According to Dr. Kaushik, in our age and time, a surgeon’s goal of successful FtM GCS/ SRS should meet the following criteria:
- Create a naturally looking vulva with all regular aspects of a female vulva
- Create a fully sensate clitoris with a natural appearance and orgasmic capability
- Create a vagina which remains patent (stays this way) till the maximum possible depth
- The vagina should be fully vascular, fully sensate, and fully functional
- The vagina should have a lubrication lining that generates proper lubrication on sexual arousal
- The vagina should enable natural sexual intercourse and hopefully vaginal orgasms
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:
- Preoperative Evaluation: The patient undergoes a thorough evaluation by a qualified medical professional to determine their eligibility for surgery. This evaluation typically includes physical examinations, psychological assessments, and discussions about the patient’s expectations and goals.
- Anesthesia: The patient is placed under general anesthesia to ensure they are comfortable and unconscious throughout the surgery.
- Penile Disassembly: The surgeon begins by dissecting the penile tissue, which includes removing the erectile tissue (corpora cavernosa) and preserving the urethra.
- Scrotal Dissection: The scrotal skin is dissected and prepared for use in creating the labia majora, which are the outer folds of the vulva.
- Penile Inversion: The penile skin is inverted and used to line the neovaginal canal. The preserved urethra is repositioned to allow for urination.
- Labiaplasty and Clitoroplasty: The scrotal skin is reshaped to form the labia majora, while the glans of the penis is used to create a clitoris. The surgeon aims to create a natural-looking appearance and enhance sensitivity.
- Closure and Suturing: The surgical incisions are closed using dissolvable sutures. Drains may be inserted to remove excess fluid or blood.
- Recovery and Postoperative Care: The patient is closely monitored in a hospital or surgical facility following the procedure. They may need to use dilators to maintain the depth and width of the neovagina and prevent stenosis (narrowing) during the healing process. Postoperative care, including pain management, wound care, and follow-up visits, will be provided.
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:
- Preoperative Evaluation: Similar to other gender confirmation surgeries, the patient undergoes a comprehensive evaluation to assess their eligibility and readiness for surgery.
- Anesthesia: The patient is placed under general anesthesia to ensure their comfort and unconsciousness during the procedure.
- Penile Disassembly: The surgeon begins by dissecting and removing the penile tissue, including the erectile tissue (corpora cavernosa) while preserving the urethra.
- Scrotal Skin Harvesting: A portion of the scrotal skin is carefully excised to provide additional tissue for grafting. The remaining scrotal skin is still used to create the labia majora.
- Penile Inversion: The penile skin is inverted and serves as the primary lining of the neovaginal canal. The scrotal skin grafts are then meticulously placed to augment the depth and provide additional tissue support.
- Labiaplasty and Clitoroplasty: The scrotal skin is reshaped to form the labia majora, and the glans of the penis is used to create a clitoris, similar to the standard penile inversion technique.
- Closure and Suturing: The surgical incisions are closed using dissolvable sutures, and drains may be inserted if necessary.
- Recovery and Postoperative Care: The patient undergoes postoperative care, which includes monitoring, pain management, wound care, and follow-up visits. Dilators may be used to maintain the depth and width of the neovagina during the healing process.
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:
- Preoperative Evaluation: The patient undergoes a comprehensive evaluation to determine their eligibility for surgery, including physical examinations, psychological assessments, and discussions about goals and expectations.
- Anesthesia: The patient is placed under general anesthesia to ensure their comfort and unconsciousness during the surgery.
- Penile Disassembly: The surgeon begins by dissecting and removing the penile tissue, including the erectile tissue (corpora cavernosa), while preserving the urethra.
- Scrotal Skin Harvesting: The entire length and thickness of the scrotal skin are harvested. This involves making incisions along the scrotum and carefully removing the skin.
- Penile Inversion: The scrotal skin graft is used to line the neovaginal canal. The graft is carefully sutured in place, providing the primary lining for the depth and width of the neovagina.
- Labiaplasty and Clitoroplasty: The scrotal skin is reshaped and tailored to form the labia majora, which are the outer folds of the vulva. The glans of the penis may be used to create a clitoris, similar to other penile inversion techniques.
- Closure and Suturing: The surgical incisions are closed using dissolvable sutures, and drains may be inserted if necessary.
- Recovery and Postoperative Care: The patient undergoes postoperative care, which includes monitoring, pain management, wound care, and follow-up visits. Dilators may be used to maintain the depth and width of the neovagina during the healing process.
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
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Sigmoid Colon GCS/SRS
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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:
- Preoperative Evaluation: The patient undergoes a comprehensive evaluation to determine their eligibility for surgery, including physical examinations, psychological assessments, and discussions about goals and expectations.
- Anesthesia: The patient is placed under general anesthesia to ensure their comfort and unconsciousness during the surgery.
- Sigmoid Colon Dissection: The surgeon begins by accessing the abdomen and identifying the sigmoid colon, which is located in the lower abdomen. The section of the sigmoid colon that will be used for neovaginal construction is identified and marked.
- Sigmoid Colon Resection: The marked portion of the sigmoid colon is surgically removed while preserving its blood supply and maintaining a sufficient length to create the neovaginal canal.
- Neovaginal Canal Creation: The sigmoid colon segment is carefully shaped and sutured to form the neovaginal canal. The remaining ends of the sigmoid colon are typically closed and may be reattached to maintain the continuity of the digestive system.
- Labiaplasty and Clitoroplasty: After the neovaginal canal is created, the surgical focus shifts to the external genitalia. The scrotal skin may be reshaped to form the labia majora, while the glans of the penis may be used to create a clitoris.
- Closure and Suturing: The surgical incisions are closed using dissolvable sutures, and drains may be inserted if necessary.
- Recovery and Postoperative Care: The patient undergoes postoperative care, which includes monitoring, pain management, wound care, and follow-up visits. Dilators may be used to maintain the depth and width of the neovagina during the healing process.
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.
