Gender Affirming Vaginoplasty in a Patient with Inflammatory Bowel Disease

Objectives: Inflammatory bowel disease (IBD) poses a unique challenge in gender affirming vaginoplasty, and there is limited information in this patient population. Considerations regarding construction of the vaginal canal include the possibility of chronic inflammation and the use of biologic therapies. These issues may predispose to rectal injury, rectovaginal fistula, and delayed wound healing and infection.

We describe a 26-year-old transgender woman with ulcerative colitis (UC) who underwent penile inversion vaginoplasty. We discuss risk mitigation strategies including perioperative management and intraoperative technical modifications.

Methods: We reviewed the charts of the 110 patients who underwent gender affirming vaginoplasty at one medical center between 2022 and 2024, screening for a concurrent diagnosis of IBD consisting of either UC or Crohn’s disease (CD). One patient was identified as meeting these criteria and is discussed in this case report.

Results: Preoperative multidisciplinary management included a colorectal surgery consultation, colonoscopy, and timing of the patient's medication regimen in conjunction with her gastroenterologist. Intraoperative techniques included the use of a Lowsley retractor and assessment of rectal wall integrity by instilling methylene blue in the rectum following dissection of the vaginal canal. Postoperatively, the patient experienced a minor superficial wound dehiscence and granulation tissue (Clavien-Dindo grade I), both treated with local care on an outpatient basis (i.e. application of silver nitrate and temporary reduction in dilator size). The patient’s UC remained quiescent and medically managed, and the remainder of her recovery was uneventful.

Conclusions: There is a fine balance between management of IBD and gender affirming vaginoplasty. A multidisciplinary approach facilitates pre- and postoperative care and recovery, including medication management and adjustment of intraoperative techniques. While the patient’s recovery was consistent with that of standard vaginoplasty, this is a single reported case. Additional studies are needed to further evaluate the impact of IBD and biologic medications in gender affirming vaginoplasty.