How Surgeons Around the Globe Perform GCS/SRS
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
Keeping in mind that most penises are about 6 to 7 inches (15 – 18 cm) in length, it can be deducted that this much skin is insufficient to gain the natural depth of vagina of around 4.8 in/ 12 cm. The reason is that about 3 to 4 inches of penile skin gets consumed for the creation of the clitoral hooding, the clitoris, and the labia minora. The conclusion being, that penile inversion is not the proper GCS/SRS technique to achieve a functional vagina and a pleasing natural vulva because of the limitations of the technique itself. In most cases the result achived after this GCS/SRS surgery does not permit proper sexual intercourse.
Dr. Kaushik’s 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.
3.) Full-Length Full-Thickness Scrotal Skin Graft SRS
4.) Peritoneum GCS/SRS Surgery
5.) Sigmoid Colon GCS/SRS
Sigmoid colon vaginoplasty was designed to overcome the limits of penile inversion, advanced PI skin-graft, full-length scrotal graft, and peritoneal GCS/SRS techniques.
A proper-length segment of sigmoid colon with its attached blood supply is used as the neovagina. The sigmoid colon graft is sutured close at one end. The open end of the sigmoid colon graft is sutured to the vaginal opening skin in around 1-2 inches (2 – 4 cm) of depth. The result is a fully deep, naturally lubricating, and sensate vagina.
The aspect of suturing inside the vagina avoids the visibility of the red mucosa of the colon graft at the vaginal opening, which was an issue in the first sigmoid colon GCS/SRS surgeries in the 1970’s and 1980’s. Also excessive prolonged vaginal discharge because of the secretions of a too-long segment of the colon or an improper sigmoid colon graft choice is nowadays a thing of the past. In earlier times, the need of prolonged dilation was sometimes necessary to keep the vaginal opening patent. The reason for that was that the junction of normal perineal skin and the colon graft sutured to it tended to contract. Nowadays this is also a thing of the past for any experienced and well-trained sigmoid colon GCS/SRS surgeon.
6.) 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 all of Olmec’s MtF transgender individuals.
The valued penile skin can be used accordingly to create wonderful, cis-like outer female 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 1 to 2 inches/ 2-4 cm) gets lined with penile skin and this skin 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 and nerve supply
This ensures complete sensation of the area and guarantees an enormously fast healing procedure. The regular depth of the SigmaLead vagina is 7 to 10 inches (17 – 25 cm) deep and the vagina is fully sensate with a self-lubricating lining upon sexual arousal. This fully functional deep vagina assists 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 a thing of the past.
Another most valuable part is minimum post-operative care and shorter dilation time periods and intervals because the zigzag suture pattern at the concealed junction of soft penile skin and sigma-lead graft has minimum chances of contraction.
Having performed all techniques over the last 14 years, Dr. Kaushik pretty soon has come to the conclusion that the fastest and best result for a TS*woman wanting GCS/SRS are achieved with his OLMEC SIGMA-LEAD SRS/GCS technique.
This procedure has consistently delivered superior overall results, both aesthetically and functionally.
Every Olmec Sigma-Lead patient will confirm that she has the experience of her genitals feeling like a natural vulva and vagina to her within a short time after surgery.