Male to female gender reassignment involves many processes such as hormonal treatment, surgery, and psychological support [1]. Many countries will have designated centres of excellence where patients are managed in accordance with the World Professional Association for Transgender Health Standards of Care. The surgery involves removing the male reproductive organs and creating a new vagina and vulva. The aims of surgery are to make the external genitalia look as natural as possible and to allow penetrative intercourse with sensation. In addition, the urethra should allow urine to flow downwards when sitting on the toilet.

Several surgical techniques are used [2], but vaginoplasty is generally done using penile skin inversion (penile infibulation) today. The sigmoid colon was used to create the vagina and is still used in certain circumstances, but there are more complications using this. However, outcomes of studies are not standardised, so it can be difficult to compare results [3]. Creation of the neoclitoris is one of the most difficult parts of the surgery, and part of the penile glans on a pedicle flap is generally used to maintain sensation [4]. The skin of the distal penile shaft is used to form the clitoral hood and inner surface of the labia minora, and the proximal penile shaft skin for the lateral surfaces [5–7]. The long male urethra is shortened. Scrotal skin is then used to form the labia majora. Corrective surgery is sometimes needed, but this should not be done in the first year after the initial surgery [8]. Details of the surgical techniques are outside the scope of this chapter, but it is important to know the potential complications and problems that may arise on the neovagina and neovulva when seeing these patients [9]. Similar problems can arise after surgery for disorders of sexual development (DSD).

Microbiology of the neovagina

The microbiota and pH will be different depending on which technique has been used to create the neovagina. If penile skin is used, the number of lactobacilli is reduced and were thought to be present in extremely low numbers initially [10]. The bacteria seen are generally those found on the skin. However, using newer molecular analytical methods, Lactobacillus delbrueckii were found in 75% [11]. If the sigmoid colon is used, the organisms are similar to those in the colon, and lactobacilli are more common [12].

Cytology of the neovagina

Stay updated, free articles. Join our Telegram channel

Join