People who meet the following requirements can undergo colon vaginoplasty surgery:
Even if it is not an explicit criterion, regular visits, agreed on the basis of individual needs, with a psychologist and/or medical specialist (e.g. endocrinologist) are recommended.
These requirements are indicated in the scientific publications listed in the "Bibliography" section.
When the necessary criteria for carrying out the surgery are met (see above), the person concerned must:
Suspension of hormone therapy with oestrogens from one month before surgery to fifteen days after. In general, if taking any prescription medication, one should discuss it with the specialist of reference. It may be necessary to stop taking it even several days before the surgery. Drug therapy may be resumed at the doctor's discretion.
The intervention involves two phases, a demolition phase and a reconstructive phase.
The demolition phase involves the removal of the original genital organs: testes, epididymis and funicles (sacs and canals that contain spermatozoa), penis and part of the urethra (the urethra is a channel that connects the bladder with the outside and that constitutes the last tract of the urinary tract). It should be noted that the prostate is not removed. The demolition phase of the intervention irreversibly precludes the ability to reproduce. In the reconstructive phase, a new vagina (neovagina) is created using a part of the intestine in addition to the skin of the penis and scrotum. We then proceed with the creation of the external genitalia (clitoris, large and small labia) and the creation of the female urethra to be able to urinate. In particular, a part of the glans penis (apex of the penis) is preserved to build a clitoris which allows, in most cases, to have a good erotic sensitivity during sexual intercourse. At the end of the surgery, a bladder catheter (cannula that allows urine to be eliminated) and a compression bandage are applied, which will be kept for a few days. About four days after the operation, the vaginal dilation maneuvers will begin and will be taught by the healthcare staff and must be performed every day following the instructions of the surgeon. Sexual activity can be resumed approximately 2-3 months after surgery.
Colon vaginoplasty is only recommended for people who do not have the ability to perform penile and scrotal inversion vaginoplasty (for example because it is reasonable to think that one will not get a sufficiently deep vagina) or who need a second surgery to stretch the vaginal canal due to of a shortening of the neovagina. Colon vaginoplasty presents more health risks than penile and scrotal inversion vaginoplasty (mortality reported in the literature up to 3-4%) as a part of the intestine must be pre-washed and it is for this reason that it is avoided unless the conditions described occur.
The surgical procedure lasts about seven hours and takes place under general anesthesia.
Colon vaginoplasty surgery involves hospitalization ranging from 7 to 14 days, depending on the characteristics of the person and post-operative recovery.
The complications of colon vaginoplasty are divided into immediate and secondary.
Secondary complications (delayed):
National Health Service (NHS): no cost.
Private practice: at the discretion of the health provider.
Coleman E, Bockting W, Botzer M, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend. 2012; 13(4): 165-232.
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. Erratum in: J Clin Endocrinol Metab. 2018; 103(2): 699. J Clin Endocrinol Metab. 2018; 103(7): 2758-2759.