Colpopoiesis

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In gynecology, colpopoiesis is the surgical creation of an artificial vagina, also known as a neovagina . Colpopoiesis is used as a treatment method for vaginal aplasia and gynatresia , as well as for surgical genital transformation . The goal of treatment is usually to enable sexual intercourse. A neovagina, on the other hand, cannot be considered as a reproductive organ.

Operation according to the Vecchietti method

Modifications of the so-called Vecchietti surgical technique are the most widespread nowadays. This makes use of the fact that the outer parts of the genitals are usually fully developed in the affected women. In particular, there is usually a dimple made of natural vaginal lining that is not deep enough to allow sexual intercourse. The goal of the Vecchietti method is to stretch this vaginal dimple to a length of about 10 cm in a process lasting several days.

First, a vaginal tunnel is prepared from the abdominal cavity, which runs between the bladder and the intestine right up to the vaginal pit. Originally an abdominal incision was necessary for this, but today this step is usually performed endoscopically as part of a laparoscopy .

A so-called plug-in link phantom made of plastic is then placed on the vaginal dimple. Two tension threads are attached to the tip of this plug-in link phantom, which are guided through the vaginal dimple into the abdominal cavity into the prepared vaginal tunnel. From there, the tension threads behind the bladder are directed towards the abdominal wall, where they are led out to the left and right of the belly button.

By means of a tensioning device, the tension threads are now tightened more and more over several days, whereby the plug-in link phantom is pulled further and further into the prepared vaginal tunnel by stretching the vaginal pit. During this stretching phase, the patient's abdomen is numbed using an epidural anesthesia . After completing the stretching phase, the plug-in link phantom and the tension threads are removed again in a second short operation.

After the operation there is always a certain amount of shrinkage in the neovagina. In order to keep this shrinkage as low as possible, a vaginal phantom must be worn for several months after the operation until the neovagina has completely healed.

The Vecchietti surgical method has the decisive advantage over other methods that the neovagina is completely lined with natural vaginal mucosa. Vaginal flora , lubrication and sensitivity largely correspond to a natural vagina. Because no foreign tissue is transplanted, there are no scars on other parts of the body.

Sharp preparation

In the surgical genital transformation between men and women, a neovagina is sharply dissected. The procedure is performed in lithotomy position . After a high castration , the penis is completely dissected and the erectile tissue removed. The skin of the penis shaft including the vascular supply is protected. Between the bladder , prostate and rectum , a vagina of sufficient depth and width is created and lined with the skin of the penis shaft. An inflatable vaginal dilator is implanted into the vaginal tube formed in this way and removed after 6 days. For the construction of the labia is scrotum tissue used. A neoclitoris is formed from a piece of the glans penis (glans), which is innervated and supplied with blood by microsurgically prepared dorsal vascular nerve bundles. The urethral mouth is adjusted. At the request of the patient, a monsoplasty (infrapubic double Z-plasty) can also be performed during the procedure.

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