Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Management of cosmetic concerns after gender-affirming vaginoplasty: a retrospective case series and guide to revisions

International Journal of Impotence Research (2025)Cite this article

Subjects

Abstract

This retrospective study examines 58 transgender women who presented with cosmetic concerns following gender-affirming vaginoplasty between January 2020 and April 2023. The cohort’s mean age was 36.8 years (±9.8), with a mean BMI of 29.5 kg/m² (±7.1). Most patients were Black or African American (41.4%) or White (31.4%), and 43.0% had wound healing comorbidities. Of the total cohort, 62.1% (36/58) underwent penile inversion vaginoplasty (PIV), 31.0% (18/58) robotic-assisted vaginoplasty with peritoneal flaps, and 6.9% (4/58) shallow-depth vaginoplasty. A total of 36.2% (21/58) patients reported cosmetic concerns, most frequently labial (20.7%), clitoral (12.1%), hypergranulation tissue (8.6%), mons pubis fullness (5.2%), and introital scarring (5.2%). Management included expectant care, in-office procedures (e.g., silver nitrate for hypergranulation), and surgical revision. Surgical revision was performed in 80.9% of patients, with all reporting post-operative cosmetic satisfaction. A guide to surgical revision is discussed for each cosmetic concern subgroup. A tiered approach involving expectant management, in-office interventions, and surgical revision can effectively address these issues and enhance patient satisfaction.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2: Representative cosmetic concerns (upper row) and their respective post-revision outcomes (lower row).
Fig. 3: Representative cosmetic concerns (upper row) and their respective post-revision outcomes (lower row).

Similar content being viewed by others

Data availability

Our data will be made available upon request.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Arlington (VA): American Psychiatric Publishing; 2022.

  2. Budge SL, Adelson JL, Howard KAS. Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. J Consult Clin Psychol. 2013;81:545–57.

    Article  PubMed  Google Scholar 

  3. De Vries ALC, McGuire JK, Steensma TD, Wagenaar ECF, Doreleijers TAH, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134:696–704.

    Article  PubMed  Google Scholar 

  4. De Cuypere G, TSjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, et al. Sexual and physical health after sex reassignment surgery. Arch Sex Behav. 2005;34:679–90.

    Article  PubMed  Google Scholar 

  5. Green R. Sexual functioning in post-operative transsexuals: male-to-female and female-to-male. Int J Impot Res. 1998;10 Suppl 1:S22–24.

    CAS  PubMed  Google Scholar 

  6. Gaither TW, Awad MA, Osterberg EC, Murphy GP, Romero A, Bowers ML, et al. Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients. J Urol. 2018;199:760–5.

    Article  PubMed  Google Scholar 

  7. Maurer V, Howaldt M, Feldmann I, Ludwig T, Vetterlein MW, Gild P, et al. Penile flap inversion vaginoplasty in transgender women: contemporary morbidity and learning-curve analysis from a high-volume reconstructive center. Front Surg. 2022;9:836335.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Falcone M, Timpano M, Ceruti C, Sedigh O, Oderda M, Gillo A, et al. A single-center analysis on the learning curve of male-to-female penoscrotal vaginoplasty by multiple surgical measures. Urology. 2017;99:234–9.

    Article  PubMed  Google Scholar 

  9. Dy GW, Jun MS, Blasdel G, Bluebond-Langner R, Zhao LC. Outcomes of gender affirming peritoneal flap vaginoplasty using the Da Vinci single port versus Xi robotic systems. Eur Urol. 2021;79:676–83.

    Article  PubMed  Google Scholar 

  10. Kocjancic E, Vigneswaran H, Sofer L, Jaunarena J, Whitehead D, Morgantini L, et al. V10-01 novel vaginoplasty technique: inversion of penile skin and use of scrotal graft without sacrospinal fixation. J Urol [Internet]. 2018 Apr [cited 2025 Jan 9];199. Available from: http://www.jurology.com/doi/10.1016/j.juro.2018.02.2657.

  11. Acar O, Sofer L, Dobbs RW, Greenwald DT, Halgrimson WR, Crivellaro S, et al. Single port and multiport approaches for robotic vaginoplasty with the davydov technique. Urology. 2020;138:166–73.

    Article  PubMed  Google Scholar 

  12. Mañero I, Arno AI, Herrero R, Labanca T. Cosmetic revision surgeries after transfeminine vaginoplasty. Aesthetic Plast Surg. 2023;47:430–41.

    Article  PubMed  Google Scholar 

  13. Dy GW, Salibian AA, Blasdel G, Zhao LC, Bluebond-Langner R. External genital revisions after gender-affirming penile inversion vaginoplasty: surgical assessment, techniques, and outcomes. Plast Reconstr Surg. 2022;149:1429–38.

    Article  CAS  PubMed  Google Scholar 

  14. Amend B, Seibold J, Toomey P, Stenzl A, Sievert KD. Surgical reconstruction for male-to-female sex reassignment. Eur Urol. 2013;64:141–9.

    Article  PubMed  Google Scholar 

  15. Goddard JC, Vickery RM, Qureshi A, Summerton DJ, Khoosal D, Terry TR. Feminizing genitoplasty in adult transsexuals: early and long-term surgical results. BJU Int. 2007;100:607–13.

    Article  PubMed  Google Scholar 

  16. Boas SR, Ascha M, Morrison SD, Massie JP, Nolan IT, Shen JK, et al. Outcomes and predictors of revision labiaplasty and clitoroplasty after gender-affirming genital surgery. Plast Reconstr Surg. 2019;144:1451–61.

    Article  CAS  PubMed  Google Scholar 

  17. Peters BR, Carboy JA, Richards H, Dy GW, Dugi Iii D. Optimizing aesthetics in gender-affirming vaginoplasty and vulvoplasty: a narrative review and discussion based on over 600 cases of transfeminine vulvar construction. Transl Androl Urol. 2024;13:274–92.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dodsworth L. Womanhood: the bare reality. London: Pinter & Martin; 2019.

    Google Scholar 

  19. McCartney J. The great wall of vagina. Brighton: Jamie McCartney; 2011.

    Google Scholar 

  20. Herbenick D, Schick V, Reece M, Sanders S, Dodge B, Fortenberry JD. The Female Genital Self-Image Scale (FGSIS): results from a nationally representative probability sample of women in the United States. J Sex Med. 2011;8:158–66.

    Article  PubMed  Google Scholar 

  21. Vedovo F, Di Blas L, Perin C, Pavan N, Zatta M, Bucci S, et al. Operated male-to-female sexual function index: validity of the first questionnaire developed to assess sexual function after male-to-female gender affirming surgery. J Urol. 2020;204:115–20.

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was provided for this work.

Author information

Author notes

  1. These authors contributed equally: John B. Smith, Ahmad Hefnawy.

Authors and Affiliations

  1. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA

    John B. Smith, Ahmad Hefnawy, Grace Chen & Omer Acar

  2. Department of Urology, Ain Shams University, Cairo, Egypt

    Ahmad Hefnawy

  3. Department of Urology, University of Chicago, Chicago, IL, USA

    Ervin Kocjancic

  4. Koç University School of Medicine, Department of Urology, Istanbul, Turkey

    Omer Acar

Authors
  1. John B. Smith
    View author publications

    Search author on:PubMed Google Scholar

  2. Ahmad Hefnawy
    View author publications

    Search author on:PubMed Google Scholar

  3. Grace Chen
    View author publications

    Search author on:PubMed Google Scholar

  4. Ervin Kocjancic
    View author publications

    Search author on:PubMed Google Scholar

  5. Omer Acar
    View author publications

    Search author on:PubMed Google Scholar

Contributions

JS analyzed data, critically reviewed, and wrote the final manuscript. AH conceptualized and designed the study and performed data collection and analysis. GC performed data collection and analysis and contributed to the writing of the manuscript. EK conceptualized and designed the study, and approved the final manuscript as submitted. OA conceptualized and designed the study, critically reviewed the manuscript, and approved the final manuscript as submitted. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to John B. Smith.

Ethics declarations

Competing interests

The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interests.

Ethical approval

All methods were performed per the Helsinki protocols. Institutional review board approval from the Ethics Committee of University of Illinois Hospital (STUDY2023-0642) was obtained. Informed consent was obtained from all participants. Written informed consent was obtained for the publication of all patient images involved.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, J.B., Hefnawy, A., Chen, G. et al. Management of cosmetic concerns after gender-affirming vaginoplasty: a retrospective case series and guide to revisions. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01039-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41443-025-01039-0

This article is cited by

Search

Advanced search

Quick links