Review of Different SRS Techniques
Today‘s goal of a successful FtM SRS
The surgeon should aim to create a vagina which remains patent till the maximum possible depth. The vagina should be fully sensate, should have a lubricating lining enabling natural sexual intercourse with orgasms, and should be fully vascular.
The following list briefly explains and compares surgical vaginoplasty methods as they became popular in chronological order
Penile Inversion SRS
Keeping in mind that most penises are about 6 to 7 inches, it can be deducted that this much skin length is insufficient to gain the natural depth of vagina. The reason is that about 3 to 4 inches of penile skin gets consumed for the creation of the clitoris hooding, the clitoris and the labia minora. The conclusion being, that penile inversion is not the proper technique to achieve a satisfying full SRS result, as in almost all cases this does not permit sexual intercourse.
In Dr. Kaushik’s opinion, various aspects of this surgical procedure should be labeled as a stage 1 SRS procedure. During this stage 1 procedure the emphasis is to create external genitalia in analogy to the common fetal tissue base and its differentiation into female or male outer genitalia. Working alongside this guideline, very cis-like female outer genitalia structures can be created, as long as the focus on using penile skin for a vaginal lining is obliterated and the focus is kept on using them primarily for vulva creation.
Minimum vaginal depth will be achieved which can either be used for a cosmetic SRS/ GCS result, or it can be used to join the sigmoid colon graft in a stage 2 step procedure. Ultimately all cases, who want to enjoy sexual intercourse will need stage 2 SRS in order to have a fully functional, naturally deep, self-lubricating, and sensate vagina.
Patients who had already undergone penile inversion SRS/GCS but lack vaginal depth, corrective SRS in the form of a sigmoid colon vaginoplasty gives excellent results in the form of naturally deep, lubricating and sensate vagina.
Advanced Penile Inversion Technique/ Penile Inversion With Scrotal Graft Technique
In most the cases there is not enough penile skin available to gain a full-length vagina.
Plus the skin graft itself is a low-quality choice for a vaginal lining for numerous reasons.
To gain extra depth, a full thickness or split thickness skin graft from the scrotum and/or the groin is used. This way, good vaginal depth of 4-5 inches can be achieved in almost every case. Drawbacks are the chances of loss and/ or shrinkage of the skin graft leading to depth and diameter restrictions. These healing issues can only be counteracted
by absolutely mandatory and prolonged painful and cumbersome dilation.
Furthermore, the glandular skin components of the sweat and sebaceous glands lead to secretions that get collected over regular intervals and often lead to unregular smelly, pus-like discharge. Also, quite a number of patients face hair growth problems within the vaginal. The revision rates are high. The technique should no longer be the first choice for MtF transgender individuals.
Full-Length Full-Thickness Scrotal Skin Graft SRS
The basic idea of the full (scrotal-) graft vaginoplasty was to overcome the limitations of the penile inversion SRS/GCS which stems from inverting the valued penile skin and using all or a big part of it to line the vagina with it. Also, it is geared to provide for a tension free vulva/ vagina setup.
To improve cosmetic appearance it was necessary to use more penile skin and preputial skin to create the various vulva parts. With that technique, it was possible to create cis-like labia minora, clitoral hooding and clitoris and also the labia minora could be extended to reach all the way down to the vaginal opening. No penile skin was used to line the vagina. A complete full-length full-thickness scrotal graft is used to line the vagina. It gets freed of the hair follicles to guarantee a hair free vagina and it gets sutured to the perineum and the outer penile skin.
This technique overcomes the cosmetic limitations of the surgical penile inversion variants, but it further increases and complicates the limitations a skin graft has, making dilation an even more substantial, painful and time-consuming process compared to penile inversion techniques.
This technique should be avoided as a first choice for MtF transgender individuals.
Sigmoid Colon SRS
Sigmoid colon vaginoplasty was designed to overcome the limits of skin grafts in penile inversion or full -length graft vaginoplasty techniques. A long segment of sigmoid colon with its attached blood supply is used as the neovagina. The graft is sutured to the perineum via the open end. The result is a fully deep, naturally lubricating, and sensate vagina.
The issue with this approach is the visibility of the red mucosa of the colon graft at the vaginal opening. Furthermore, excessive prolonged vaginal discharge will happen because of the secretions of the long segment of the colon with its mucosa producing a great amount of secretion. The need of prolonged dilation is sometimes necessary to keep the vaginal opening patent with a few patients. The reason for that being, that the junction of normal perineal skin and the colon graft sutured to it tends to contract. It still remains a better option than penile inversion alternatives. It has become the gold standard for secondary/corrective sigmoid colon SRS.
OLMEC SIGMA-LEAD GCS/SRS
This advanced type of sigmoid colon SRS/GCS is exclusively practiced at OLMEC and has become the technique of choice and thus the gold-standard for MtF transgender individuals.
The valued penile skin can be used accordingly to create wonderful, cis-like outer genitalia without compromise since there is hardly any penile skin needed for the vaginoplasty.
In this technique, the first portion of the introitus – the vaginal opening – (about 2 to 3 inches ) gets lined with penile skin and the extra depth is then sutured to the sigmoid colon graft. All tissues that are being used for the creation of the vagina – the small part of the pedicled penile skin and the pedicled sigmoid colon graft – have their own blood supply. This ensures complete sensibility of the area and guarantees an enormously fast healing procedure. The resultant vagina is 7 to 12 inches deep and is fully sensate with a self-lubricating lining upon sexual arousal. This fully functional deep vagina results in natural orgasms during masturbation as well as during sexual intercourse. The vaginal opening (introitus) looks natural. The colon graft length needed is small. Hence the part utilized is restricted to the distal sigmoid colon, also known as rectosigmoid colon. This bowel part is known to produce minimum secretions, hence the problem of excessive secretions is overcome.
Another most valuable part is minimum post-operative care and shorter dilation time periods and intervals because the zigzag concealed junction of soft penile skin with the sigma-lead graft has minimum chances of contraction.
Having performed all the techniques over the last 14 years, Dr. Kaushik has come to the conclusion that the fastest and best results are with his OLMEC SIGMA-LEAD SRS/GCS technique.
This procedure has consistently delivered superior overall results, both aesthetically and functionally. Every MtF transgender individual will have the experience of feeling like a complete female within two weeks.