Male-to-female transsexual surgical techniques are well defined and give good cosmetic and functional results.

All patients had been cross-dressing and living as women. Patients were at least 23 years old. Procedure includes bilateral orchidectomy, amputation of the penis, creation of the neovaginal cavity, lining of this cavity and reconstruction of a urethral meatus and, finally, construction of the labia and clitoris.

Mean follow-up is 32 months (range 4-150). 11 patients showed partial necrosis of the scrotal flap; in 7 patients there was an important postoperative bleeding that was treated surgically in 3 case. In the long term, neomeatus stricture occurred in 6 patients and was treated with meatotomy. 11 patient developed stenosis of the neovagina. Hematoma of the labia majora of the neovagina occurred in 24 case and resolved spontaneously in all caes. Prolapse of the neovagina occurred in 12 patients. 3 patients developed a right leg muscular contusion (due to the prolonged lithotomic position during operation), which required fasciotomy of the peronaeorum communis fascia. 69 patients have been evaluated by a questionnaire after 12 months: physical and functional results of surgery were judged to be excellent and patients were satisfied with the quality of the functional genitalia as well as cosmetic result.

Although the surgical techniques for vaginoplasty have evolved significantly, it must be stressed that both medical and surgical treatment are rarely perfect. Major complications are possible, and revisional surgery is sometimes required to optimize aesthetic results.