背景:跨性别女性是指出生时被分配为男性的女性,以及具有女性性别认同的人。大多数人要求通过外阴阴道成形术进行性别确认生殖器手术。我们的目的是根据手术的历史回顾这个手术,然后介绍不同的手术技术及其成功率和并发症发生率。
方法:进行了叙述性回顾,基于Pubmed上具有2000年至2022年关键字的参考书目搜索。
结果:跨性别妇女的阴道成形术始于1931年,第一个病例系列始于1969年。手术包括阴囊皮肤切除,睾丸切除术,阴蒂成形术,尿道成形术,阴唇成形术,膀胱前列腺解剖和阴道腔的形成(通过阴茎皮肤倒置和移植进行,肠,或腹膜)。通过阴茎皮肤倒置(VPPI)进行外阴阴道成形术是当今的参考手术技术。它代表了绝大多数随访时间最长的手术。大多数跨性别女性对手术的美学(90%)和功能(80%)感到满意,积极的性行为。主要并发症很少见(<5%),它们对应于瘘管或阴道狭窄。
结论:VPPI是具有令人满意的总体结果的黄金标准技术,但需要长期随访。
BACKGROUND: 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 vulvo-vaginoplasty. The objective is to review this surgery based on its history, then by presenting the different surgical techniques and their success and complication rates.
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.
CONCLUSIONS: VPPI is the gold standard technique with satisfactory overall results, but long-term follow-up is requested.