Fold-back perineoscrotal flap plus penile inversion vaginoplasty
for male-to-female gender reassignment surgery
in circumcised subjects
Kamyar Tavakkoli Tabassi
Received: 4 October 2014 /Accepted: 3 November 2014 /Published online: 3 December 2014
Springer-Verlag Berlin Heidelberg 2014
Background The use of the penile skin for vaginoplasty is a
common method in male-to-female (MTF) transsexual surgery.
We aim to describe the results of a one-stage vaginoplasty in
previously circumcised sex reassignment surgery using fold-
back perineoscrotal flap plus penile inversion flap.
Methods In a prospective study, 112 previously circumcised
MTF subjects underwent a modification of penile inversion
vaginoplasty by adding a fold-back perineoscrotal flap to
form the whole posterior vaginal wall and about half of the
anterior vaginal wall (the proximal part). Patients follow-up,
outcomes, and complications were recorded.
Results The mean age of the subjects was 25.8±3.3 years
underwent feminizing genitoplasty. The success rate was
92.86 %, and the complication-free success rate was achieved
in 74.11 % of subjects in general. The need for repeated
surgery (failure rate) was 7.14 % (due to vaginal shrinkage
in four patients, bulging in anterior vaginal wall in one case
and excessive labial skin in three cases). By adding the
perineoscrotal flap to the penile skin flap, we were able to
reach a mean vaginal depth of 13.1±1.7 and a satisfaction
level of 85.71 %.
Conclusions Fold-back perineoscrotal flap plus penile inver-
sion vaginoplasty is a suitable surgical approach for achieving
adequate vaginal depth in cases of male-to-female (MTF)
transsexual vaginoplasty when subjects have short penile skin
flap because of circumcision.
Level of Evidence: Level III, therapeutic study.
Vagin o pl as ty
Benjamin Franklin for the first time described transsexualism
as a gender identity disease in 1953 [1, 2]. In transsexuals,
gender identity is inconsistent with their physical characteris-
tics, genetic type, hormonal status, and occasionally the per-
ception of others about their gender. Such individuals, after
passing the essential psychological and legal steps and
obtaining the necessary permits (licenses), undergo various
hormonal interventions followed by different surgical
In transsexual male-to-female (MTF) cases, the most im-
portant surgical approach is feminizing genitoplasty which
aims to create a female external genitalia with desirable func-
tion and appearance [3, 4]. The use of the penile skin for
vaginoplasty is a common method in MTF transsexual sur-
gery [5–8]. One of the main challenges in this technique is the
resultant reduced vaginal depth, in cases with a short penis.
This problem is further compounded in circumcised patients,
who have lost 5 to 6 cm of the penile flap. To overcome the
problem of short penis flap in MTF genitoplasty, we used a
modified surgical technique. Here, we report our experience
with this procedure and our outcomes.
K. Tavakkoli Tabassi (*)
Mashhad Center for Reconstructive Urology and Plastic Surgery of
Genitalia, Mashhad University of Medical Sciences, Mashhad, Iran
New York University, New York, NY, USA
University of Vienna, Vienna, Austria
Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
Eur J Plast Surg (2015) 38:43–48