A Primer on Colon Vaginoplasty

The average layperson thinks a vaginoplasty is a vaginoplasty is a vaginoplasty. It never occurs to them that there are actually different kinds of vaginoplasty—but there are. Let’s consider, for instance, the somewhat new and invasive procedure known as a colon vaginoplasty. We won’t be evaluating its relative merits or drawbacks (We’ll save that for another time and place), but rather, just explaining what it is, so that when someone uses the term, you’ll understand what they mean.

The recto-sigmoid colon vaginoplasty, as it’s technically known, is a procedure in which the plastic surgeon uses a portion of the sigmoid colon to create the neo-vagina. Put more clearly, the surgeon uses the portion of the large intestine which is “s shaped and sits above the rectum rather than using a skin-graft for the procedure.

The surgical technique is actually similar to the skin-graft vaginoplasty in many respects. However, the procedure is often used in situations where the skin-graft or penile inversion hasn’t produced an adequate result.

The colon vaginoplasty is normally more complex than the skin-graft vaginoplasty because it requires full access into the patient’s abdomen. The result will be extensive lateral scarring. However, some surgeons believe that these scars do not disfigure as much as those which result from a significant skin-graft being taken. Indeed, in recent years, some plastic surgeons have started advocating an approach to the procedure that doesn’t involve as significant scarring as in the more conventional procedure; this is known as a “laparoscopic” approach. This means it requires just a small abdominal incision, allowing the surgeon to retrieve the resection specimen via the patient’s anus.

Those who argue in favor of the colon vaginoplasty cite benefits such as self-lubrication as well as a deep neo-vagina. On the other side are those who point out that the procedure is more involved and that it requires a longer recovery period in the hospital. Also, we should point out that secretions from the colon graft are at times somewhat smelly and excessive, particularly in the first year to year and a half after the procedure. Plus the colon graft itself is a dark red color, requiring the surgeon to take care that the graft is properly connected to the patient’s vaginal skin to keep this unnatural redness from being overly visible.

As with any plastic surgery, there may be some complications possible One possible complication with the colon vaginoplasty is diversion colitis, a colon inflammation that sometimes occurs after a colostomy. But some surgeons have noted a lower risk of shrinkage in the neo-vagina than would be true with the older skin-graft methods. If so, this would mean a reduced amount of vaginal dilation required for ensuring that the vagina stays open after the surgery. (However, this doesn’t change the fact that an important part of the patient’s after-care will include vaginal dilation.)

After the colon vaginoplasty, the surgeon will typically remove the patient’s stitches about a week after the operation. During this time, the stent or vaginal packing will also likely be removed as well.