Vaginoplasty

Vaginoplasty is the description of the following surgical interventions: • separation of congenitally fused urethra and vagina • vaginal construction Vaginoplasty is used as part of the series of surgeries needed to treat those girls and women born with the bladder located outside of their abdomen. After the repairs, women have been able to give birth but are at risk of prolapse. There are human rights concerns about vaginoplasties and other genital surgeries in children who are not old enough to consent, including concern with post-surgical sexual function, and assumptions of cisnormativity. There is no consensus attitude among clinicians about their necessity, timing, method or evaluation. Vaginoplasties may be performed in children or adolescents with intersex conditions or disorders of sex development. ==Techniques==

Non-surgical vagina creation was used in the past to treat the congenital absence of a vagina. The procedure involved the wearing of a saddle-like device and the use of increasing-diameter vaginal dilators. The procedure took several months and was sometimes painful. It was not effective in every instance. Gender-affirming surgery Several techniques may be used in gender-affirming surgery to create a neovaginal canal or neovagina in short. Penile inversion Inversion of the penile skin is the method most often selected to create a neovagina by surgeons performing gender-affirming surgery. The inverted penile skin uses inferior pedicle skin or abdominal skin for the lining of the neovagina. The skin is cut to form an appropriate-sized flap. The skin flap is sometimes combined with a scrotal or urethral flap. as did the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, The Society of Obstetricians and Gynaecologists of Canada published a policy statement against elective vaginoplasty based upon the risks associated with unnecessary cosmetic surgery in 2013. Vaginal rejuvenation is a form of elective plastic surgery. Its purpose is to restore or enhance the vagina's cosmetic appearance. A small, plastic sphere called an olive is threaded (sutured) against the vaginal area; the threads are drawn though the vaginal skin, up through the abdomen, and through the navel. There, the threads are attached to a traction device, and then daily are drawn tight so that the olive is pulled inwards and stretches the vagina, by approximately 1 cm per day, thereby creating a vagina, approximately 7 cm deep by 7 cm wide, in 7 days. The mean operating room (OR) time for the Vecchietti vaginoplasty is approximately 45 minutes; yet, depending upon the patient and her indications, the procedure might require more time. The outcomes of Vecchietti technique via the laparoscopic approach are found to be comparable to the procedure using laparotomy. In vaginal hypoplasia, traction vaginoplasty such as the Vecchietti technique seems to have the highest success rates both anatomically (99%) and functionally (96%) among available treatments. Other surgical techniques that have been developed include ileal neovagina (Monti's technique), Creatsas vaginoplasty, Wharton–Sheares–George neovaginoplasty, or the Davydov procedure. The most widely used is the Vecchietti laparoscopic procedure. Sometimes sexual intercourse can result in the dilation of a newly constructed vagina. Instead of using a vaginal expander, many surgeons nowadays opt to use a vaginal packing soaked in antibiotic solution and surgical lubricant immediately post-op, which is removed after a few days, upon which vaginal dilation using vaginal dilators starts. Solid vaginal dilators or stents made from plastic or silicone are also used during surgery to keep the passage from attachments, and post-operatively to maintain the viability of the neovagina to loss of depth or length of the vaginal canal. The frequency of post-surgical dilation varies from multiple times daily, to every few days. The frequency required to use decreases over time, But some amount of dilation is typically a lifelong requirement. ==Risks and complications==

Reconstructive vaginoplasty in children and adolescents carries the risk of superinfection. In adults, rates and types of complications varied with gender-affirming surgery. Necrosis of the clitoral region was 1–3%. Necrosis of the surgically created vagina was 3.7–4.2%. Vaginal shrinkage occurred was documented in 2–10% of those treated. Stricture, or narrowing of the vaginal orifice was reported in 12–15% of the cases. Of those reporting stricture, 41% underwent a second operation to correct the condition. Necrosis of two scrotal flaps has been described. Posterior vaginal wall is a rare complication. Genital pain was reported in 4–9%. Rectovaginal fistula is also rare with 1% documented. Vaginal prolapse was seen in 1–2% of people assigned male at birth undergoing this procedure. The ability of emptying the bladder was affected for some patients after this procedure: 13% reported improvement, 68% said that there was no change and 19% reported that voiding got worse. Those reporting a negative outcome who experienced loss of bladder control and urinary incontinence were 19%. Urinary tract infections occurred in 32% of those treated. ==History==

Reports of people seeking vaginoplasty go back to the 2nd century. The first modern vaginoplasty was performed in 1931 on Dora Richter. Lili Elbe also underwent a vaginoplasty the same year. ==See also==