Closing of the inner skin margins followers. The knots are placed inside the created neovagina to avoid early decomposition, which could lead to wound opening.

A layer of sutures is followed to approximate the subcutaneous fat and the perineal muscles. Finally, the external skin is closed (Fig. 17.1d). For the closing of both the skin layers (Fig. 17.1b, c), interrupted absorbable 2-0 sutures are used, starting posteriorly and proceeding anteriorly.

The criterion for the success of the operation is the creation of a neovagina up to 10–12 cm in depth and 4–5 cm in width. The functional dimensions of the neovagina are measured using sonovaginography [1]. A clinical re-examination in 4 weeks and 6 months and then on a yearly basis is recommended (Fig. 17.2). Following our procedure, no significant postoperative complications were reported and all patients have had a satisfactory sexual intercourse. A mean hospital stay up to 6 days is required to prevent postoperative complications such as dehiscence and to maximize patient’s compliance. Finally, there is no need for postoperative vaginal dilatations, which usually reduce the psychological impact on the patient [3, 6].