Embryologic development of the external genitalia as it relates to vaginoplasty for the transgender woman

Brought to you by the Society of Gynecologic Surgeons. In this video, we review the development of the external genitalia for males and females and describe our technique for performing male-to-female vaginoplasty for the transgender woman. We describe the penile inversion vaginoplasty technique that creates a neovagina using a proximal scrotal-perineal flap and a distal pedicled penile skin flap. We perform male-to-female vaginoplasty accounting for the homologous embryologic structures of the male and female external genitalia. With our technique, the neoclitoris is created from the glans of the penis, which developed from the genital tubercle and otherwise would have developed into a clitoris in a biologic female. This ensures a sensate neoclitoris. The neovestibule is created from the urethra. Both the female vestibule and the male urethra developed from the endodermal lining of the urogenital sinus. The result is a functional neovestibule that provides moisture to the neovagina.