Full-Length Peritoneal Flap Vaginoplasty: A Feasible Approach for Hairless Neovaginal Reconstruction in Gender-Affirming Surgery.

Abstract

The authors present a technique for neovaginal reconstruction in gender-affirming vaginoplasty using an anteriorly based peritoneal turnover flap to create a full-length lining throughout the depth of the neovaginal canal. Between 2024 and 2025, 10 patients successfully underwent the procedure without major complications. At the 3-month follow-up, 80% of patients maintained neovaginal depth comparable to the immediate postoperative measurement. Internal neovaginal examination demonstrated that the neovaginal lining exhibited a mucosal surface, high elasticity, and self-lubrication. The potential impact of peritoneal flap harvesting on the urinary bladder was evaluated using the Incontinence Questionnaire-Male Lower Urinary Tract Symptoms. This technique may represent a feasible approach for achieving hairless neovaginal reconstruction in gender-affirming surgery, particularly for patients with scrotal skin deficiency or extensive genital hair.