The protocol that we have in Christchurch differs from protocols elsewhere in the world to our knowledge. We use portion of the ascending colon for the neovagina. This neovagina has considerable advantages over the previous operations where penile skin and skin graft is used to make the new vagina.

The operation for construction of the new vagina using ascending colon was described in England in 1990 by Turner-Warwick, for construction of a vagina in young girls with vaginal agenesis. Mr E G Perry (General Surgeon, Christchurch New Zealand) adapted the use of the colon, modified the operation and we have successfully used this operation in 33 patients to date (Sep 2000). The advantage of using the large bowel is that the bowel is naturally distensible, does not contract, it has its own blood supply so remains healthy, and wards off infection. The bowel is self cleansing with a small amount of mucus so it is also self lubricated. The cases that we have performed so far have been most satisfactory. One case has required dilatation of the urethra; two cases have narrowing of the introitus of the vagina which required dilatation; one required further operation. As the post operative oedema has resolved the function and the appearance of the external genitalia and the neovagina have proved to be anatomically correct and most satisfactory.

We take care to preserve the erogenous sensation of the labia folds and can construct a clitoris from glans penis which has erogenous sensation.

The patients donate their own blood four weeks, three weeks and two weeks prior to the operation and the blood is then returned to the patient at the time of the operation. In the unusual event that more blood is required I have the patient understand that blood from blood donors may be used (all blood is screened for HIV, Hepatitis A, Hepatitis B and C) and cross matched in the usual manner. Routine post operative cares are undertaken in the Ward. Following the operation the patient may be nil by mouth for approximately 24 - 48 hours. The bowel begins to work again approximately 3 - 4 days after the operation; drains are removed about that time. The catheter would stay in for approximately one week to ten days.