{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:22:21Z","timestamp":1776831741970,"version":"3.51.2"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Gender affirmation surgery significantly improves the quality of life and psychological well-being of transgender women. Among various techniques, sigmoid vaginoplasty is widely performed due to its ability to provide adequate vaginal depth and intrinsic lubrication. However, it carries risks, with neovaginal perforation being a serious yet underreported complication. Materials and Methods: This review examines the etiology, clinical manifestations, diagnosis, and management of neovaginal perforation. A literature review was conducted to analyze reported cases and treatment strategies. Additionally, we present a case from our institution to highlight diagnostic and therapeutic challenges. Results: Neovaginal perforation arises from mechanical trauma, ischemia, infection, or structural weaknesses in the sigmoid segment. Common risk factors include improper dilation, introital stenosis, and vascular compromise. Symptoms range from mild pelvic discomfort to peritonitis and sepsis. Computed tomography (CT) is the gold standard for diagnosis. Conservative management is effective in mild cases, whereas severe cases require surgical repair. Conclusions: Neovaginal perforation is rare but potentially life-threatening. Future research should refine surgical techniques, dilation protocols, and tissue engineering solutions. Standardized guidelines and patient education are essential for prevention and improved outcomes.<\/jats:p>","DOI":"10.3390\/medicina61040691","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T08:46:20Z","timestamp":1744274780000},"page":"691","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neovaginal Perforation in Sigmoid Vaginoplasty: An Underrecognized Complication\u2014A Literature Review"],"prefix":"10.3390","volume":"61","author":[{"given":"Yen-Ning","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5748-1659","authenticated-orcid":false,"given":"Jeng-Fu","family":"You","sequence":"additional","affiliation":[{"name":"Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ching-Hsuan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"rjad333","DOI":"10.1093\/jscr\/rjad333","article-title":"Major complications of sigmoid vaginoplasty: A case series","volume":"2023","author":"Meece","year":"2023","journal-title":"J. Surg. Case Rep."},{"key":"ref_2","first-page":"398","article-title":"The Formation of an Artificial Vagina by Intestinal Trransplantation","volume":"40","author":"Baldwin","year":"1904","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Salgado, C.J., Nugent, A., Kuhn, J., Janette, M., and Bahna, H. (2018). Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes. Biomed. Res. Int., 2018.","DOI":"10.1155\/2018\/4907208"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0022-5347(17)32698-8","article-title":"Use of bowel for vaginal reconstruction","volume":"152","author":"Hendren","year":"1994","journal-title":"J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0022-5347(17)59931-0","article-title":"Vaginal reconstruction using cecal and sigmoid bowel segments in transsexual patients","volume":"111","author":"Markland","year":"1974","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1159\/000076476","article-title":"Laparoscopic technique for secondary vaginoplasty in male to female transsexuals using a modified vascularized pedicled sigmoid","volume":"57","author":"Wedler","year":"2004","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.urology.2008.04.004","article-title":"Robotic sigmoid vaginoplasty: A novel technique","volume":"72","author":"Kim","year":"2008","journal-title":"Urology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e2169","DOI":"10.1097\/GOX.0000000000002169","article-title":"Sigma-lead male-to-female gender affirmation surgery: Blending cosmesis with functionality","volume":"7","author":"Kaushik","year":"2019","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1590\/S1677-55382012000300011","article-title":"Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development","volume":"38","author":"Nowier","year":"2012","journal-title":"Int. Braz. J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1097\/01.PRS.0000066169.78208.D4","article-title":"Long-term results in patients after rectosigmoid vaginoplasty","volume":"112","author":"Kim","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1053\/jpsu.2002.31623","article-title":"Vaginal reconstruction utilizing sigmoid colon: Complications and long-term results","volume":"37","author":"Parsons","year":"2002","journal-title":"J. Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.euros.2024.06.013","article-title":"Systematic review of neovaginal prolapse after vaginoplasty in trans women","volume":"66","author":"Tran","year":"2024","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1111\/jsm.12538","article-title":"Intestinal vaginoplasty revisited: A review of surgical techniques, complications, and sexual function","volume":"11","author":"Bouman","year":"2014","journal-title":"J. Sex. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1097\/SAP.0000000000001393","article-title":"Complications and patient-reported outcomes in male-to-female vaginoplasty-where we are today: A Systematic Review and Meta-Analysis","volume":"80","author":"Manrique","year":"2018","journal-title":"Ann. Plast. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Deliktas, H., Ozcan, O., Cullu, N., and Erdogan, O. (2014). Neovaginal perforation following sexual intercourse in a transsexual patient. BMC Res. Notes, 7.","DOI":"10.1186\/1756-0500-7-797"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1007\/s00192-014-2609-1","article-title":"Laparoscopic reconstruction of an iatrogenic perforation of the neovagina and urinary bladder by a neovaginal dilator in a patient with Mayer\u2013Rokitansky\u2013K\u00fcster\u2013Hauser syndrome","volume":"26","author":"Khoder","year":"2015","journal-title":"Int. Urogynecol. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e01110","DOI":"10.1016\/j.idcr.2021.e01110","article-title":"Perforation of sigmoid neovagina in a patient with Mayer-Rokitansky-K\u00fcster-Hauser syndrome","volume":"24","author":"Kamath","year":"2021","journal-title":"IDCases"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1752-1947-9-24","article-title":"Perforation of the neovagina in a male-to-female transsexual: A case report","volume":"9","author":"Shimamura","year":"2015","journal-title":"J. Med. Case Rep."},{"key":"ref_19","first-page":"828","article-title":"Acute peritonitis due to introital stenosis and perforation of a bowel neovagina in a transsexual","volume":"97","author":"Liguori","year":"2001","journal-title":"Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/PRS.0000000000001459","article-title":"Long-Term Outcomes of Rectosigmoid Neocolporrhaphy in Male-to-Female Gender Reassignment Surgery","volume":"136","author":"Morrison","year":"2015","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"bcr0820103241","DOI":"10.1136\/bcr.08.2010.3241","article-title":"Conservatively treated perforation of the neovagina in a male to female transsexual patient","volume":"2011","author":"Amirian","year":"2011","journal-title":"BMJ Case Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"135e","DOI":"10.1097\/01.prs.0000185999.71439.06","article-title":"Gender identity disorder: General overview and surgical treatment for vaginoplasty in male-to-female transsexuals","volume":"116","author":"Selvaggi","year":"2005","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.eururo.2020.06.040","article-title":"Outcomes of Gender Affirming Peritoneal Flap Vaginoplasty Using the Da Vinci Single Port Versus Xi Robotic Systems","volume":"79","author":"Dy","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1097\/PRS.0000000000002684","article-title":"Surgical outcome after penile inversion vaginoplasty: A retrospective study of 475 transgender women","volume":"138","author":"Buncamper","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1111\/jsm.12915","article-title":"Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques","volume":"12","author":"Casoli","year":"2015","journal-title":"J. Sex. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/22925503231190923","article-title":"Rectovaginal fistula repair following vaginoplasty in transgender females: A systematic review of surgical techniques","volume":"33","author":"Lava","year":"2025","journal-title":"Plast. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/691\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:11:37Z","timestamp":1760029897000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/691"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,9]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040691"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040691","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,9]]}}}