The skin surrounding the scrotum (a pouch-like structure containing the testicles) is called the scrotal skin.

The skin graft made from the scrotal skin is typically used for the total vaginal lining during gender affirming surgery by Dr. Chettawut’s non-penile inversion technique.

The average depth of the neo-vagina is 6 inches, which does not depend on the size of the penis because the only scrotal skin is the single material used for the neo-vagina lining.

The steps of skin graft vaginoplasty:

Step 2: Skin graft preparation

The purpose of skin graft preparation is to remove the deep dermis layer of skin, which contains hair follicles (hair roots) so that there will be no hair growth inside the neo-vagina after skin graft vaginoplasty.

Once the deep dermis layer, including all hair follicles, is discarded, the scrotal skin graft becomes a thin, elastic tissue composed of only the epidermis and superficial dermis layer.

Step 3: Stabilize the skin graft inside the neo-vagina

The sheet of skin graft will be formed like a tube and inserted into the neo-vaginal tunnel. The gauze packing will stabilize the skin graft with the surrounding tissue inside the vaginal canal.

Step 4: The gauze packing will be removed on the seventh day after surgery.

Limitation of skin graft availability

The scrotal skin must be used for outer labia construction as the priority, so those whose scrotal skin is originally short or shrunk from the previous orchidectomy may not be a good candidate for scrotal skin graft vaginoplasty due to skin insufficiency.

Since every technique for vaginoplasty has pros and cons, the table below can help patients compare each method and select the one that matches their requirements and lifestyle.