title: Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics.
abstract: OBJECTIVE
  To assess the endoscopic characteristics of the sigmoid-derived neovagina, which have been scarcely described.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University tertiary medical center.
  
  
  METHODS
  Patients that underwent sigmoid vaginoplasty.
  
  
  METHODS
  Patients were invited yearly to undergo neovaginoscopy and sigmoidoscopy, preceded by taking a medical history and physical examination, as routine follow-up.
  
  
  METHODS
  Endoscopic signs of neovaginal inflammation.
  
  
  RESULTS
  Thirty-four patients with a sigmoid neovagina underwent a total of 43 combined neovaginoscopies and sigmoidoscopies. After a mean postoperative time of 23 months, the most notable endoscopic features of the sigmoid-derived neovagina comprised a diminished vascular pattern, edema, granularity, friability, decreased resilience, and erythema. In the control rectosigmoidoscopy images, no concurrent abnormalities were observed. When applying the MAYO score to the neovaginal images, 12 (35%) patients scored MAYO 0, 19 (56%) MAYO I, 3 (9%) MAYO II, and none MAYO III. The presence of neovaginal discharge and malodor correlated with inflammatory endoscopic alterations.
  
  
  CONCLUSIONS
  The endoscopic appearance of a sigmoid segment after use in neovaginoplasty differs significantly from that of the remaining rectosigmoid. Inflammatory changes of the sigmoid-derived neovagina were observed in most patients. Clinically, the inflammatory changes appear similar to those encountered in diversion colitis.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; Emgo 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 Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; Emgo 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: WJHJ
authors.lastname: Meijerink
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Lian
authors.initials: L
authors.lastname: Elfering
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands; Emgo 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, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.
authors.forename: Nanne K H
authors.initials: NKH
authors.lastname: de Boer
authors.affiliation: Department of Gastroenterology and Hepatology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Internal Medicine, Gastroenterology and Geriatrics, Zuyderland Medical Center, Heerlen-Sittard-Geleen, the Netherlands. Electronic address: v.bodegraven@vumc.nl.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: van Bodegraven
mesh_terms: D000293:Adolescent; D000328:Adult; D064592:Autografts; D012809:Colon, Sigmoid / Q000473:pathology / Q000637:transplantation*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D057830:Gender-Affirming Surgery / Q000009:adverse effects* / Q000379:methods; D012812:Sigmoidoscopy; D019738:Surgically-Created Structures; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina / Q000473:pathology / Q000601:surgery*; D014627:Vaginitis / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
keywords: Laparoscopic vaginoplasty; colocolponeopoiesis; diversion colitis; intestinal neovagina; male-to-female transsexuality