Vaginoplasty is one of the most requested gender-affirming surgeries among trans women. Traditionally, the most common technique has been penile inversion, but when there is not enough skin to achieve good vaginal depth, other techniques such as colovaginoplasty (which uses a segment of colon) are performed. However, in recent years, peritoneal vaginoplasty has gained importance. Here we explain what peritoneal vaginoplasty is and everything you need to know about it.
Peritoneal vaginoplasty is a surgical method that creates a vagina using part of the peritoneal tissue.
What is the peritoneum and why is it used in trans surgery?
The peritoneum is a serous membrane that lines the abdominal cavity and covers the organs within it. Why is it used in a trans vaginoplasty technique? Some of its properties make it an ideal tissue to line the vaginal canal of neovaginas in trans women or non-binary people assigned male at birth who wish to undergo vaginoplasty. Some of these characteristics are:
-
- High elasticity: it can be mobilized and stretched easily to line new cavities.
- Natural lubrication: it secretes a serous fluid that helps keep the surface moist.
- Its own vascularization: which promotes healing and reduces the risk of necrosis.
- Resistance: it is a very durable tissue with strong adaptive capacity.
What does peritoneal vaginoplasty involve?
A technique that is increasingly necessary
Over the last 20 years, especially in Spain, there has been a very significant change in early care for trans people. This has meant that many trans adolescents and young people have been able to transition properly and access puberty blockers, always with medical evaluation and consent. These blockers halt the production of sex hormone precursors, stopping the typical development and growth of primary and secondary sexual organs.
What does this mean for trans women who want vaginoplasty? The penis does not fully develop, making penile inversion insufficient to provide adequate vaginal depth. This explains the growing use of other vaginoplasty techniques, such as colovaginoplasty or peritoneal vaginoplasty.
The peritoneal vaginoplasty surgery
Peritoneal vaginoplasty is a surgical technique aimed at creating a new vagina with sufficient vaginal depth to allow penetrative sexual intercourse.
The first part of the surgery is very similar to the penile inversion technique, meaning the available penile skin is used to line the first part of the neovagina. For the deeper segment of the vaginal cavity, the peritoneum is pulled down from the abdominal cavity to line it.
In this way, the neovagina is lined with two types of tissue: the outer part with skin, which provides resistance and a natural appearance, and the inner part with peritoneum, which ensures depth, lubrication, and proper healing.
Indications for the peritoneal technique
Peritoneal vaginoplasty is mainly indicated for patients who have penile skin available but not enough to line the entire neovagina, requiring an additional solution to achieve depth and proper vaginal functionality. In other words, this technique is used when the penile skin covers at least half of the vaginal cavity (about 15 cm), but not enough to line it completely.
When there is not enough skin to perform peritoneal vaginoplasty, colovaginoplasty must be used to achieve adequate depth.
Advantages of peritoneal vaginoplasty
The main advantages of peritoneal vaginoplasty include:
-
- Natural lubrication thanks to the properties of the peritoneum, which many women highly value.
- Lower risk of retraction in the deepest area.
- Better adaptation of the tissue compared to other grafts.
- Adequate depth for proper functionality.
Each vaginoplasty technique has its own benefits, and although the medical team will evaluate each case individually and advise the patient on the most suitable option, at IM GENDER we believe in patient autonomy, so the final decision is always made collaboratively.
Postoperative care and recovery
Postoperative care after peritoneal vaginoplasty is very similar to that of penile inversion or colovaginoplasty. Therefore, it is important to consider:
-
- Hospital stay: between 5 and 7 days to monitor the initial recovery.
- Progressive diet: starting with liquids and gradually returning to a normal diet as the intestines recover.
- Pain and swelling control with medication.
- Relative rest for several weeks, avoiding intense physical effort.
- Vaginal dilations: usually start 7 days after surgery and continue for at least the first 3 months, unless penetrative sexual activity begins earlier.
Vaginal dilations: an important difference
It is important to emphasize that in all vaginoplasty techniques, vaginal dilations are essential to maintain depth and width of the canal. At IM GENDER, patients receive a dilation kit after surgery along with detailed postoperative care instructions after vaginoplasty and all the necessary tools for cleaning and dilations.
The difference with peritoneal vaginoplasty is that, instead of glass dilators used in other techniques, a silicone dilator with a stopper is used. This design prevents the dilator from going beyond the vaginal cavity and coming into contact with the peritoneal cavity.
Expected results
The combination of penile skin and peritoneum makes it possible to achieve a neovagina with:
-
- Adequate depth for a satisfying sexual life with penetration.
- Natural lubrication in the inner portion of the vagina.
- A natural aesthetic, as the external genitalia are designed similarly to penile inversion vaginoplasty.
- Good vascularization.
- Good healing and high resistance.
Peritoneal vaginoplasty offers excellent results for trans women who do not have enough penile skin to cover the entire neovagina, thanks to the properties of the peritoneum—elasticity, lubrication, vascularization, and resistance. As with all techniques, an in-depth and personalized evaluation is necessary to determine whether this approach is appropriate.
With over 25 years of experience, the IM GENDER medical team is skilled in all trans vaginoplasty techniques, ensuring each trans person receives the procedure best suited to their needs and lifestyle.
If you are interested in learning more about peritoneal vaginoplasty or want to assess which technique is best for your case, contact the IM GENDER team.
