Abstract Introduction This study investigates the growing preference for shallow depth vaginoplasty (SDV) among transgender women seeking genital gender-affirming surgery, focusing on the desire to create a recessed vulva without a vaginal canal. Previous research identified key priorities for transgender women, including the elimination of visible genital anatomy associated with their assigned birth sex, achieving normal female genital appearance, and preserving genital sensation for orgasm. Objective A new decision making tool and a novel surgical technique for SDV that does not involve the creation of a vaginal canal, offering a simpler, natural appearing and patient base preference alternative. Methods A retrospective analysis of transgender women undergoing SDV was conducted, incorporating data from consultations and surgical outcomes. A patient decision-making aid tool was developed to guide patients in their choice of procedure, highlighting risks and benefits with 15 outcome categories to help patients decide between SDV and FDV (full depth vaginoplasty). The surgical technique involves the use of penile skin to create a natural-appearing vaginal introitus, with options for additional scrotal skin (graft or flap) use when necessary. Postoperative satisfaction was assessed across three domains: sexual function, genital appearance, and pain control. Results Approximately 50% of patients who seek feminizing genital surgery opt for SDV. The majority of these patients prioritize the ability to avoid long-term dilation and douching. Post-operative satisfaction with SDV was reported to be high, with patients achieving satisfactory sexual function, genital appearance, and recovery times. The technique of using either full-thickness scrotal grafts or pedicled scrotal flaps for the introitus creation resulted in consistently favorable outcomes, particularly when the pedicled flap method was employed. Conclusions SDV offers an effective and satisfactory option for transgender women who choose not to undergo the creation of a vaginal canal. This technique eliminates the need for dilation and douching, addressing a critical concern for many patients. With thorough preoperative counseling and clear patient education, SDV can provide a fulfilling solution for those seeking a non-canal-based vaginoplasty. The terminology used to describe these procedures should reflect patient preferences and be inclusive of their needs and concerns. Disclosure No
Garcia et al. (Mon,) studied this question.