Done By Dr.Ma'ad Al-Jubouri >>> Iraq-Baghdad

1. Vaginoplasty
Done By :- Ma’ad Adnan
:- Dr.Ali Al- HussainiSupervised By

2. What is Vaginoplasty?
Vaginoplasty is a medical procedure
that serves to ‘tighten up’ vaginal
muscles, which can loosen up with
aging and childbirth.
It helps in correcting defects and
deformities of vaginal canal, congenital
disease, acquired cause – physical
trauma, cancer.

3. Different therapeutic options
Non-operative method Operative methods
A. For Neovagina
1. Vecchietti operation
2. Balloon Vaginoplasty
Foreign tissue
vaginoplasty
1. free skin graft (McIndoe
method)
2. Sigmoid vaginostomy
3. Buccal mucosa
4. Wilson Method(for Intersex pt.)
5. Don Flap (labia minora flap)
B. For Vaginal Tightening
1. Laser Vaginal Tightening

4. Non-operative method
A. For Neovagina
1.Vecchietti procedure :-
the Vecchietti procedure is a laparoscopic surgical
technique that produces a vagina of dimensions
(depth and width) comparable to those of a
normal vagina (ca. 8.0 cm. deep) A small, plastic
sphere (“olive”) is threaded (sutured) against the
vaginal area; the threads are drawn though the
vaginal skin, up through the abdomen, and
through the navel. There, the threads are
attached to a traction device

5. and then daily are drawn tight so that the
“olive” is pulled inwards and stretches the
vagina, by approximately 1.0 cm. per day,
thereby creating a vagina, approximately
7.0 cm. deep by 7.0 cm. wide, in 7 days.
The mean operating room (OR) time for the
Vecchietti vaginoplasty is approximately 45
minutes; yet, depending upon the patient
and her indications, the procedure might
require more time.

6. plastic sphere (“olive”) in vecchiette procedure

7. Disadvantages of the Vecchietti procedure
1.It requires specialized teams utilizing
sophisticated instrumentation.
2.and it is tedious to perform.
3. It has the drawbacks of requiring daily
traction for 8 to 10 days.
4.it lifts the posterior urethrovesical angle,
making it more obtuse.

8. 5.possible consequence of causing stress
incontinence later on (the posterior traction on
the urethral supports also placing the patient at
higher risk for stress incontinence).
6. Furthermore, a change in the pelvic floor
balance has been suspected .
7.Another problem with the Vecchietti
vaginoplasty is the use of a special abdominal
traction device for a few days

9. 2.Balloon vaginoplasty
In the balloon vaginoplasty technique,
a Foley catheter is laparoscopically inserted
to the rectouterine pouch whereupon
gradual traction and distension are applied
to create a neovagina . Moreover, balloon
vaginoplasty also is a new technique for
treating vaginal aplasia,

10. which also is applied as a technically simple,
physically safe, and medically effective
alternative vaginoplasty for creating a
neovagina, especially when conventional
laparoscopic surgery is either infeasible or
unsafe.Balloon vaginoplasty was introduced by
professor Ali El Saman from Egypt as the fastest
methodfor creation of a naturally covered
neovagina.

11. Balloon vaginoplasty is both effective and
unique in the ability to manage and control
both the depth and the length of the
reconstructed neovagina.Interestingly, the
balloon vaginoplasty procedure is so simple
that it could be conducted under local
anesthesia.Furthermore, balloon vaginoplasty
is associated with cosmetically appealing
vagina especially when it was conducted via
single port.

15. is a non-surgical, vaginal rejuvenation
treatment. Using the strong ablative and
thermal effect of the CO2 laser . It act by
stimulating collagen production, it
restructures lax skin and regenerates
damaged tissue. LVT provides significant
relief for women with post-childbirth loss of
sensation, and those suffering from stress
incontinence.
B. For Vaginal Tightening
1.Laser Vaginal Tightening

17. Operative methods
• free skin graft (McIndoe method)
The McIndoe vaginoplasty technique used in
congenital absence of vagina utilizes split-
thickness skin grafts that cover a mold, which is
then inserted into a surgically created space
between the bladder and the rectum. The
principal technical difference between the
McIndoe vaginoplasty and the Vecchietti
vaginoplasty is which tissue to utilize to line the
created neovagina .

18. Each surgical procedure has positive
and negative factors, especially
regarding upon whom such a plastic
surgical technique can be applied,
because the post-operative outcome
varies with the patient’s indications.

19. • Sigmoid vaginostomy :-
The Sigmoid Vaginostomy technique
creates a vagina by cutting a segment of
the sigmoid colon along with its vascular
pedicle and using it to form vaginal lining.
This surgery is performed on women
with androgen insensitivity syndrome ,
congenital adrenal hyperplasia , vaginal
agenesis, müllerian agenesis,

20. and other intersex conditions where in
non-invasive forms of deepening the
vagina cannot be performed (mostly on
trans women patients) as an alternative
to penile inversion, with or without an
accompanying skin graft (usually from
the thigh or the abdomen).

21. Because of the potential complications
(e.g. diversion colitis) most surgeons will
recommend a colovaginoplasty procedure
only when there is no alternative
procedure.
The benefit of this procedure is that it gives
good space and length to neo-vagina .

22. . Buccal (oral) mucosa :-
A relatively novel surgical approach to
treating vaginal agenesis is utilizing the buccal
mucosa as the tissue for lining the vagina
(ca. 8.0 cm. deep).
The medical advantages of this vaginoplasty
technique include the biological and healing
qualities of the buccal mucosa tissue, minimal
scarring, and a short, post-operative recovery
for the patient.

23. The disadvantages include limited
vaginal dimensions (depth and width),
and the possibility of either intraoral
damage, when tissue-harvesting, or of
complications.

24. • Wilson Method ( For Intersex condition ) :-
The penile-inversion technique of the Wilson
Method is different from the traditional
penile-inversion technique in that it is a
three-stage surgery, comprising a two-stage
initial vaginoplasty. The Wilson Method
surgery is initially performed like a traditional
penile inversion, until the vaginal-vault
creation step,

25. in which the vault of the vagina is left
unfinished, as a raw surface, and is packed
with a sterile stent, which, after 5–7 days,
then is lined with a skin graft harvested from
the buttocks. The penile skin is used to
create the labia minora, clitoral hooding, and
the anterior fourchette (frenulum); the glans
penis is used to create the clitoris, and the
scrotum is used to create the labia majora .

27. .Don Flap (labia minora flap) :-
The Don Flap correction of vaginal
agenesis uses a technique similar to that
of penile inversion, that sutures the labia
minora together to create a neovagina. A
refinement of this vaginoplastic technique
is its utilization of the prepucial skin
(hood) of the clitoris as a horseshoe-
shaped, one-piece flap.

28. Yet, although the Don Flap technique is a
relatively simple surgical procedure, the most
obvious disadvantages of the labia minora
flap surgery include the need for restorative
labiaplasty and cervical dilation to produce a
vagina of adequate dimensions (depth and
width).

30. Risks & Recovery of Vaginoplasty
Risks:-
1. There may be a permanent increase or
decrease in genital sensation after surgery.
2. Ongoing pain can occur if the muscles are
Tightened too much during surgery.
3. Scarring of genital area.
5. Bleeding

31. -Recovery :
1. During the first few days a person feels
a bit uncomfortable, full recovery usually
takes about 6 weeks.
2. A person can return to work after a
week from the surgery.

32. THE END
THANK YOU