(282) A PROPOSED SURGICAL TECHNIQUE TO CREATE A NATURAL-APPEARING RECESSED VAGINAL INTROITUS WITH GENDER-AFFIRMING “SHALLOW-DEPTH VAGINOPLASTY” (VULVOPLASTY) UTILIZING A PEDICLED ADVANCEMENT FLAP

Abstract Introduction Feminizing genital gender-affirming surgery (fgGAS) options include vaginoplasty with- (“full-depth vaginoplasty”), or without neovaginal canal (“vulvoplasty” or “shallow-depth vaginoplasty (SDV)”). If a transgender woman does not desire receptive vaginal intercourse, SDV is an excellent option, eliminating lifelong dilation/douching and lower complication risks. Achieving “normal appearing” feminine anatomy is critical for these patients. Currently, techniques for SDV rely on a full thickness skin graft. Objective 1) To better understand decision-making factors when undergoing SDV. 2) To describe a novel technique used to create a recessed vaginal introitus. 3) To evaluate patient perceptions of appearance as compared to cisgender vulvae. Methods Patients undergoing fgGAS between 04/2017-07/2022 were included. Of the patients undergoing SDV, an anonymous electronic survey querying decision-making factors and overall post-operative satisfaction was undertaken. In addition, our novel technique is described. Results 110 patients underwent fgGAS. Of these, 35/110 (32%) underwent SDV. Priorities: Achieving an appearance “comparable to” cisgender vulvae was ranked second highest after “elimination of male genital anatomy” (Fig. 1a). Technique: To achieve a recessed skin-lined vaginal introitus, gathering sutures create a “dimple” from penile/scrotal skin flap based off the posterior perineum, tethered to the tendon of the bulbospongiosus muscle, behind the urethral bulb (Fig. 1b-e). Attractiveness (Fig. 1f): When compared to cisgender vulvae of similar age/weight, 26/26 (100%) patients reported their vulvae had “similar” or “somewhat similar” appearance to cisgender vulvae. 24/26 (92%) of patients found their vulvae to be either “similarly or more attractive”, and 2/26 (8%) found their vulvae to be “less attractive” as compared to cisgender vulvae. Conclusions Women opting for SDV greatly consider cosmetic appearance which must be indistinguishable from cisgender female anatomy. This appears to be offered by this technique. In addition, this technique offers women the opportunity to have external anatomy in line with their gender identity, and for women not interested in using a vaginal canal for receptive vaginal intercourse, this option foregoes the added risks and commitment to lifelong dilation and douching. Disclosure No.