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Do Histologic Changes in the Skin-Lined Neovagina of Male-to-Female Transsexuals Really Occur?

Dekker, Judith J. M. L. MD*; Hage, J Joris MD, PhD§; Karim, Refaat B. MD, PhD; Bloemena, Elisabeth MD, PhD

doi: 10.1097/
Original Article

Controversy exists on whether or not the epidermal keratinizing squamous epithelium of skin grafts and flaps applied to line a neovagina changes histologically to a nonkeratinizing mucosal type squamous epithelium after vaginoplasty in male-to-female transsexuals. To end this discussion, the aim of this study was to objectify the short-term and long-term histologic aspect of this neovaginal epithelial lining.

Biopsies were taken from the epithelium lining of the neovagina of 9 male-to-female transsexuals, from the moment of vaginoplasty up to 14 years after. These were stained with hematoxylin-eosin and periodic acid-Schiff stain for histologic comparison to normal vaginal biopsies. Because no changes that might have been induced by local influences or hormonal therapy were found, we concluded that short-term and long-term changes in the histologic aspect of inverted skin flaps do not occur after penile and scrotal skin vaginoplasty in male-to-female transsexuals.

Biopsies of the lining epithelium of nine neovaginas in male-to-female transsexuals demonstrated no short-term or long-term metaplastic changes toward vaginal epithelium.

From the *Department of Gynecology and Obstetrics and †Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; §Department of Plastic and Reconstructive Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; and the ‡Department of Plastic and Reconstructive Surgery, OLVG Hospital, Amsterdam, The Netherlands.

Received December 24, 2006, and accepted for publication, after revision, January 4, 2007.

Reprints: Dr. J. J. Hage, Department of Plastic and Reconstructive Surgery, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.