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Chao et al. Plast Aesthet Res. 2025;12:29 Plastic and
DOI: 10.20517/2347-9264.2025.18
Aesthetic Research

Technical Note Open Access

Technical considerations for neovaginal canal
creation during primary and revision gender-

affirming vaginoplasty

2
1
Brian W. Chao 1 , Cathrine Keiner , Alysen Demzik , Joseph J. Pariser 1
1
Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA.
2
Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA.
Correspondence to: Dr. Brian W. Chao, Genitourinary Reconstructive Surgery, Department of Urology, University of Minnesota,
420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA. E-mail: brian.wen.chao@gmail.com

How to cite this article: Chao BW, Keiner C, Demzik A, Pariser JJ. Technical considerations for neovaginal canal creation during
primary and revision gender-affirming vaginoplasty. Plast Aesthet Res. 2025;12:29. https://dx.doi.org/10.20517/2347-9264.
2025.18
Received: 19 Feb 2025 First Decision: 13 Jun 2025 Revised: 22 Jul 2025 Accepted: 11 Aug 2025 Published: 15 Sep 2025

Academic Editors: Miroslav L. Djordjevic, Xiao Long Copy Editor: Xing-Yue Zhang Production Editor: Xing-Yue Zhang

Abstract
A critical component of gender-affirming vaginoplasty is the creation of a functional neovaginal canal capable of
penetrative intercourse. Canal creation is inherently challenging due to the deep pelvic anatomy and risk of injury
to the urethra, bladder, and rectum. These challenges are amplified in revision cases undertaken to correct
neovaginal stenosis or convert minimal-depth to full-depth canals.

With increasing interest in and access to gender-affirming surgery, myriad techniques for canal creation have
arisen. These utilize a variety of donor tissues to line the canal, including genital and extragenital skin grafts,
xenografts, allografts, peritoneum, and intestine. Moreover, the rectoprostatic dissection necessary for canal
creation can be performed via a perineal approach or with robotic assistance. However, few comparative studies
exist to inform the choice of surgical approach or donor tissue.

In this article, we briefly review the donor tissue options available for neovaginal canal creation, discuss the
associated advantages and disadvantages, and reference pertinent contemporary research. We additionally
describe our institutional approach for canal creation in primary and revision vaginoplasties, highlighting technical
nuances for success.

Keywords: Gender-affirming vaginoplasty, gender dysphoria, penile inversion vaginoplasty, revision vaginoplasty,
vaginoplasty

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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