According to Dr. Kaushik, in our age and time, a surgeon’s goal of successful FtM GCS/ SRS should meet the following criteria:
The following list briefly explains and compares surgical vaginoplasty methods as they became popular in chronological order
1.) Penile Inversion (PI) GCS/ SRS
Penile inversion is a surgical technique used in gender confirmation surgery (also known as gender reassignment surgery or sex reassignment surgery) for trans women. During the procedure, the penile tissue is used to create a neovagina.
Here is a general overview of the penile inversion procedure:
It’s important to note that the specific surgical techniques and details can vary among surgeons and healthcare facilities. If you or someone you know is considering gender confirmation surgery, it’s best to consult with a qualified healthcare professional who specializes in transgender healthcare to discuss the available options, potential risks, and expected outcomes.
Dr. Kaushik nowadays considers PI GCS/SRS to be a purely Cosmetic GCS/SRS surgery because the emphasis is to create proper external genitalia – a vulva – 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 for vulva creation.
Very little skin is used to create a vaginal opening and a non-functional “vagina” of 1-2 inches only – which Dr. Kaushik defines as Cosmetic GCS/SRS.
This vaginal opening can be connected to a Sigma-Lead graft at a later time. All of Dr. Kaushik’s Cosmetic GCS/SRS patients, who want to enjoy natural sexual intercourse after their Cosmetic GCS/SRS can opt for the Sigma-Lead CompletionGCS/SRS in order to have a fully functional, naturally deep, self-lubricating, and sensate vagina.
Patients who already underwent PI SRS/GCS but lack vaginal depth, proper vagina function, or whose neovagina has closed itself completely, can have Sigma-Lead Revision GCS/SRS with excellent results in the form of a naturally deep, lubricating, and sensate vagina.
2.) Advanced Penile Inversion Technique/ Penile Inversion With Scrotal Graft Technique
In quite a number of patients the penile skin available will be insufficient for a full-length penile skin neovagina.
In the standard penile inversion technique, the penile skin is inverted and used to create the neovaginal canal. However, in cases where the penile skin alone may not provide enough tissue or depth for the desired result, scrotal skin grafts can be incorporated to augment the neovagina.
Here are the basic steps involved in the penile inversion with the scrotal graft technique:
It’s essential to note that the advanced penile inversion technique with scrotal grafts is a more complex surgical procedure that may require additional expertise and experience. As with any surgical technique, the specifics can vary among surgeons and healthcare facilities. If you are considering gender confirmation surgery, it’s crucial to consult with a qualified healthcare professional who specializes in transgender healthcare to discuss the available options, potential risks, and expected outcomes specific to your case.
3.) Full-Length Full-Thickness Scrotal Skin Graft SRS
Here is a general overview of the full-length full-thickness scrotal skin graft technique:
It’s important to note that the full-length full-thickness scrotal skin graft technique is a complex surgical procedure that requires significant expertise and experience. The specific details of the technique may vary among surgeons and healthcare facilities. If you are considering gender confirmation surgery, it’s crucial to consult with a qualified healthcare professional who specializes in transgender healthcare to discuss the available options, potential risks, and expected outcomes specific to your case.
4.) Peritoneum GCS/SRS Surgery
Since 1974, surgeons have used this method for CIS-female MRKH patients, mainly as a pull-through operation.
This method has just recently been adapted for transsexual women by surgeons. Because of its abundance, proximity to the vaginal canal, mucosa-type (squamous epithelium cell) surface, and ability to lubricate, the peritoneum is a good alternative to any skin transplant GCS/SRS. When Sigma-Lead GCS/SRS is not achievable for whatever reason, peritoneum GCS/SRS is the best alternative for all transsexual women seeking GCS/SRS.
The peritoneum is not as trauma-resistant as a colon graft and lacks the Sigma-Lead graft’s room-space and wall thickness ratio. The main advantage over the Sigma-Lead GCS/SRS is that no anastomosis with its related risks is required.
5.) Sigmoid Colon GCS/SRS
Sigmoid Colon GCS/SRS
Sigmoid colon vaginoplasty, also known as sigmoid colon neo vaginoplasty or sigmoid vaginoplasty, is a surgical technique used in gender confirmation surgery (also known as gender reassignment surgery or sex reassignment surgery) for trans women. This technique involves utilizing a section of the sigmoid colon, a portion of the large intestine, to create the neovaginal canal.
Here is a general overview of sigmoid colon GCS/SRS:
It’s important to note that sigmoid colon GCS/SRS is a complex surgical procedure that requires expertise and experience. The specific details of the technique may vary among surgeons and healthcare facilities. If you are considering gender confirmation surgery, it’s crucial to consult with a qualified healthcare professional who specializes in transgender healthcare to discuss the available options, potential risks, and expected outcomes specific to your case..
6.) OLMEC SIGMA-LEAD GCS/SRS
This advanced type of sigmoid colon SRS/GCS is only used at OLMEC and has become the technique of choice, as well as the gold standard, for all of Olmec’s MtF transsexual patients.
Because vaginoplasty requires very little penile skin, the prized penile skin can be used to construct exquisite, cis-like outer female genitalia without compromise.
The first segment of the introitus, the vaginal aperture (approximately 1 to 2 inches/ 2-4 cm), is coated with penile skin and sutured to the sigmoid colon transplant in this procedure. This assures total sensation of the area and a remarkably quick healing procedure. The typical depth of the SigmaLead vagina is 7 to 10 inches (17 – 25 cm), and with sexual excitement, the vagina is totally sensate with a self-lubricating lining. This completely functional deep vagina promotes natural orgasms during masturbation and sexual intercourse. The vaginal opening (introitus) appears to be natural. The length of the colon graft required is little. As a result, the component used is limited to the distal sigmoid colon, also known as the rectosigmoid colon. Because this intestinal section is known to produce minimal secretions, the problem of excessive secretions is no longer a problem.
Another advantage is that there is less post-operative care and shorter dilation time periods and intervals since the zigzag suture pattern at the concealed junction of soft penile skin and sigma-lead graft has a low risk of contracting.
Dr. Kaushik has done all techniques over the last 14 years and quickly concluded that his OLMEC SIGMA-LEAD SRS/GCS methodology produces the quickest and best results for a TS*woman seeking GCS/SRS.
This technique has routinely produced outstanding overall outcomes, both visually and functionally.
Every Olmec Sigma-Lead patient will acknowledge that her genitals feel like a normal vulva and vagina to her within a few weeks following surgery.