History
Dr. Bowers developed her one stage procedure with basic principles of embryology in mind. As everyone has female genitalia early in gestation, the goal of the procedure is to reverse the current anatomy to its earlier configuration. Although the procedure is technically a version of the original ‘penile inversion technique,’ the current version is highly modified including the use of scrotal skin grafting to line the vagina and numerous other advances that continue to evolve on an ongoing basis.
Procedure
For GAV, the testicles are removed (if present) and the neo-vagina is created, using the inverted penile skin and part of the scrotal skin to line the vagina. The urethra is shortened. The clitoris is formed from part of the glans of the penis and is sensitive, allowing for most patients to retain their ability to achieve an orgasm. The surgery lasts approximately 3.5 hours. Breast augmentation and/or tracheal shave (reduction of the “Adam’s apple”) can also performed at the time of the primary gender affirming vaginoplasty, if desired.
| Original Genitals | New Genitals |
| Penile/perineal skin | Labia majora, vaginal opening, clitoral hood |
| Glans penis (tip of penis) | Clitoris |
| Urethra | Labia minora, inner lining of vulva (vestibule) |
| Scrotum | Vaginal cavity, labia majora |
Peritoneal Skin Grafting for GAV
Traditional methods of grafting best use groin skin or lower abdominal skin. New procedures like peritoneal grafting and other sources of vaginal lining are exciting and important but still relatively new—Dr. Bowers does have a fair amount of experience with use of the peritoneal lining and confidence that this will be a major breakthrough. However, Dr. Bowers does all of her innovations with Dr. Jess Ting, Bella Avenassian and the Gender Services team that we have created at Mt. Sinai in New York City, where she has a 15% faculty appointment. However, unlike our California office, all NY cases need to be coordinated with our Practice Manager.
Zero Depth Vaginoplasty (ZDV)
A recent trend in vaginoplasty is zero depth vaginoplasty—creation of a female vulva without vagina. This trend has been partially driven by consumers interested in avoiding complications and/or eliminating the chore of daily dilation for someone not interested in receiving penetrative sex of any kind.