ABSTRACT
In this chapter, the authors discuss the surgeon's role in the interdisciplinary team, the preoperative evaluation for surgery, the variety of available surgical options, and the postoperative care. They address the evolving health care environment, with specific attention to improving access and recognizing ongoing barriers faced by this underserved population. The surgeon should take an active role in the interdisciplinary health care team. Communication between health care providers is essential in optimizing the treatment plan. It is important for the surgeon to understand the individual's diagnosis as well as the appropriateness of surgical therapy. There are three surgical options for vaginoplasty: penile inversion vaginoplasty, intestinal transplantation, or nongenital flaps. Most centers perform primary vaginoplasty with the penile inversion technique; this technique uses penile skin combined with scrotal-perineal tissue and skin grafts to create a neovagina. Vaginoplasty techniques were originally developed for the treatment of vaginal agenesis and have been adapted to serve the needs of transgender women.
