Abstract
Patients diagnosed with male-to-female gender dysphoria require a multidisciplinary management. Patients pursing care for gender dysphoria encompass five steps: diagnosis, psychotherapy, real-life experience in an identity-congruent gender role, hormonal therapy, and sex reassignment surgery. Vaginoplasty represents the mainstay of sex affirmation surgery in male-to-female patients and an increasing number of patients have underwent this surgery over the years. The primary challenge of male-to-female reassignment surgery is to create natural-appearing female genitalia with neovaginal dimensions adequate for intercourse, neoclitoris sensitivity, and minimal risk of complications. Although no vaginoplasty technique has proved to be the gold standard, the most commonly used technique involves the utilization of inverted penile and scrotal flaps for neovagina and neovulva formation. Despite recent years have been characterised by major breakthroughs in surgical techniques, intra and postoperative complications that lead to poor cosmetic and functional results after vaginoplasty are not uncommon. We modified various vaginoplasty techniques to decrease the chance for complications and vaginal stricture, and enhance aesthetic satisfaction. Our surgical procedures provided excellent cosmetic and functional results with severe complications.

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