{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T11:01:33Z","timestamp":1761562893888,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Publishing Fund of University of T\u00fcbingen"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The ideal timing of genital surgery in differences\/disorders of sex development (DSD) is controversial and differs according to the underlying type of DSD. Increasing numbers of persisting sinus as a result of delayed feminizing genitoplasty in DSD patients require interdisciplinary collaboration of pediatric surgeons\/urologists and gynecologists. This study focusses on surgical techniques other than bowel vaginoplasties and results of gender assigning surgery in young adolescents. Methods: Data of adolescent and adult patients treated between 2015 and 2022 were analyzed retrospectively: underlying type of malformation, techniques of vaginoplasty, vaginal length and caliber, possibility of sexual intercourse, and temporary vaginal dilatation. Results: A total of 9 patients received a primary vaginoplasty at a median age of 16.75 years (range 10.3\u201329.25). The underlying anatomical conditions were persistent urogenital sinus (UGS) in 8 patients (3 patients with CAH, 2 patients with XY-DSD, 1 patient with cloacal malformation and missed UGS, 2 patients with UGS only). One patient had a MURCS association. Surgical techniques were total urogenital mobilization and perineal flap vaginoplasty in 4 patients, modified McIndoe vaginoplasty in 4 patients, and a laparoscopic vaginal pull-through in 1 patient. In a median follow-up of 45 months (2\u201384), all but 1 patient presented with physiological vaginal length and width. Conclusions: If possible, modern treatment concepts delay gender assigning surgery until the participation of the patient in the decision-making process is possible. Optimal treatment concepts are given by transfer of surgical techniques from pediatric urology\/surgery by multidisciplinary teams. Techniques other than bowel vaginoplasties are favorable.<\/jats:p>","DOI":"10.3390\/jcm11133688","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T22:31:14Z","timestamp":1656369074000},"page":"3688","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Techniques of Primary Vaginoplasty in Young Adults with Differences of Sex Development and Female Identification"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0221-5841","authenticated-orcid":false,"given":"Verena","family":"Ellerkamp","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology, University Hospital T\u00fcbingen, D-72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Rall","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital T\u00fcbingen, D-72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juergen","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital T\u00fcbingen, D-72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5162-1542","authenticated-orcid":false,"given":"Sara","family":"Brucker","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital T\u00fcbingen, D-72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joerg","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology, University Hospital T\u00fcbingen, D-72076 T\u00fcbingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"150929","DOI":"10.1016\/j.sempedsurg.2020.150929","article-title":"Evolving indications for surgical intervention in patients with differences\/disorders of sex development: Implications of deferred reconstruction","volume":"29","author":"Weidler","year":"2020","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/S0002-9378(16)32683-7","article-title":"Vaginal malformations","volume":"141","author":"Evans","year":"1981","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"344","DOI":"10.3389\/fped.2018.00344","article-title":"Is It Beneficial to Patients to Include Congenital Adrenal Hyperplasia (CAH) Among the Disorders of Sex Development (DSD)?","volume":"6","author":"Gonzalez","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"353.e1","DOI":"10.1016\/j.jpurol.2022.02.028","article-title":"Surgical experiences in adolescents and young adults with differences of sex development: A qualitative examination","volume":"18","author":"Flewelling","year":"2022","journal-title":"J. Pediatr. Urol."},{"key":"ref_5","first-page":"545","article-title":"Vaginoplasty technique for female pseudohermaphrodites","volume":"118","author":"Fortunoff","year":"1964","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0022-3468(97)90191-3","article-title":"Total urogenital mobilization\u2014An easier way to repair cloacas","volume":"32","year":"1997","journal-title":"J. Pediatr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.jpurol.2006.04.002","article-title":"Partial urogenital mobilization: A limited proximal dissection","volume":"2","author":"Rink","year":"2006","journal-title":"J. Pediatr. Urol."},{"key":"ref_8","first-page":"131","article-title":"Creation of an artificial vagina in Rokitansky-Kuster-Hauser syndrome","volume":"11","author":"Vecchietti","year":"1965","journal-title":"Attual. Ostet. Ginecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1016\/j.fertnstert.2007.08.070","article-title":"Neovagina creation in vaginal agenesis: Development of a new laparoscopic Vecchietti-based procedure and optimized instruments in a prospective comparative interventional study in 101 patients","volume":"90","author":"Brucker","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/j.1471-0528.2005.00845.x","article-title":"Laparoscopic vaginoplasty: Alternative techniques in vaginal reconstruction","volume":"113","author":"Ismail","year":"2006","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_11","first-page":"1055","article-title":"Congenital absence of the vagina, treated by means of an indwelling skin-graft","volume":"31","author":"Banister","year":"1938","journal-title":"Proc. R. Soc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2954","DOI":"10.1093\/humrep\/dei152","article-title":"Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia","volume":"20","author":"Giannesi","year":"2005","journal-title":"Hum. Reprod."},{"key":"ref_13","first-page":"35","article-title":"Formation of vagina (colpopoiesis) from peritoneum of Douglas pouch","volume":"16","author":"Davydov","year":"1974","journal-title":"Acta Chir. Plast."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1016\/S0022-5347(06)00337-5","article-title":"Sexual function following bowel vaginoplasty","volume":"175","author":"Hensle","year":"2006","journal-title":"J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1007\/s00192-013-2316-3","article-title":"Systematic review of sexual function and satisfaction following the management of vaginal agenesis","volume":"25","author":"McQuillan","year":"2014","journal-title":"Int. Urogynecol. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1016\/j.juro.2013.08.073","article-title":"Sigmoid vaginoplasty with a modified single Monti tube: A pediatric case series","volume":"191","author":"Castellan","year":"2014","journal-title":"J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"50","DOI":"10.3389\/fped.2013.00050","article-title":"Congenital Adrenal Hyperplasia: Review from a Surgeon\u2019s Perspective in the Beginning of the Twenty-First Century","volume":"1","author":"Piaggio","year":"2014","journal-title":"Front. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3389\/fendo.2013.00029","article-title":"Vaginoplasty for disorders of sex development","volume":"4","author":"Guarino","year":"2013","journal-title":"Front. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.jpurol.2020.05.166","article-title":"Post-operative complications following feminizing genitoplasty in moderate to severe genital atypia: Results from a multicenter, observational prospective cohort study","volume":"16","author":"Baskin","year":"2020","journal-title":"J. Pediatr. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.jpurol.2012.06.015","article-title":"Secondary vaginoplasty for disorders for sexual differentiation: Is there a right time? Challenges with compliance and follow-up at a multidisciplinary center","volume":"9","author":"Isharwal","year":"2013","journal-title":"J. Pediatr. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.eprac.2022.02.007","article-title":"Gender-affirming surgery: Perioperative medical care","volume":"28","author":"Shin","year":"2022","journal-title":"Endocr. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.jsxm.2022.02.014","article-title":"Comprehensiveness of online information in gender-affirming surgery: Current trends and future directions in academic plastic surgery","volume":"19","author":"Aryanpour","year":"2022","journal-title":"J. Sex. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1016\/j.jsxm.2021.07.008","article-title":"Surgical therapy after failed feminizing genitoplasty in young adults with disorders of sex development: Retrospective analysis and review of the literature","volume":"18","author":"Ellerkamp","year":"2021","journal-title":"J. Sex. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/978-1-4419-8002-1_11","article-title":"Clitoroplasty in congenital adrenal hyperplasia: Description of technique","volume":"707","author":"Poppas","year":"2011","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.urology.2012.01.009","article-title":"Laparoscopically assisted vaginal pull-through for high urogenital sinus: A new surgical technique","volume":"79","author":"Fuchs","year":"2012","journal-title":"Urology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/s10508-021-01953-6","article-title":"Early genital surgery in disorders\/differences of sex development: Patients\u2019 perspectives","volume":"50","author":"Bennecke","year":"2021","journal-title":"Arch. Sex. Behav."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.beem.2007.11.001","article-title":"Disorders of sex development: A new definition and classification","volume":"22","author":"Hughes","year":"2008","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_28","unstructured":"Krege, S., Eckoldt, F., Richter-Unruh, A., and Mo\u00df, A. (2022, June 01). Variants of Sex Developments [S2k-Leitlinie\u2014Varianten der Geschlechtsentwicklung]. AWMF Online, 174\/001. Available online: https:\/\/www.aem-online.de\/fileadmin\/user_upload\/Publikationen\/S2k_Geschlechtsentwicklung-Varianten_2016-08_01_1_.pdf."},{"key":"ref_29","unstructured":"Brandenburg, J., Helling-Plahr, K., and Thomae, S. (2022, June 01). Gesetzliche Verankerung der Unzul\u00e4ssigkeit aufschiebbarer geschlechtsangleichender medizinischer Eingriffe an Kindern. Deutscher Bundestag, Drucksache 19\/7586. Available online: https:\/\/dipbt.bundestag.de\/doc\/btd\/19\/075\/1907586.pdf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1055\/s-0029-1233490","article-title":"Congenital adrenal hyperplasia: A critical appraisal of the evolution of feminizing genitoplasty and the controversies surrounding gender reassignment","volume":"19","author":"Braga","year":"2009","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1016\/j.juro.2006.07.078","article-title":"Use of the mobilized sinus with total urogenital mobilization","volume":"176","author":"Rink","year":"2006","journal-title":"J. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jpag.2004.09.009","article-title":"Early versus late intervention of congenital adrenal hyperplasia","volume":"18","author":"Creighton","year":"2005","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000363664","article-title":"Timing of surgery for feminizing genitoplasty in patients suffering from congenital adrenal hyperplasia","volume":"27","year":"2014","journal-title":"Endocr. Dev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"118","DOI":"10.3389\/fped.2016.00118","article-title":"Surgical treatment after failed primary correction of urogenital sinus in female patients with virilizing congenital adrenal hyperplasia: Are good results possible?","volume":"4","author":"Sircili","year":"2016","journal-title":"Front. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s11255-008-9384-1","article-title":"An insight into vaginal surgery in a severely masculinized CAH patient","volume":"40","author":"Nyirady","year":"2008","journal-title":"Int. Urol. Nephrol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"275213","DOI":"10.1186\/1687-9856-2010-275213","article-title":"Guidelines for the development of comprehensive care centers for congenital adrenal hyperplasia: Guidance from the CARES Foundation initiative","volume":"2010","author":"Auchus","year":"2010","journal-title":"Int. J. Pediatr. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3389\/fped.2013.00054","article-title":"Should the genitoplasty of girls with CAH be done in one or two stages?","volume":"1","author":"Gonzalez","year":"2014","journal-title":"Front. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1053\/j.semperi.2017.03.011","article-title":"Restoring normal anatomy in female patients with atypical genitalia","volume":"41","author":"Baskin","year":"2017","journal-title":"Semin. Perinatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s00404-005-0079-x","article-title":"Lifetime changes in the vulva and vagina","volume":"273","author":"Farage","year":"2006","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1289\/ehp.10409","article-title":"Pilot studies of estrogen-related physical findings in infants","volume":"116","author":"Bernbaum","year":"2008","journal-title":"Environ. Health Perspect."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Oliveira, J.C., Sousa, F.C., Campos, S.T., Geraldes, F.B., Belo, J.L., Leite, M.H., Mirante, M.A., and \u00c1guas, M.F. (2022). Congenital adrenal hyperplasia in adolescence\u2014A gynecological perspective. Ginekol. Pol.","DOI":"10.5603\/GP.a2021.0248"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/S0022-5347(05)00329-0","article-title":"Feminizing reconstructive surgery for ambiguous genitalia: The Leipzig experience","volume":"175","author":"Hoepffner","year":"2006","journal-title":"J. Urol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4089","DOI":"10.1210\/jc.2018-01863","article-title":"Genital reconstructive surgery in females with congenital adrenal hyperplasia: A systematic review and meta-analysis","volume":"103","author":"Almasri","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1007\/s00404-017-4372-2","article-title":"Mullerian dysgenesis: A critical review of the literature","volume":"295","author":"Choussein","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_45","first-page":"581","article-title":"Study and evaluation of neovagina epithelium","volume":"25","author":"Piazza","year":"2021","journal-title":"JBRA Assist. Reprod."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.jpag.2014.02.002","article-title":"Laparoscopically assisted neovaginoplasty in vaginal agenesis: A long-term outcome study in 240 patients","volume":"27","author":"Rall","year":"2014","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/j.1447-0756.2010.01335.x","article-title":"Vaginal reconstruction using no grafts with evidence of squamous epithelialization in neovaginal vault: A simple approach","volume":"37","author":"Marzieh","year":"2011","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/j.1471-0528.2004.00517.x","article-title":"Female genital appearance: \u201cNormality\u201d unfolds","volume":"112","author":"Lloyd","year":"2005","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/0029-7844(95)00291-X","article-title":"Vaginal anatomy and sexual function","volume":"86","author":"Weber","year":"1995","journal-title":"Obs. Gynecol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s00192-009-1051-2","article-title":"Does vaginal size impact sexual activity and function?","volume":"21","author":"Schimpf","year":"2010","journal-title":"Int. Urogynecol. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1016\/j.juro.2007.05.097","article-title":"Nerve sparing ventral clitoroplasty: Analysis of clitoral sensitivity and viability","volume":"178","author":"Yang","year":"2007","journal-title":"J. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/13\/3688\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:38:53Z","timestamp":1760139533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/13\/3688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,27]]},"references-count":51,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jcm11133688"],"URL":"https:\/\/doi.org\/10.3390\/jcm11133688","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,6,27]]}}}