Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics

Abstract

Objective: To assess the endoscopic characteristics of the sigmoid-derived neovagina, which have been scarcely described.

Design: Prospective observational study.

Setting: University tertiary medical center.

Patient(s): Patients that underwent sigmoid vaginoplasty.

Intervention(s): Patients were invited yearly to undergo neovaginoscopy and sigmoidoscopy, preceded by taking a medical history and physical examination, as routine follow-up.

Main outcome measure(s): Endoscopic signs of neovaginal inflammation.

Result(s): Thirty-four patients with a sigmoid neovagina underwent a total of 43 combined neovaginoscopies and sigmoidoscopies. After a mean postoperative time of 23 months, the most notable endoscopic features of the sigmoid-derived neovagina comprised a diminished vascular pattern, edema, granularity, friability, decreased resilience, and erythema. In the control rectosigmoidoscopy images, no concurrent abnormalities were observed. When applying the MAYO score to the neovaginal images, 12 (35%) patients scored MAYO 0, 19 (56%) MAYO I, 3 (9%) MAYO II, and none MAYO III. The presence of neovaginal discharge and malodor correlated with inflammatory endoscopic alterations.

Conclusion(s): The endoscopic appearance of a sigmoid segment after use in neovaginoplasty differs significantly from that of the remaining rectosigmoid. Inflammatory changes of the sigmoid-derived neovagina were observed in most patients. Clinically, the inflammatory changes appear similar to those encountered in diversion colitis.

Keywords: Laparoscopic vaginoplasty; colocolponeopoiesis; diversion colitis; intestinal neovagina; male-to-female transsexuality.