Creation of Clitoral Hood and Labia Minora in Penile Inversion Vaginoplasty in Circumcised and Uncircumcised Transwomen.

Abstract

Gender dysphoria, the incongruence between anatomical sex and gender identity, is estimated to affect 1 percent of the population. Creation of a feminine vulva with labia minora remains a technical challenge for surgeons, especially in circumcised patients. The authors present the technique developed by the senior author (S.M.) that uses prepuce skin in uncircumcised patients or distal shaft skin in circumcised patients for creation of both clitoral hood and labia minora. A retrospective case review was conducted of all penile inversion vaginoplasties performed by the senior author between 2014 and 2016. Patient characteristics, history of circumcision, and revision surgery were recorded. Surgical technique to create and inset the neoclitoris and labia minora in a single-stage penile inversion vaginoplasty is described in detail. A total of 161 penile inversion vaginoplasty operations were performed. Creation of labia minora and clitoral hood was achieved in all patients, with 4.3 percent undergoing an early intervention for bleeding or dehiscence and 5.6 percent requiring late revision surgery for diverted urinary stream. Average length of follow-up was 29 months. Age, hormonal therapy time, body mass index, smoking, and diabetes were the investigated risk factors for postoperative complications, but no significant correlations were found. All patients met the standards of care set forth by the World Professional Association for Transgender Health. Creation of the clitoral hood and labia minora during penile inversion vaginoplasty is achievable in both circumcised and uncircumcised patients, with good aesthetic results and a low revision surgery rate. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.