaginoplasty.Clin Plast Surg. 2018;45(3):343-350. doi:10.1016/j.cps.2018.04.001
Johns Hopkins Medicine.Vaginoplasty for gender affirmation.
Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG.Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.J Sex Med. 2014 Jul;11(7):1835-47. doi:10.1111/jsm.12538Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG.Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques.J Sex Med. 2015 Jun;12(6):1499-512. doi: 10.1111/jsm.12868.Li FY, Xu YS, Zhou CD, Zhou Y, Li SK, Li Q.Long-term outcomes of vaginoplasty with autologous buccal micromucosa.Obstet Gynecol. 2014 May;123(5):951-6. doi:10.1097/AOG.0000000000000161Qin C, Luo G, Du M, Liao S, Wang C, Xu K, Tang J, Li B, Zhang J, Pan H, Ball TW, Fang Y.The clinical application of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital absence of vagina.Int J Gynaecol Obstet. 2016 Jun;133(3):320-4. doi:10.1016/j.ijgo.2015.11.015
Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG.Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.J Sex Med. 2014 Jul;11(7):1835-47. doi:10.1111/jsm.12538
Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG.Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques.J Sex Med. 2015 Jun;12(6):1499-512. doi: 10.1111/jsm.12868.
Li FY, Xu YS, Zhou CD, Zhou Y, Li SK, Li Q.Long-term outcomes of vaginoplasty with autologous buccal micromucosa.Obstet Gynecol. 2014 May;123(5):951-6. doi:10.1097/AOG.0000000000000161
Qin C, Luo G, Du M, Liao S, Wang C, Xu K, Tang J, Li B, Zhang J, Pan H, Ball TW, Fang Y.The clinical application of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital absence of vagina.Int J Gynaecol Obstet. 2016 Jun;133(3):320-4. doi:10.1016/j.ijgo.2015.11.015
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
