FRI-09 THE CREATION OF THE NEOVAGINA: A HISTORY OF VAGINAL RECONSTRUCTION

Abstract

INTRODUCTION AND OBJECTIVES: After Realdus Colombus described congenital vaginal agenesis in the 16th century, vaginal reconstruction became of interest to urologists, plastic surgeons, and gynecologists. We will review the evolution of neovaginal reconstruction as it’s indications expanded from treatment of congenital disease, to restoration of normal function following radical surgery and finally to elective gender reassignment surgery. METHODS: A comprehensive literature review (PubMed, Clinical Key) was performed to elucidate relevant historical and clinical information. RESULTS: Early reports of surgical vaginal reconstruction attempted to use the labia majora for vaginoplasty, however the first use of extravaginal tissue came in 1898 when Dr. Abbe described the construction of a neovagina using skin grafts. The technique was largely abandoned until McIndoe refined the procedure in 1938. Although the procedure was successful in over 133 reported cases by 1948, patients developed scarring and subsequent stenosis. Techniques in reconstruction expanded as the indications for neovaginal reconstruction began including patients with large defects following radical pelvic surgery. In the 1950’s Conway and Stark popularized the use of bowel similar to their predecessors at the turn of the century, however this approach proved to be afflicted with complications. The use of regional tissue transposition began with McGraw in 1976 that utilized a gracilis myocutaneous flap. For larger defects following pelvic exenteration, Tobin described the use of a rectus abdominis myocutaneous flap in 1988. Alternatively, in 1974 Davydov described a procedure using peritoneum from the pouch of Douglas to reconstruct upper vaginal defects. A new interest has currently been taken in this procedure as it is now being performed laparoscopically. The vaginal reconstructive techniques described for treating patients with vaginal atresia helped form the foundation for neovaginal construction in male-to-female transgender surgery which became popularized in the late 1960’s. Although penile disassembly and inversion vaginoplasty remains the preferred surgical technique, nongenital flaps and intestinal interposition remain suitable options as primary or revision vaginoplasty. CONCLUSIONS: Techniques in vaginoplasty have evolved since their original descriptions in the turn of the century and their contemporary applications are used for numerous indications.