Outcomes of gender-affirming sigmoid colon vaginoplasty: A retrospective study of 119 patients.

BACKGROUND

Sigmoid colon vaginoplasty (SCV) is a recognized alternative to penile inversion vaginoplasty (PIV) for transgender and non-binary (TGNB) individuals seeking genital gender-affirming surgery. SCV provides self-lubricating mucosa, requires less dilation, enables a longer neovaginal canal, and may reduce the risks of stenosis and reoperation. This study evaluated the safety and efficacy of SCV and compared the outcomes between primary and revision cases.

METHODS

A retrospective review of TGNB patients who underwent SCV at a single center was conducted from December 2020 to June 2024. Patient demographics, operative details, and postoperative complications were analyzed, categorized as short-term (<30 days) or long-term (≥30 days).

RESULTS

Among the 119 SCV cases, 66 (55.5%) were primary and 53 (44.5%) were revisions. Median age was 33 years, body mass index (BMI) was 28.5 kg/m², and operative duration was longer in primary cases (209 vs. 162 min, p<0.001). Median follow-up was 9.3 months. Short-term complications occurred in 21 (17.7%) patients, including full-thickness dehiscence (8.4%) and ileus (5.0%), with 6 (5.0%) requiring reoperation. Long-term complications affected 29 (24.4%) patients, primarily mucosal prolapse (11.8%), and introital stenosis (9.2%). Reoperations were necessary in 20 (16.8%) cases. Complication rates were similar between primary and revision cohorts.

CONCLUSION

SCV is a safe and effective alternative to PIV, with comparable complication and reoperation rates. Although mucosal prolapse remains a concern, SCV may be preferable for patients with penoscrotal hypoplasia, higher BMI, or complete vaginal stenosis. Furthermore, patient preferences and tissue availability should guide surgical decisions.