Colovaginoplasty, also known as vaginoplasty with a pedicled rectosigmoid flap, is a vaginoplasty technique in which a segment of the colon – usually the rectosigmoid – is used to create the vaginal canal and the vagina. It is usually performed when there is not enough genital tissue to build a vaginal canal with adequate depth and stability. In other words, when the penile inversion technique does not guarantee optimal results.
Colovaginoplasty is a gender-affirming surgery that requires a highly specialized and experienced team to personalize the procedure and adapt it to the needs of each trans woman.
Why is the colon used to create a vagina?
The colon has two characteristics that explain why it is used in certain cases:
● It allows the construction of a vaginal canal without depending on the amount of available genital skin. This is key for patients with limited genital development, extensive circumcision, or previous surgeries.
● It is mucosal tissue, which means the canal has its own moisture (this is not the same as “sexual lubrication,” but many patients experience it as an advantage in daily life).
It should be noted that this technique is used in very specific circumstances that must be evaluated by the medical team, taking into account the benefits it may offer the woman, such as greater vaginal depth than could be achieved with other techniques. At IM GENDER, more than 25 years of experience and over 4,000 gender surgeries have allowed the development of an algorithm to choose the most appropriate vaginoplasty technique for each patient, enabling personalized recommendations in every case.
In which cases is colovaginoplasty usually indicated?
Although each case is assessed individually, there are situations in which colovaginoplasty is often the best option. This includes:
● Limited availability of penile skin due to size, elasticity, or development.
● Extensive prior circumcision or other conditions such as scars that limit usable tissue.
● Early use of puberty blockers that prevents full development of the birth genitals.
● Previous surgeries in which the desired depth was not achieved or complications occurred that recommend reconsidering the technique.
Differences between colovaginoplasty and other vaginoplasty techniques
Colovaginoplasty is one of the types of vaginoplasty that a medical team may consider. Other techniques include penile inversion vaginoplasty, peritoneal vaginoplasty, and vulvoplasty.
Penile inversion vaginoplasty
This is a widely used technique when there is sufficient tissue. It uses penile skin to create the vaginal canal and the external part of the vagina. Penile inversion vaginoplasty can offer excellent aesthetic and functional results when anatomy allows.
Peritoneal vaginoplasty (vaginoperitoneal)
This technique uses the peritoneum (an inner abdominal layer) to create or extend part of the vaginal canal. It is usually considered when, despite having tissue, it is not enough to achieve functional depth with inversion alone. It can be a very interesting alternative in certain cases and should be part of the discussion when explaining how the vaginoplasty technique is chosen.
Vulvoplasty (zero depth)
What is vulvoplasty? It is an option for women who do not want a vaginal canal for penetration but do want feminine, erogenous, and functional external genitalia. Recovery is usually simpler, and it avoids the need for dilations to maintain a vaginal canal. It is a valid option for people whose sexuality, history, or relationship with their body fits better with this approach.
Is colovaginoplasty increasingly in demand?
In recent years, the profile of many patients requesting gender-affirming surgery has changed. In Spain and other countries, early access to medical support for trans people is becoming more common, which may include puberty blockers at ages when genital development is not yet complete.
This has a positive impact on many aspects of well-being, such as avoiding unwanted pubertal changes that can affect self-esteem and emotional well-being. However, the lack of full genital development can mean there is not enough tissue to perform penile inversion vaginoplasty with the desired depth. This is where colovaginoplasty is becoming increasingly necessary as an alternative to build a functional vaginal canal for penetration.
Is colovaginoplasty the best option?
The answer is clear: No. As Dr. Trinidad Labanca, a gender surgery specialist at IM GENDER, explains, “There is no technique that is better than another. There is a technique that is more suitable for specific patients because it will allow them to achieve optimal results.”
This means that if there is enough tissue, inversion can be an excellent option. If there is not, all possible options must be evaluated—and colovaginoplasty is one of them. It is important for the patient to participate in the decision about the technique. How? With clear information about their specific case. It is essential to evaluate other aspects beyond whether there is genital skin available, such as the woman’s realistic expectations, lifestyle, sexual goals, medical history, and needs.
Dr. Ivan Mañero, director of IM GENDER, summarizes it this way: “At IM GENDER, trans people today have greater autonomy and participation in choosing the surgical technique that best suits their needs. It is no longer a single decision by the medical team; now the reality and needs of each patient are taken much more into account.”
Recovery and care after colovaginoplasty
Although each postoperative course is unique and individual, after this type of surgery, follow-up and compliance with medical instructions are part of the outcome. Colovaginoplasty is major surgery that requires recovery time, patience, and support, especially during the first days.
Some recovery data:
● Hospital stay is usually around 7 days.
● Oral intake (eating) is resumed two or three days after surgery, to allow the intestine to recover motility.
● You will have a urinary catheter for the first 10–14 days or until periurethral swelling is minimal.
● On the last day of hospitalization, the IM GENDER team will perform the first dilation and teach you how to do them at home, as well as vaginal douching.
● A postoperative care guide will be provided to follow at home.
● You must continue analgesic and antibiotic treatment at home according to medical instructions.
The best vaginoplasty technique
There is no universally best technique; there is the best technique for each person who wants vaginoplasty to be part of their transition. An accurate diagnosis by a specialized and experienced medical team is the first step. Truthful and realistic information allows the patient to participate in the final decision.
If you are considering colovaginoplasty or other vaginoplasty techniques, request a consultation and we will answer all your questions.
