In the period of 1980 to 1992, primary genital reassignment surgery was performed for 200 male-to-female transsexuals aged 18 to 71 years. For this, the penile and scrotal skin inversion technique was used. Because, apart from minor complications in 32 patients, neovaginal obliteration was encountered only twice and early in this series, we believe it is worthwhile to report in detail our pre-, intra-, and postoperative measures. Discontinuation of hormonal treatment may prevent venous thrombosis. The preoperative rectal rinse and antibiotics are believed to be of importance to avoid rectovaginal fistulae. A soft and pliable intravaginal Vaseline tampon may prevent sloughing of the inverted skin. Intermittent daily neovaginal dilatation may successfully ensure neovaginal depth and width and, in our opinion, is superior to a long-term continuous intravaginal stent.