One of the differences with the simple vaginoplasty is the depth, with a colovaginoplasty we can reach 20 cm or more. Usually we leave a segment of the large bowel that goes from the vaginal introitus to the upper part of the sacral promontory, that is, to the abdominal cavity, hence the sexual intercourses become completely normal. Another difference is that the colon mucosa secretes mucus, so it lubricates very well the neovagina. The reason why this technique is not performed in all patients is because it’s a longer surgery with a longer recovery time. Moreover a surgical connection in the large bowel has healing times and may have life-threatening risks in case of anastomotic leak. There may be intra-abdominal infection or necrosis of the bowel graft that we have interposed between the prostate and the rectum. As a result it is a more delicate surgery and with a little more risk, so it is reserved for people who want to get more depth and who accept the risks.
It is necessary to do a prior evaluation to be able to advise each patient who is the best technique for him, so you always have to talk about your sexual habits, if you want much depth and what partner you have. There are people who do not want to have sex and the depth does not matter too much, only the appearance, people who are homosexual within their transsexuality, so they will never have relationships with a man, people who are older and more at risk and do not want to assume them.