This procedure is a combination of a penile skin inversion and animmediate full thickness skin graft.The vaginal canal and opening is created beneath the urethral opening and prostategl and.Vaginal depth is of concern to most patients.The most important factor in creatingthis depth is the amount of penile shaft skin. Our technique lengthens the depth of the vagina by using the full thickness skin graft from the scrotal skin.Hair on the scrotum must be removed so that the skin graft is placed at the distal end of the penile skin ap. This technique can lengthen the depthatleast 2 more inches. A portion of the glands atthehead of the penis,where the nerves and vessels are located, is converted into a clitoris. In so doing, the clitoris will be functional in sensation as well as in appearance.The excess erectile tissue around the urethra should be removed in order to avoid symptomsthatstem from engorged erectile tissue during sexual arousal that may result in the narrowing of the vaginal opening. Colon transposition is used for patients who need more depth (exceeding 8 inches).