Feminizing genitoplasty (FG) in the transgender population was first reported in medical literature in 1931. Over the years it has undergone variations, generally including the removal of the male external genitalia to be shaped as female genitalia. The aim is to achieve aesthetic and functional results according to each patient.

The surgical technique of a feminizing genitoplasty in a trans woman patient is presented in this video. To create a neovagina it is necessary to develop a wide canal between the anterior segment of the anus and rectum and the posterior segment of the prostate and the bladder up to the level of the peritoneal pouch, known as Denonvilliers space. In this video we show how an advanced bipolar vessel sealing device helps in dissecting and hemostasis of this critical step of the surgery. Then, genital skin flaps are sutured together to cover this new canal; penile and pre anal flaps and scrotal skin graft were used. In order to meet functional needs, a sensitive neoclitoris was created from a segment of the glans penis preserving the neurovascular deep dorsal bundle. At the same time, the male urethra is modified and relocated between the clitoris and the vagina. Ultimately the labia majora is created from the remaining genital scrotal skin.

FG is a complex surgery and outcomes depend not only on the technical experience of the surgeon but also upon the amount and quality of each patient’s tissues available for genital reconstruction and most importantly on the realistic expectations of the patients themselves.

FG is a surgical challenge because of the aesthetic and functional results that must be achieved. The use of an advanced bipolar vessel sealing device may help during the canal dissection.