title: Morphological spectrum of neovaginitis in autologous sigmoid transplant patients.
abstract: OBJECTIVE
  Autologous intestinal grafts are used to (re)create a vagina in selected patients. The risk of diversion colitis is mentioned as a disadvantage, although its prevalence remains unclear. This study aimed to assess the histopathological characteristics of the sigmoid-derived neovaginal epithelial lining after diverting surgery and correlate these with clinical findings.
  
  
  RESULTS
  Biopsy specimens were obtained from the epithelial lining of the sigmoid-derived neovagina and remaining rectosigmoid as regular follow-up from 26 patients with a median age of 22 years (range 19-52) and median postoperative follow-up of 13 months (range 6-52). Medical history, neovaginal symptoms and sexual activity were documented. An experienced gastrointestinal histopathologist assessed the specimens using a descriptive item-score, comprising signs of chronic and active inflammation. Inflammatory changes were observed in 21 (80.7%) neovaginal and one (3.8%) rectosigmoid specimens. The neovaginal appearance was characterized by an increase of lymphoid aggregates and lymphoplasmacellular infiltrate. Other common features were the presence of polymorphonuclear neutrophils and Paneth cell metaplasia. Neovaginal discharge was correlated with the presence of inflammatory changes (P = 0.008, Spearman's rho = 0.506).
  
  
  CONCLUSIONS
  Acute and chronic inflammation of the sigmoid-derived neovagina was commonly observed and consistent with a proposed diagnosis of diversion neovaginitis. Neovaginal discharge correlates with this histopathological entity.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands.|EMGO and Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Wouter B
authors.initials: WB
authors.lastname: van der Sluis
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Eskelina A
authors.initials: EA
authors.lastname: Neefjes-Borst
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands.|EMGO and Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.|Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Mark-Bram
authors.initials: MB
authors.lastname: Bouman
authors.affiliation: Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands.|Department of Gastro-Intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Wilhelmus J H J
authors.initials: WJ
authors.lastname: Meijerink
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Nanne K H
authors.initials: NK
authors.lastname: De Boer
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands.|EMGO and Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.|Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Margriet G
authors.initials: MG
authors.lastname: Mullender
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands.|Department of Internal Medicine, Gastroenterology, and Geriatrics, Orbis Medical Center, Sittard-Geleen, the Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: van Bodegraven
mesh_terms: D000328:Adult; D003092:Colitis / Q000473:pathology*; D012809:Colon, Sigmoid / Q000473:pathology / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D057830:Gender-Affirming Surgery / Q000009:adverse effects*; D012812:Sigmoidoscopy; D019738:Surgically-Created Structures; D014621:Vagina / Q000473:pathology / Q000601:surgery*; D014627:Vaginitis / Q000209:etiology / Q000473:pathology*; D055815:Young Adult
keywords: colocolponeopoiesis; diversion colitis; diversion neovaginitis; gender surgery; gender-confirming surgery; intestinal neovagina; male-to-female transsexuality; sex reassignment surgery