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Non-grafted Vaginal Depth Augmentation for Transgender Atresia, Our Experience and Survey of Related Procedures

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Abstract

Introduction

Neovaginal atresia especially following male-to-female transgender vaginoplasty is a distressing concern. A pelvic space must be re-created. Traditionally, an epithelial or mucosal lining is employed to cover the space. However, in our series of 18 patients, a non-grafted approach has been equally efficacious, as previously described by others.

Aim

To follow the outcome of male-to-female transsexuals undergoing secondary depth enhancement without use of graft or flap.

Methods

Patient selection included two operated on elsewhere, one of whom had a lower abdominal skin graft, and the remainder done here using an inverted penile skin flap supplemented by a scrotal graft extension as needed. The time lag from primary to revision surgery varied from 5 months to 23 years, average 3.7 years. The fascial plane of Denonvilliers was reopened and packed for 7 days to facilitate maintenance of a pelvic space. Patients are requested to perform serial self-dilations with a stent set indefinitely to maintain patency and procure additional depth. Immuno-histochemistry staining was performed to demonstrate estrogen receptor (ER) presence in male genital skin. Estrogen cream may be utilized to facilitate wound healing. Main outcome measures were post-operative depth results and Female Sexual Function Index (FSFI) scores. Several attempts were made to contact all patients for completion of a FSFI. Ten out of 18 responded.

Results

Following revision of the pelvic space, static depths increased two-fold on average, from 2.4 in. (6.2 cm) to 5.0 in. (12.7 cm). The FSFI domain scores (of desire, arousal, lubrication, orgasm, satisfaction, and pain) were all mid-range or above. Full scale FSFI scores (compilation score) averaged 23.4 (range limits 2–36). Histologic staining showed the presence of ER in genital skin of all genetic males tested regardless of estrogen usage and perceived gender.

Conclusions

Given adequate development of the rectal-vesical space and preservation of that space with self-dilation, epithelialization will ensue providing sexual gratification for patient and partner (as per patient).

Level of Evidence III

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Acknowledgments

The authors wish to thank Ethel R Slater, associate librarian at the Mount Sinai Medical Center Medical Library for her tireless efforts and George Wayne, statistician for his analysis and commentary.

Conflict of interest

The authors declare they have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, FL, USA

    Harold M. Reed, Rafael E. Yanes & Joan C. Delto

  2. Reed Centre for Ambulatory Urological Surgery, Bay Harbor Islands, FL, USA

    Harold M. Reed

  3. The Arkadi M. Rywlin, M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA

    Yumna Omarzai & Kailee Imperatore

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  1. Harold M. Reed
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  2. Rafael E. Yanes
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Correspondence to Harold M. Reed.

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Reed, H.M., Yanes, R.E., Delto, J.C. et al. Non-grafted Vaginal Depth Augmentation for Transgender Atresia, Our Experience and Survey of Related Procedures. Aesth Plast Surg 39, 733–744 (2015). https://doi.org/10.1007/s00266-015-0523-7

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