Current trends of feminizing genitoplasty

Feminizing genitoplasty for genital ambiguity associated with a urogenital sinus anomaly involves three steps : (1) clitoroplasty, (2) vaginoplasty, and (3) labioplasty. These days, every effort is made to maintain normal clitoral innervation to the preserved glans, while preserving painless erections and providing nearly normal cosmesis. The type of vaginoplasty required depends on the anatomical location of the vaginal entrance into the common urogenital sinus. These vaginoplasties are divided into four types : (1) cut-back vaginoplasty, (2) flap vaginoplasty, (3) pull-through vaginoplasty, and (4) complete vaginal replacement. In 1997, circumferential mobilization of the entire urogenital sinus as a single unit was developed and termed total urogenital mobilization (TUM). Although this technique was employed to those with cloacal anomalies at first, it has now been applied to those with urogenital sinus anomalies without rectal involvement. In 2006, the technique of partial urogenital mobilization (PUM) was described. Dissection was limited to the pubourethral ligament. We show the procedure of feminizing genitoplasties using the technique of PUM and TUM.