What happens in the sigmoid colon in vaginoplasty for trans women?

Dr Salil explains that there are techniques like the sigmoid colon, “which uses your intestine, using your intestine we can create a vagina.”

Advantages

There are numerous advantages of this procedure. So firstly, your bowel is already the shape of a tube so we don’t have to carve out a tube. It has, from the inside, a natural covering, which matches the covering of the vagina which is called the mucosa. It is soft and it has secretions so you won’t need any lubrication. There are muscles in it which can contract, even though these contractions aren’t voluntary and not under your control, it is still there.

And so all these factors kept in mind, it is established that it is a really good technique.

The last thing is that you can get as much length as you want.

Why isn’t it used much?

Dr Salil explains, “So this technique is a really good one but it isn’t used much. That is because our bowel is a long tube-like structure and we have to cut it from the middle first and then join the other tubes together. The cut part, with its blood supply, is very carefully brought down towards your pelvis where your anal opening is located.

And then from there taking the scrotal opening, we can make the vagina.

So in this, you have to do surgery on the tummy which can be done laparoscopically so there won’t be big cuts in there, just small, tiny cuts, incisions and punctures that are one cut each.

There might be additional technical issues like we are doing bowel surgery so we would hope that there are no problems with that.

That’s done. And then the bowel secretion that comes out, the normal liquid that is secreted, its smell is different and in some people, the smell creates problems for some people. This smell reduces in a few months but in the initial stages when it happens, some people might not like it.

So because of all these issues, it is not used regularly in surgeries.”

Revision surgeries

But it is an ideal technique in revision surgeries. So if someone, for any reason, wants to revise their surgery and lengthen the vagina, or increase its size or there is some infection or there is a low supply of blood, because the vagina wasn’t made properly. So in these cases, bowel surgery is ideal.

In my opinion, bowel surgery is not preferred in the first surgery so I would keep it as a backup option or for revision surgery.

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