ORIGINAL RESEARCH—SURGERY Rectosigmoid Vaginoplasty: Clinical Experience and Outcomes in 86 Cases Miroslav L. Djordjevic, MD, PhD, Dusan S. Stanojevic, MD, PhD, and Marta R. Bizic, MD School of Medicine—University of Belgrade, Belgrade, Serbia DOI: 10.1111/j.1743-6109.2011.02494.x ABSTRACT Introduction. There are several techniques for creation of a neovagina. However, rectosigmoid segment presents the most natural substitute for vaginal tissue. Aim. To evaluate the anatomical and functional results of sigmoid vaginoplasty and long-term sexual and psycho- logical outcomes in 86 patients with vaginal absence. Methods. Between April 2000 and February 2009, 86 patients, aged 18 to 57 years (mean 22) underwent rectosigmoid vaginoplasty. Indications were vaginal agenesis (54), female transgenderism (27), and genital trauma (5). Rectosigmoid segments ranging from 8 cm to 11 cm were isolated, to avoid excessive mucus production. Preferably, it should be dissected distally first in order to check its mobility and determine the correct site for its proximal dissection. Stapling device was used for the colorectal anastomosis as the safest procedure. Creation of perineal cavity for vaginal replacement was performed using a simultaneous approach through the abdomen and perineum. Perineal skin flaps were designed for anastomosis with rectosigmoid vagina for the prevention of postoperative introital stenosis. Main Outcome Measures. Sexual and psychosocial outcomes assessment was based on the Female Sexual Function Index, Beck Depression Inventory, and standardized questionnaires. Results. Follow-up ranged from 8 to 114 months (mean 47 months). Good aesthetic result was achieved in 77 cases. Neovaginal prolapse (7) and deformity of the introitus (9) were repaired by minor surgery. There was no excessive mucus production, vaginal pain, or diversion colitis. Satisfactory sexual and psychosocial outcome was achieved in 69 patients (80.23%). Conclusions. Rectosigmoid colon presents a good choice for vaginoplasty. According to our results, sexual function and psychosocial status of patients who underwent rectosigmoid vaginoplasty were not affected in general, and patients attained complete recovery. Djordjevic ML, Stanojevic DS, and Bizic MR. Rectosigmoid vaginoplasty: Clinical experience and outcomes in 86 cases. J Sex Med 2011;8:3487–3494. Key Words. Vaginal Agenesis; Transsexualism; Rectosigmoid Colon; Vaginal Reconstruction Introduction R econstruction of the vagina is indicated in con- genital vaginal agenesis (Mayer–Rokitansky– Kuster–Hauser syndrome), sexual development disorder, and transgenderism, as well as following pelvic tumors or trauma. There are numerous pro- cedures described in the literature, with inherent advantages or disadvantages [1–10]. A variety of tissues have been used for vaginoplasty, including the split-thickness skin graft, full-thickness skin graft, labial flaps, peritoneum, myocutaneous flaps, bladder mucosa, buccal mucosa grafts, intestinal segments, surgical modification of Frank’s dilation method (Vecchietti), and penile/scrotal skin in trans- sexual patients [2,3]. The principal objective of each method is to create a vaginal cavity of adequate diameter and length and appropriate axis to accom- modate sexual intercourse. Traditionally, the most common method of vaginal reconstruction has been the split-thickness skin graft, first described by McIndoe [1]. Despite a positive functional result, 3487 © 2011 International Society for Sexual Medicine J Sex Med 2011;8:3487–3494