Male to Female

"Modified" Penile Inversion Vaginoplasty

Gender affirming surgery (GAS) generally refers to all surgical procedures which are performed to comprise the desired appearance and sexual function of the person. Vaginoplasty constitutes the main part of male to female (MtF) GAS, as it provides complete sexual ability in terms of functionality and aesthetics.


Preoperative assessment and surgical technique

- Hospitalization is initiated the day before surgery.

- To prevent postoperative wound contamination, bowel preparation with antibiotic prophylaxis is initiated 1-2 hours, prior to surgery.

- Hormonal treatment is discontinued at least three weeks preoperatively

- Basically, in this technique, the urethra is incised longitudinally from the midline and passed through a hole in the base of the penile skin.

- Afterwards, without damaging its vascularization, the urethral flap prepared by incising the penile skin flap dorsally is attached to the penile flap, which forms the upper and posterior wall of the neo-vagina and is fixed in the previously prepared neo-vaginal canal between the rectum and the prostate.

- However, to preserve sensation as much as possible, the glans penis is preserved and the neo-clitoris created from the protected glans penis is fixed to the pubic bone.

- All cases are performed, in collaboration of a plastic surgeon and urologist with sufficient experience in GAS, with the same "modified" PIV technique.


Advantages of "Modified" PIV

Integrating a well-protected urethra into a penile skin flap provides:

- Maximum vaginal depth and width

- Vaginal lubricity

- Vaginal sensation