Rectosigmoid vaginoplasty is a surgical procedure used to create or reconstruct a vagina. This method involves using a segment of the rectosigmoid colon (the part of the large intestine that transitions from the rectum to the sigmoid colon) to form a new vaginal canal. The procedure is often used for patients with gender dysphoria in the process of transitioning from male to female, as well as for women born without a vagina or those who have lost vaginal tissue due to disease or trauma.

The planning of the surgery primarily focuses on assessing the needs and goals of the patient. For patients undergoing transition, a thorough psychological evaluation is necessary to confirm gender dysphoria and readiness for surgery. In cases of congenital absence of the vagina or its loss, medical evaluations and consultations are focused on the physical aspects and possibilities for reconstruction.

Rectosigmoid vaginoplasty is performed in several steps. The surgeon selects a segment of the rectosigmoid colon that is suitable for forming the vaginal canal. The segment is isolated, taking care to preserve its blood supply. The isolated segment of the intestine is then shaped and implanted in the area between the rectum and the bladder, creating a new vaginal canal. Connection to the external genitalia is made to ensure a natural appearance and functionality.

Recovery from this surgery requires hospitalization and monitoring to ensure there are no complications such as infections or issues with sutures. Patients are advised to rest and avoid heavy physical activities.
Rectosigmoid vaginoplasty is often chosen when other methods of creating a vagina, such as using penile skin or dilation, are not possible or have been unsuccessful. This method has advantages such as more natural lubrication and sensation, but it can also carry specific risks such as scarring at the site where the intestinal segment was removed, as well as potential for bowel function issues.
Patients considering this type of surgery should have detailed discussions with their surgical team about all aspects of the procedures, including expectations, potential risks, recovery duration, as well as the need for additional surgical interventions or adjustments in the future.