# Neovaginal Perforation in Sigmoid Vaginoplasty: An Underrecognized Complication—A Literature Review

## TL;DR

This paper reviews neovaginal perforation, a rare but serious complication in sigmoid vaginoplasty, and discusses its causes, symptoms, diagnosis, and treatment.

## Contribution

The paper highlights neovaginal perforation as an underrecognized complication and provides insights into its management and prevention.

## Key findings

- Neovaginal perforation can result from mechanical trauma, ischemia, infection, or structural weaknesses.
- Computed tomography is the most reliable diagnostic tool for this complication.
- Conservative management works for mild cases, while severe cases require surgical intervention.

## Abstract

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.