XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Secondary Corrections of the Vulva in Male-to-Female Transsexuals: The Amsterdam Experience

Karim RB, Hage JJ, Goedkoop AY, and Kanhai RCJ

Department of Plastic and Reconstructive Surgery, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.

From December 1980 to January 1998, 390 male-to-female transsexuals underwent vaginoplasty by inversion of penile skin and a triangular perineoscrotal flap. Although minor modifications were adapted throughout the years, the basic surgical technique remained the same over this 18-year period. In 21% of our patients, secondary corrections of the vulva were deemed necessary.

The use of the triangular perineoscrotal flap favours the introital width, but its base may obstruct the introitus and surgical introitus widening by five-flap advancement was needed.

In cases where the ventral part of the labia majora remain too wide apart, bilateral Z-plasties will correct this. Unlike Meyer and Kesselring, we do not advise to do this primarily as it will reduce the vascular supply of the penile skin flap.

Secondary construction of a labia minora is the third form of correction sometimes requested by these patients who often seek ultimate finesse of female appearance. We feel that secondary corrections should not be performed within the first postoperative year.