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MTF Surgery Procedures » Peritoneal Vaginoplasty

Peritoneal Pull-Through Vaginoplasty

An Old Approach With a New Application

Peritoneal Pull-Through Vaginoplasty (PPT) is one variation of peritoneal vaginoplasty based on a gynecological surgery called the Davydov Procedure. However, “peritoneal vaginoplasty” is not a single standardized operation. Modern gender-affirming approaches differ in how peritoneal tissue is used, how the vaginal canal is constructed, and how extensively techniques have been described in peer-reviewed studies.

First described in Russian medical literature, the Davydov Procedure uses abdominal lining (the peritoneum) to create a vaginal canal in women born without a functional vagina. Decades later, the technique was adapted for gender-affirming surgery as Peritoneal Pull-Through Vaginoplasty. Interest in PPT has grown particularly in revision cases and in patients with limited genital tissue.

How PPT is Performed

PPT Vaginoplasty combines traditional vaginoplasty techniques with the use of peritoneal tissue. Surgical approaches to PPT may vary between surgeons. Some methods use laparoscopic or robotic abdominal surgery to mobilize vascularized peritoneal flaps, while others use peritoneal tissue as a graft lining through modified pull-through approaches. As a result, procedures described as “peritoneal vaginoplasty” may differ substantially in technique.

In one described pull-through approach, a space is developed between the bladder, urethra, and rectum to form the future vaginal canal. Peritoneal tissue from the abdominal lining is then mobilized and brought downward through the perineum to help line the upper portion of the canal, while vulvar reconstruction is performed using methods similar to penile inversion vaginoplasty.

Depending on the surgeon and technique, PPT may be performed as a primary vaginoplasty procedure, as part of a hybrid approach with penile inversion, or in revision cases requiring additional depth or tissue.

Potential Advantages of PPT

Interest in PPT has grown in part because peritoneal tissue may offer several potential advantages in selected patients:

  • May reduce reliance on extensive dilation in some patients
  • Additional vaginal depth in some patients
  • Use of non-hair-bearing tissue for part of the vaginal canal, which may reduce the need for extensive pre-operative hair removal in some cases
  • A lining with moisture-producing characteristics and some elasticity
  • Avoids some considerations associated with intestinal vaginoplasty, including mucus-producing bowel tissue and long-term colon monitoring

Potential Risks and Considerations

In addition to the risks associated with traditional vaginoplasty, techniques involving laparoscopic or robotic abdominal surgery may introduce additional risks, including organ injury, ileus, or herniation.

Who May Be a Candidate for PPT?

Because PPT techniques can vary in complexity, patient selection is an important part of determining whether this approach is appropriate. PPT may be considered in patients who:

Long-Term Data and Published Outcomes

Despite growing interest in PPT vaginoplasty, there are currently no peer-reviewed clinical series specifically describing gender-affirming Peritoneal Pull-Through Vaginoplasty. The long-term outcome data in gender-affirming peritoneal vaginoplasty comes from Robotic-Assisted Peritoneal Flap Vaginoplasty (RAPV), a distinct peritoneal flap-based approach developed at NYU Langone Health and described in published medical literature.

Peritoneal Pull-Through Vaginoplasty represents one adaptation of the Davydov concept within modern gender-affirming surgery. While interest in peritoneal techniques has grown, “peritoneal vaginoplasty” is not a single standardized procedure and approaches may differ substantially between surgeons. For patients considering PPT or other peritoneal techniques, understanding these differences — and discussing them directly with surgeons — is an important part of informed surgical decision-making.

Surgeons Offering Peritoneal-Based Vaginoplasty Techniques

“Peritoneal vaginoplasty” may refer to several different surgical approaches, including Peritoneal Pull-Through Vaginoplasty (PPT), Robotic-Assisted Peritoneal Flap Vaginoplasty (RAPV), and hybrid techniques. Patients should ask surgeons how peritoneal tissue is used in their specific procedure.

  • Dr. Rachel Bluebond-Langner & Dr. Lee Zhao – New York City (RAPV)
  • Dr. Min Jun – San Francisco (RAPV)
  • Dr. Nicholas Bene - Palo Alto, California (RAPV)
  • Dr. Praful Ramineni & Dr. Sarah Eidelson – Washington, D.C.
  • Dr. Jonathan Keith & Dr. Drew Marano – Livingston, NJ & New York City
  • Dr. Gabriel Del Corral – Baltimore and Washington, D.C.
  • Dr. Loren Schechter – Chicago
  • Dr. Geolani Dy & Dr. Blair Peters – Portland OR (RAPV)
  • Dr. Heidi Wittenberg & Dr. Adam Bonnington – San Francisco
  • Dr. Kenan Celtik – San Francisco
  • Dr. Katherine Gast – Madison, WI
  • Dr. Marci Bowers – Burlingame, CA
  • Dr. Shubham Gupta – Cleveland
  • Dr. Kirtishri Mishra – Cleveland
  • Dr. Jess Ting & Dr. Bella Avanessian – New York City
  • Dr. Miroslav Djordjevic – New York City & Belgrade, Serbia
  • Dr. Christi Butler – San Francisco (RAPV)
  • Dr. Joseph Pariser – Minneapolis
  • Dr. Ervin Kocjancic – Chicago
  • Dr. Parag Telang – Mumbai, India

More Vaginoplasty Techniques:

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Last updated: 05/21/26