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Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-vagina in Male-to-Female Reassignment Surgery

  • Original Article
  • Genital Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Plastic surgeons have used several methods for the construction of neo-vaginas, including the utilization of penile skin, free skin grafts, small bowel or recto-sigmoid grafts, an amnion graft, and cultured cells.

Purpose

The aim of this study is to compare the results of amnion grafts with amnion seeded with autograft fibroblasts.

Materials and Methods

Over 8 years, we compared the results of 24 male-to-female transsexual patients retrospectively based on their complications and levels of satisfaction. Sixteen patients in group A received amnion grafts with fibroblasts, and the patients in group B received only amnion grafts without any additional cellular lining. The depths, sizes, secretions, and sensations of the vaginas were evaluated. The patients were monitored for any complications, including over-secretion, stenosis, stricture, fistula formation, infection, and bleeding.

Results

The mean age of group A was 28 ± 4 years and group B was 32 ± 3 years. Patients were followed up from 30 months to 8 years, (mean 36 ± 4) after surgery. The depth of the vaginas for group A was 14–16 and 13–16 cm for group B. There was no stenosis in neither group. The diameter of the vaginal opening was 34–38 mm in group A and 33–38 cm in group B. We only had two cases of stricture in the neo-vagina in group B, but no stricture was recorded for group A. All of the patients had good and acceptable sensation in the neo-vagina. Seventy-five percent of patients had sexual experience and of those, 93.7% in group A and 87.5% in group B expressed satisfaction.

Conclusion

The creation of a neo-vaginal canal and its lining with allograft amnion and seeded autologous fibroblasts is an effective method for imitating a normal vagina. The size of neo-vagina, secretion, sensation, and orgasm was good and proper. More than 93.7% of patients had satisfaction with sexual intercourse. Amnion seeded with fibroblasts extracted from the patient’s own cells will result in a vagina with the proper size and moisture that can eliminate the need for long-term dilatation. The constructed vagina has a two-layer structure and is much more resistant to trauma and laceration. No cases of stenosis or stricture were recorded.

Level of Evidence IV

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Acknowledgements

The authors have no financial disclosure related to this article.

Author information

Authors and Affiliations

  1. Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran

    Kamal Seyed-Forootan & Hamid Karimi

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Nazilla-Sadat Seyed-Forootan

Authors
  1. Kamal Seyed-Forootan
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  2. Hamid Karimi
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  3. Nazilla-Sadat Seyed-Forootan
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Corresponding author

Correspondence to Hamid Karimi.

Appendix

Appendix

A sample of our questionnaire about sexual satisfaction:

  1. 1.

    Do you have a partner?

  2. 2.

    Do you have sex with your partner?

  3. 3.

    How long after surgery, you started the sex?

  4. 4.

    How often you have sex during a week?

  5. 5.

    In how many percent of sexes, you are the one who start?

  6. 6.

    Do you have orgasm? In how many percent of sexes?

  7. 7.

    Do you have sensation inside your new vagina?

  8. 8.

    Are you satisfied with your sex? Yes, no, most of all yes, most of all no

  9. 9.

    Do you think that this satisfaction is related to your surgery?

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Seyed-Forootan, K., Karimi, H. & Seyed-Forootan, NS. Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-vagina in Male-to-Female Reassignment Surgery. Aesth Plast Surg 42, 491–497 (2018). https://doi.org/10.1007/s00266-018-1088-z

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  • DOI: https://doi.org/10.1007/s00266-018-1088-z

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