Colon vaginoplasty is a surgical procedure used in gender affirmation surgery for transgender women who wish to undergo vaginoplasty to provide a new vagina with a mucosal lining similar to that of a cisgender vagina.

This surgical technique involves using a section of the sigmoid colon (a portion of the large intestine) with blood supply from mesenteric arteries.

The colon vaginoplasty procedure can be performed in primary gender reassignment surgery or corrective vaginoplasty called secondary colon vaginoplasty.

Secondary colon vaginoplasty is the most reliable treatment for the short or collapsed vagina. The colonic flap from the sigmoid colon can survive and heal appropriately in post-scarring tissue. The surgical technique involves removing scar tissue inside the vagina, re-created vaginal tunnel to achieve adequate depth and width of the vaginal canal, then bringing the colonic flap for a new & healthy lining inside the vagina.

The colon vaginoplasty procedure can also be applied to treat a biological woman who is suffering from a rare congenital female genital abnormality called Vaginal agenesis or Mullerian agenesis, or Mayer-Rokitansky-kuster-hauser syndrome (MRKH).

This disorder is characterized by the absence of a vaginal canal and uterus, and the colonic flap from colon vaginoplasty turned out to be more beneficial for this group of patients rather than the skin graft technique, harvesting skin from somewhere in the body, which leaves an unsightly scar.

Laparoscopic colon vaginoplasty, considered minimally invasive, is now a better choice than open-technique colon vaginoplasty. The advantages of the laparoscopic colon vaginoplasty compared with the open technique are as follows:

1. Minimal scar and less muscle trauma

The laparoscopic technique requires four mini incisions (1-1.5 cm) in the abdomen through which surgical instruments and a camera are inserted, and the open approach requires a long incision (7-9 cm) and cutting the abdominal muscle to access the intra-abdominal cavity. The weakness of the abdominal muscle resulting from the open technique may cause lower abdominal protrusion.

2. Less pain compared to traditional open technique.

3. Quicker recovery time compared to traditional open technique.

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.

Comparison with variety of Vaginoplasty for Male to Female gender affirming surgery