Information on colon vaginoplasty

The skin graft is normally used for the vaginal lining during sex reassignment surgery by Dr. Chettawut’s non penile inversion technique.

However the colon graft can also be used as an alternative surgical procedure in primary sex change surgery as well as corrective surgical procedure in post-status SRS patients who have unsatisfactory depth of vagina.

Colon vaginoplasty is an intrusive procedure in which the intra-abdominal cavity must be entered via a low transverse abdominal incision (like Caesarean section incision in biological female).

A 20 cm colon segment is selected from a part of the sigmoid colon for being used as the colon graft.

One end of colon graft is closed while the other end is open and slide down through the vaginal tunnel for suturing to vaginal opening.

Below is the indications for colon vaginoplasty

A: Primary colon vaginoplasty (Male to Female SRS with colon graft)

For primary sex reassignment surgery, Dr. Chettawut normally recommend standard SRS (Non penile inversion SRS with skin graft technique) rather than the primary colon vaginoplasty (Non penile inversion SRS with colon graft technique) to avoid the possible risks or complications inside abdomen related to colon surgery.

Dr.Chettawut may consider performing the primary colon vaginoplasty in selective cases with the following criteria:

1. Patients’ age must be less than 45 years old.

2. Patients’ weight must be less than 80 kg.

3. Patient’s BMI must be less than 28

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B: Secondary colon vaginoplasty (Colon graft technique for treating patients who suffer short vagina from their primary SRS)

Short vagina (vaginal depth is less than 4 inches) is considered a non-functional vagina as it cannot provide satisfactory sexual intercourse with average sized penis.

Collapse vagina is a condition of total vaginal canal shrink while vaginal opening is still normal appearance.

The causes of short or collapse vagina from primary SRS can be

1. Insufficient creation of vaginal tunnel or inadequate skin graft during SRS operation

2. Poor healing inside neo-vagina due to skin graft failure or post-inflammatory scar

3. Patients’ failure to maintain their original vaginal depth by stopping or ignoring to do a regular and proper vaginal dilation schedule

The treatment of short or collapse vagina comprise of

1. Remove post-inflammatory scar inside vagina

2. Re-created vaginal tunnel with proper dimension (vaginal width)

3. Use the colon graft for being a new & healthy lining inside vagina

The skin graft technique cannot be effectively applied inside recreated vagina because the skin graft cannot heal and survive in post-scarring tissue. Unlike skin graft, the colon graft brings its own blood supply to the post-scarring area and can heal properly.

This is why the colon graft technique is the best solution to treat short or collapse vagina as it can provide healthy tissue for a new lining inside vagina with excellent depth and self-lubrication.

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C: Colon Vaginoplasty in Female patients (Colon graft technique for treating congenital absence of the vaginal canal)

The colon vaginoplasty is no longer limited to transgendered patients as a part of sex reassignment surgery, however it can be applied to those biological woman who are 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 absence of vaginal canal and uterus, however the ovaries are intact and ovulation usually occurs.

Since the abnormality cannot be seen from the outside, this is often detected when a child reaches the puberty stage and experiences absence of menstruation.

Even though both skin graft and colon graft technique can be used for vaginal canal reconstruction in vaginal agenesis (Mayer-Rokitansky-kuster-hauser syndrome or Mullerian agenesis), the colon graft from colon vaginoplasty turned out to be more beneficial for this group of patients.

While the skin graft technique requires harvesting skin from somewhere in body which leave unsightly scar, the colon graft technique requires only short horizontal linear scar (like c-section).

The colon vaginopasty can also provide adequate lubrication and an appropriate vaginal depth for those patients who suffer from vaginal agenesis.

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Dr. Chettawut's recommendation program for Vaginal dilation routine
after Sex reassignment surgery with colon graft (Colon vaginoplasty)

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