Vaginal Reconstruction and Neovagina Surgery in Turkey
Vaginal reconstruction is a reconstructive surgical procedure performed in selected patients when the vagina has not developed from birth or when a significant amount of vaginal tissue has been lost.
In conditions such as congenital vaginal agenesis, assessment should not be limited to plastic surgery alone. The anatomy of the reproductive system and any associated abnormalities also need to be evaluated, which is why treatment is planned together with a gynaecology team.
At Anka Plastic Surgery, our approach is multidisciplinary. In suitable patients, the gynaecology team creates the vaginal space in the appropriate anatomical plane, after which the reconstructive stage is performed to line this space with suitable tissue. The reconstructive technique is selected according to the patient’s anatomy, available tissues and any previous operations.
What Is Vaginal Agenesis?
Vaginal agenesis is a congenital condition in which the vagina is absent or has not developed fully.
In some patients, abnormalities involving the uterus, cervix or other reproductive structures may also be present. For this reason, assessment should consider the reproductive anatomy as a whole rather than focusing only on the vaginal canal.
Not every patient with vaginal agenesis requires surgery. Non-surgical dilation may be considered in suitable patients and may be recommended before an operation is discussed.
The decision to proceed with surgery depends on the patient’s anatomy, age, expectations and gynaecological assessment.
What Is a Neovagina?
A neovagina is a new vaginal canal created surgically when the vagina is absent because of a congenital condition or has been lost as a result of surgery, trauma or another cause.
The aim is not simply to create an anatomical space. Reconstruction is planned to achieve, as far as possible, a vaginal canal with adequate length and width that is durable and functional.
How Is Vaginal Reconstruction Performed?
There is no single reconstructive technique that is suitable for every patient.
At Anka Plastic Surgery, these operations are performed in collaboration with a gynaecology team. Once the vaginal space has been created in the appropriate anatomical plane, its inner surface needs to be lined with suitable tissue.
In selected patients, one of the techniques I most commonly use is reconstruction with a skin graft.
Neovagina Reconstruction with a Skin Graft
In skin-graft reconstruction, a thin layer of skin is usually taken from the groin area and used to line the newly created vaginal space.
One advantage of the groin as a donor site is that the resulting scar can generally be positioned in a relatively concealed area.
The graft is placed within the newly created canal and is expected to heal onto the underlying surface, becoming the lining of the neovagina.
In suitable patients, I often favour this technique because it provides a relatively thin and flexible lining.
When Are Local Flaps Used?
A number of local flap techniques have been described for vaginal reconstruction.
In some patients, however, local flaps can create tissue that is thicker than desirable for the lining of the vaginal canal. For this reason, I do not routinely use local flaps when a thinner graft-based reconstruction is more appropriate.
Previous surgery, the amount and quality of available tissue, and the extent of the defect may nevertheless make a different reconstructive technique more suitable in individual cases.
Vaginal Reconstruction with Free Jejunum
Segments of bowel can also be used for vaginal reconstruction. We have previously performed neovaginal reconstruction using free jejunal tissue.
Jejunal mucosa has a soft, moist surface and can resemble some of the characteristics of vaginal tissue. However, intestinal mucosa continues to produce secretions after reconstruction.
For some patients, this can result in persistent or excessive discharge and may lead to the need for regular use of sanitary pads. For this reason, free jejunal reconstruction is not my first-choice technique in most cases.
Why Is Dilatation Important After Surgery?
Creating the neovagina is only one part of the treatment.
After surgery, regular dilation may be required to help maintain the width and length of the newly formed vaginal canal.
The frequency and duration of dilation depend on the surgical technique, healing process and individual anatomy. Compliance with the recommended dilation programme can play an important role in the long-term functional result.
Recovery After Vaginal Reconstruction
Recovery varies according to the reconstructive technique used.
When a skin graft has been used, one of the main priorities during the early postoperative period is allowing the graft to heal successfully onto the newly created surface.
Postoperative care may include:
- Wound and graft care
- Careful hygiene
- Measures to reduce the risk of infection
- Following the recommended dilation programme
- Regular clinical follow-up
Complete healing of the graft and adaptation of the reconstructed canal take time.
Sexual Function After Vaginal Reconstruction
One of the main aims of vaginal reconstruction is to create a functional vaginal canal that may allow sexual intercourse when healing is complete and the patient is medically ready.
Function is not determined by vaginal length or width alone. Tissue flexibility, scar formation, the condition of the vaginal opening, adherence to dilation and individual healing characteristics can all influence the result.
For this reason, realistic expectations and the possible limitations of reconstruction should be discussed carefully before surgery.
Who May Be Considered for Vaginal Reconstruction?
Vaginal reconstruction may be considered in patients with:
- Congenital vaginal agenesis
- A previous unsuccessful vaginal reconstruction
- Significant loss of vaginal tissue
- Selected traumatic or surgery-related vaginal defects
The need for surgery and the most appropriate reconstructive technique are assessed individually.
A Multidisciplinary Approach
Particularly in congenital vaginal agenesis, assessment by a gynaecologist is an important part of treatment planning.
The evaluation may include the anatomy of the genital tract, the presence or absence of the uterus and cervix, associated abnormalities and other aspects of reproductive anatomy.
The role of reconstructive surgery is to restore the vaginal lining and structure when this is required. For this reason, I prefer these procedures to be planned jointly by gynaecology and plastic reconstructive surgery teams.
Vaginal Reconstruction at Anka Plastic Surgery
The aim of vaginal reconstruction is not simply to create a new anatomical space. The objective is to create a neovagina that is appropriate for the patient’s anatomy and, as far as possible, durable and functional.
In suitable patients, after the vaginal space has been created by the gynaecology team, I most commonly use a skin graft taken from the groin area for reconstruction.
The final surgical plan is always individualised according to the patient’s anatomy, previous operations, available tissues and overall reconstructive needs.