Peritoneal flap vaginoplasty

At IM GENDER, we understand how important it is to see the results we achieve with a vaginoplasty using a peritoneal graft. Although each case is different, we can guarantee that the result is an aesthetic and functional vagina. By learning about real testimonials, you can get an idea of what to expect from your genital gender-affirming surgery.

Before performing peritoneal flap vaginoplasty surgery, the surgeon will always carry out a medical evaluation to determine whether the procedure is safe and viable. They will need to know the patient’s medical history and perform a blood test to assess the patient’s overall health.

Many people are undergoing estrogen and anti-testosterone therapy when they have this surgery. Taking estrogen is safe in healthy individuals, so it is not necessary to stop treatment except in older people, those with obesity, or those with risk factors for thrombosis. Anti-testosterone medications also pose no danger and do not need to be discontinued.

Your doctor will recommend following a healthy diet and avoiding alcohol and tobacco, as this is important for proper healing and to reduce the risk of complications during the postoperative period of peritoneal vaginoplasty.

The day before the operation, it is necessary to administer a rectal laxative to facilitate bowel emptying. In addition, you should drink plenty of water during the two days prior to surgery.

Peritoneal flap vaginoplasty involves creating a vaginal canal using a peritoneal graft. An abdominal entry is made through a laparotomy or Pfannenstiel incision – an incision of about 10 – 12 cm in the lower abdomen – from which the peritoneum that will line the deepest portion of the neovagina is obtained. This operation lasts at least 5 hours. It is always performed after the penis and testicles have been removed.

This is a complex technique that requires specialized doctors with extensive experience in genital reassignment surgeries. This surgery offers excellent results because peritoneal tissue has several advantages. It is a membrane with natural lubrication that is flexible and resistant. In addition, this type of vaginoplasty carries a lower risk of abnormal scarring due to the type of graft used.

However, each person is unique, so it is essential to assess individually which technique is most appropriate. There is no single technique that is better than another; the best technique is the one that best adapts to each patient’s anatomical characteristics and goals.

After the operation, it is essential for the patient to remain in the hospital for about 7 days to ensure proper recovery and adequate medical monitoring.

During the first week, a urinary catheter will be placed to protect the urethra. Intravenous painkillers will also be administered to relieve pain and discomfort during the first few days, followed later by oral medication. Gentle walking is recommended from the first days to promote fluid circulation and prevent thrombosis.

The surgeon will explain how to use dilators, which are essential for maintaining the depth and diameter of the neovagina. They are generally used starting around 6 to 8 weeks after surgery, several times a day, although the frequency will gradually decrease. It is also important to perform regular cleansing with saline solution or mild antiseptics.

As with any surgery, strenuous exercise and heavy lifting should be avoided until your doctor indicates it is safe.

Recovery time is usually around three months. It is a gradual process during which swelling will slowly subside.

What is the difference between peritoneal flap vaginoplasty and penile inversion vaginoplasty?

The main difference is that in penile inversion vaginoplasty the entire canal is covered with skin, whereas in the peritoneal technique about two-thirds of the vagina is lined with penile skin and the deepest part with peritoneum.

Will scars be visible after surgery?

Abdominal scars after vaginoplasty with a peritoneal graft are usually minimal because the incisions are very small — only a few millimeters — and they tend to fade over time. The visible vulvar area is constructed in the same way as in other vaginoplasty techniques.

Will I keep erogenous sensitivity after peritoneal flap vaginoplasty?

Erogenous sensitivity does not depend on the vaginoplasty technique itself but on how the clitoris is created and how the nerves are preserved. At IM GENDER we use the most advanced surgical methods to preserve erogenous sensitivity so patients can continue enjoying their sexuality.

Are there risks in peritoneal vaginoplasty?

As with any surgery, complications can occur. The most common risks include wound dehiscence, infections, or pelvic pain.

Who is peritoneal graft vaginoplasty recommended for?

This genital affirmation surgery is recommended for trans women who do not have enough skin to perform penile inversion vaginoplasty. The peritoneum allows greater depth to be created in the vaginal cavity. It may also be used in cases where greater vaginal depth or improved lubrication characteristics are desired.