Genital gender affirming surgery in trans women: Vulvo-vaginoplasty review

Introduction. - A trans woman is a woman who was assigned male at birth, and who has a female gender identity. The majority are requesting a gender affirming genital surgery by vulvovaginoplasty. The objective is to review this surgery based on its history, then by presenting the different surgical techniques and their success and complication rates. Material and methods. - A narrative review was performed, based on a bibliography search with keywords from 2000 to 2022 on Pubmed. Results. - Vulvo-vaginoplasty for trans women began in 1931, and the first case series date from 1969. The procedure includes excision of scrotal skin, orchiectomy, clitoroplasty, urethroplasty, labioplasty, recto-vesico-prostatic dissection and creation of a vaginal cavity (performed by penile skin inversion and graft, intestine, or peritoneum). Vulvo-vaginoplasty by penile skin inversion (VPPI) is today the reference surgical technique. It represents the vast majority of surgeries performed with the longest follow-up. The majority of trans women are satisfied with the procedure aesthetically (90%) and functionally (80%), with an active sexuality. Major complications are rare (< 5%), they correspond to fistulas or vaginal stenosis. Conclusion. - VPPI is the gold standard technique with satisfactory overall results, but longterm follow-up is requested. (c) 2023 Elsevier Masson SAS. All rights reserved.