Colovaginoplasty is a surgical procedure that involves using a section of the end of the large intestine (the sigmoid colon) to create a neovagina.
It will be the surgeon, together with his or her medical team, who will decide upon the most appropriate technique for each patient in light of their physical characteristics and medical history.
A colovaginoplasty is usually carried out in cases in which the penile inversion technique is unviable. This can occur when the penis skin, when stretched, is less than 12 centimetres long, when the patient has been circumcised or when the patient has been operated on before without successfully achieving vaginal depth.
Patients must stop hormone therapy some four weeks prior to the operation, since oestrogens (female hormones) in the bloodstream increase the risk of deep vein thrombosis (blood clots inside the veins) with all the associated risks and problems. This process should be progressive, and patients are therefore advised to reduce the dosage in the week prior to the four hormone-free weeks.
The effects of stopping hormone therapy will be clear to patients. Although they vary from one person to another, the symptoms range from sharp mood swings, dizziness and nausea to the appearance of clearly masculine traits (facial hair, involuntary erections, etc.). The situation will soon stabilize and the discomfort may well disappear. The more gradual the cut in hormones, the more bearable the change.
In addition to the tests previously mentioned, a colonoscopy will be required before the procedure. This is a study, carried out under sedation, involving the insertion of a tiny camera into the intestine to allow the medical team to ascertain the state of the portion of the intestine to be transplanted.
Three days prior to admission, the medical team will stipulate a diet to help ensure the colon is clean. Patients must follow it scrupulously to ensure the success of the procedure.
Patients are admitted the day before the procedure. Over the course of the day, the relevant tests are carried out and the colon (large intestine) cleaned out with an enema to ensure that it is clean and as free from bacteria as possible.
Colovaginoplasty requires at least a week to ten days in hospital, so that the medical team can better monitor patients’ progress.
The operation generally lasts between six and nine hours, plus pre-anaesthesia and patient preparation time and recovery immediately after surgery. It is always carried out under general anaesthetic.
It begins with a Pfannenstiel incision (the same as that used during a caesarean) in the abdomen, providing the surgeon with access to the abdominal cavity.
18 to 20 centimetres of the sigmoid colon, complete with blood vessels, are separated and sectioned, and moved to the area of the perineum. Previously, a tunnel has been made in the area, running from the perineum inside the abdomen. The rest of the sectioned colon is joined together so it can continue to carry out its function after the operation.
The rest of the procedure (removing the testicles, shortening of the urethra and vaginal aesthetics) is the same as with the penile inversion technique.
After the operation, two abdominal drainage catheters are put in place which will be removed after at least 48 hours post-op, at the time the medical team deems fit.
The intestine will not recover its function for two or three days, and it will thus not be until after then that food is taken by mouth. During the operation, a urinary catheter will be inserted and will not be removed for two weeks.
Healing and dilation exercises will begin on the seventh day after the intervention and a member of the medical team will instruct the patient on dilation and washing techniques. To this end, two dilators of different sizes and a vaginal stent kit are supplied: these should be used when the doctor indicates.
Once back home, patients should contact the doctor who oversees their hormone therapy to restart it (after around four weeks) and adjust the dosage. Under no circumstances should patients themselves adjust their hormone therapy dosage, as this could cause health problems.
The possible complications following this procedure are the same as with the penile inversion technique. In other words, those that may appear immediately subsequent to the procedure include wound infection, hematomas and/or urine retention. In later post-op, the following could occur: introitus or vaginal stenosis, urethral and meatum stenosis and/or deep vein thrombosis and pulmonary embolism.
Additionally, there is the possibility of a defect in the colon’s suture, which would require corrective surgery, as well as necrosis of the new vagina due to lack of blood supply.
A member of the medical team will tell patients how to prevent these possible complications and how to act should they appear. If they have any doubts or anomalies after the operation, patients should consult their doctor, to allow him or her to carry out a diagnosis and provide a solution.