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

Background: Sigmoid vaginoplasty has become a preferred technique for gender affirmation surgery in transgender women due to its ability to provide adequate vaginal width and depth, intrinsic mucosal lubrication, and resistance to postoperative shrinkage. However, despite its advantages, this technique is associated with rare but potentially severe complications, including neovaginal perforation. Objective: This review aims to comprehensively analyze neovaginal perforation following sigmoid vaginoplasty, highlighting its incidence, underlying mechanisms, clinical presentation, management strategies, and preventive measures. Methods: A systematic review of existing literature was conducted to evaluate reported cases of neovaginal perforation, its etiology, and treatment outcomes. Additionally, we present a representative case from our institution, providing further insights into the clinical course and management of this complication. Results: Neovaginal perforation, though uncommon, can lead to serious consequences such as abscess formation, peritonitis, and sepsis if not promptly diagnosed and treated. The primary contributing factors include improper postoperative vaginal dilation techniques, vascular compromise due to stenosis or ischemia, and tissue fragility of the sigmoid neovagina. Management strategies vary from conservative treatment with antibiotics and drainage to surgical intervention in severe cases. Conclusion: While sigmoid vaginoplasty remains a valuable technique for gender affirmation surgery, awareness of its potential complications—particularly neovaginal perforation—is crucial. Early recognition, appropriate management, and adherence to postoperative care protocols, including proper dilation techniques, are essential in preventing this rare but serious complication. A multidisciplinary approach involving plastic surgeons, colorectal surgeons, and gynecologists is key to optimizing patient outcomes and minimizing risks.