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learning this operation. Certain differences in technique are preference based, such as whether a Foley catheter, Van Buren sound or Lowsley retractor is used for prostate capsule identification. We favor use of a catheter to minimize anatomical variation based on assistant retraction. Some aspects of the described technique are more idiosyncratic, such as use of the pelvic Bookwalter retractor with aggressive levator release. Whether the extent of pelvic muscle release relates to vaginal stenosis has not been effectively studied, nor whether any morbidity may result from this. These and other variations, such as supratunica vs subtunica dissection of the neurovascular neoclitoral pedicle, have not been directly compared to understand the effects on critical outcomes such as vaginal stenosis, incontinence and erogenous function. As vaginoplasty matures as a procedure, comparison studies will be vital in optimizing techniques, as will the inclusion of instruments to measure patient reported outcomes and improvements in gender incongruence. Overall, this is a thoughtful article from a skilled vaginoplasty surgeon with favorable outcomes. It should be widely referenced for trainee education on a critical portion of the vaginoplasty procedure.