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FAQs on Peritoneal Pull-Through Vaginoplasty (PPV)

Peritoneal Pull-Through Vaginoplasty, or Peritoneal Vaginoplasty, is a new male to female surgery procedure that’s based on a gynecological procedure called the Davydov Procedure.

Instead of using skin from the penis and scrotum to line the vagina, this surgery uses a thin layer of tissue from the underside of the abdomen called the peritoneum. To get this tissue, we perform a minimally invasive robotic surgery through 5 small (<1cm) incisions in the abdomen.

Though this surgery has been performed for many years for cisgender women born without a vagina, it has only recently been used for transgender and nonbinary patients. Therefore, there are no long-term data on the outcomes of this surgery for these patients. Usually, we can get 2-3 additional centimeters of vaginal depth in surgery compared to penile inversion vaginoplasty, although final depth for this procedure is variable. Also, it seems as though the peritoneal lining has a lower chance of scarring down compared to skin, but still requires lifelong dilation. The lining also produces a natural lubrication for some patients. Another added benefit is that hair removal is not required for the vaginal lining as the lining is fully peritoneal. Penile inversion technique even after hair removal treatments and follicle scraping, occasional dormant or resilient follicles can sprout hair from skin grafting inside the vagina. Peritoneal lining does not have any hair follicles but pre-operative hair removal is required. – please see our hair removal guide for PPV.

Compared to a penile inversion vaginoplasty, the PPV procedure requires an abdominal surgery which has additional risks of bleeding, infection, and injury to things like the bowel and bladder. However, it is likely safer than colon vaginoplasty because of the risks associated with removing a portion of bowel. If a PPV vaginoplasty is performed and the vagina scars closed, then the recommended option of regaining depth would be colon surgery. Also, the amount of discharge can be bothersome for some patients and it may require that you wear a thin underwear liner to absorb the moisture.

This surgery can be a great option for patients whose other options are limited to including colon vaginoplasty. This includes patients needing revision surgery, nonbinary patients who do not want a penectomy, patients with trauma to area, not enough skin available from penile shaft and/or scrotal donor sites, patients who have been on puberty blockers and patients resistant to hair removal treatments. Patients can also choose to have a PPV vaginoplasty as their primary surgery if they understand and accept that there are no long-term data on the outcomes of this surgery.

For a primary surgery, the procedure takes around 5-8 hours and patients stay in the hospital 5-7 nights. For a revision surgery, the procedure usually takes less time and patients go home the same day or possibly stay in the hospital for 1-2 nights.