A woman has become the first trans person in the world to undergo successful vaginal reconstruction using fish. Identified only as Maju, 35, she had surgery using a tilapia after her vagina began to shrink following a botched gender reassignment operation in 1999. She said that sex with her then partner had become painful and resigned herself to a life of celibacy.
But then Maju heard about a procedure called neovaginoplasty which involves the use of a tube-shaped acrylic mould, wrapped with the skin of the tilapia that would rebuild and extend her vaginal canal. Speaking about her experience, she said: ‘I was the fourth person in Brazil in 1999 to have, what was then, experimental surgery.
But ten years ago I developed vaginal stenosis. The opening of my vagina started to get narrower and shorter and the canal collapsed.’ Three weeks after treatment Maju said: ‘I’m absolutely thrilled with the result. For the first time in my life I feel complete and like a real woman.’
Maju, a florist in Sao Paulo, Brazil, was looked after by Professor Leonardo Bezerra. He said: ‘We were able create a vagina of physiological length, both in thickness and by enlarging it, and the patient has recovered extremely well. ‘She is walking around with ease, has no pain and is urinating normally.
In a couple of months we believe she will be able to have sexual intercourse.’ Prof Bezerra has treated 10 women with the condition that causes the vagina or uterus to be underdeveloped or absent. In April 2017, Jucilene Marinho, 23, became the first woman to have her vaginal canal reconstructed from tilapia fish skin after being diagnosed as having no cervix, uterus, ovaries or womb.
Last November, Elisiane Gusmão, 41, underwent the procedure while recovering from cancer. Prof Bezerra explained that vaginal tract closure is common in post-op trans women. He said: ‘This is because, in the traditional procedure, most of the inside parts of the penis are removed and the penile skin is folded into the space between the urethra and the rectum. The outside skin of the penis then becomes the inside of the vagina.
‘But because the patient has had hormonal treatment to develop female characteristics, there is penile and testicle atrophy resulting in shrinkage in the size of the penis caused by the loss of tissue. This means the vagina can also be small.’
There were complications in Maju’s case when they discovered problems relating to the initial surgery. They found remnants of cavernous bodies, erectile tissue structures, still in the vaginal space. Prof Bezerra said: ‘The presence of these leftovers of the penis aggravated the closure of the vaginal tract, worsening the symptoms.’
How the procedure was carried out
The process involved inserting two separate molds to create the new vagina. The first device, mounted with the marine membrane, was incorporated inside the vagina over a period of six days. In contact with the patient’s body, the sterilized and odour free fish skin displays stimulatory cell growth properties.
It is rich in type 1 collagen a substance that promotes healing and has firmness and elasticity which is as strong and resilient as human skin. The tilapia membrane attached to and recoated the walls of the vaginal canal acting like stem cells.
These were absorbed into the body, transforming into cellular tissue similar to that of an actual vagina. The second device made from silicone and described as a very ‘big tampon’ (an inserted feminine hygiene product used to absorb the menstrual flow) is designed to remain inside the vagina for up to six months to prevent the walls from closing.
To reverse this problem, the most common method is to do a skin graft taken from other parts of the body, usually from the intestines, to increase the width and length of the canal. This type of surgery is invasive, long and leaves scars.
Bezerra said: ‘The great benefit of our technique is that it’s minimally invasive and there’s no need to do abdominal incisions.’ Research shows that tilapia skin is disease resistant with little chance of rejection as there is an absence of cross-infection between aquatic animals and humans, unlike with other animals.
Since 2015 scientists have been trialling a radical procedure that uses the biological dressing to heal burns victims. More than 200 have been treated with notable success. The normal regime is painful and involves regular changes of gauze bandages along with painkillers and ointments.
Before it can be used, the tilapia skin is subjected to an extensive and rigorous process of sterilization and irradiation at the Nucleus of Research and Development of Medicines (NPDM) part of the UFC.
The end result is an odourless light coloured product which is vacuum packed and stored for up to two years in refrigerators at the first tilapia skin bank inaugurated in 2017. The procedure means the material can be safely distributed to treatment centres across Latin America and exported abroad.
