Sex reassignment male to female surgery is a reconstructive operation aimed at obtaining a good cosmetic appearance. Surgical techniques are well codified and relatively simple to perform. Microsurgery is useful for performing the most delicate procedures such as neurovascular bundle dissection, glans conversion into clitoris and urethral dissection and reanastomosis. Postoperative complications are generally not severe and include the possible stenosis of the new urethral meatus, the necrosis of the glans and urethral fistulas. These may be avoided with experience and the use of atraumatic techniques during the operation. Stenosis of the neovagina is generally due to improper postoperative dilation by the patient. Rectal injury during the perineal dissection is a severe intraoperative complication. The use of microlaparoscopy avoids the risk of this complication and allows some complementary maneuvers such as the fixation of the apex of the neovagina to the bottom of the perineal cavity by means of a few sutures. This procedure allows the hitching of the neovagina deeply in the perineum and a better functional and cosmetic result.

The surgical reconstruction of a well functioning vagina is important but not the only aim of this operation. Psychological evaluation and support are required before surgery in order to select the patients who can benefit from the operation. Aid in obtaining a complete social adjustment subsequently is also important.

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