While penile inversion vaginoplasty is considered the “gold standard” gender-affirmation surgery option for transgender women, gender-confirming vulvoplasty (GCV) is a viable alternative for some patients.
The number of patients undergoing GCV is still relatively small, researchers report in the Journal of Sexual Medicine. But they tend to be satisfied with their results.
The procedure, also called zero-depth or shallow-depth vaginoplasty, involves the creation of labia and a clitoris, but no vagina. Instead, a “neovaginal dimple” is created.
Data for the retrospective study came from the medical records of 1,343 patients who underwent gender-affirmation procedures at one clinic in the Netherlands between January 1990 and January 2020.
Seventeen of these patients opted for GCV. Their ages ranged from 29 to 65 years with a median age of 56. They tended to be older than patients having vaginoplasty, whose average age was 38.
Motivations for GCV
The patients cited a variety of reasons for choosing GCV over gender-affirmation vaginoplasty. Almost 60% said that they had no interest in penetrative sexual intercourse. Thirty-five percent said they were sexually attracted to women and did not desire penetration. And about a quarter said their decision was based on negative sexual experiences in the past.
Another 24% said they had wanted vaginoplasty, but the procedure was not an option for them for medical reasons, such as regional radiotherapy.
The women were followed for a median duration of 34 months. About 65% of the women had no surgical complications. Others experienced mild wound dehiscence, meatal stenosis, or urinary tract infection. These complications were “generally minor and treatable,” the authors said.
Satisfaction data were available for 12 women. Overall, they gave their neovagina a rating of 8.2 points out of 10.
One patient underwent a neolabial reduction procedure six years after GCV. Another chose to have secondary depth augmentation vaginoplasty later on.
GCV has some advantages, the authors explained, including a lower risk of rectal and urethral perforations. No vaginal dilation is necessary. Remaining skin and other tissues can be used to create the external genitalia.
However, surgical complications can still occur. And women might wish to have a deep vagina later. While this is an option, there is a need for skin grafts and the surgery can be complicated.
“Therefore, we do not see GCV as a ‘bridge to vaginoplasty’ procedure,” the authors wrote.
“When counseling transgender women, the information on different options for genital surgery should be provided in which advantages and disadvantages are discussed on an individual basis,” they added.
The Journal of Sexual Medicine
Van der Sluis, Wouter B., MD, PhD, et al.
“Gender-Confirming Vulvoplasty in Transgender Women in the Netherlands: Incidence, Motivation Analysis, and Surgical Outcomes”
(Full-text. Published: May 16, 2020)