It's actually the historic development of GRS/SRS surgery that created the largest pitfall that most TS women fall into when they begin research before they have GRS/SRS performed - me included.
This trap is set up in a deceiving way to leave you with a cosmetic result of your vulva that might be good or even great - but it leaves the TS woman with an often poorly functioning vagina that oftentimes has flaws so gravely that quite a number of girls wish they had never gone through with GRS/SRS.

One has to understand that GRS/SRS undergoes permanent development.
There is no "general best option" or "general best surgeon" but only a "best GRS/SRS option at a specific time in history for an individual".

When Dr. Burou's genius invented the penile inversion concept in 1956 it was the only viable option for us TS women - and this genius is also responsible for the pitfall that nearly all TS women in our time fall into - making a poor choice for their GRS/SRS surgery in our century.
Let me explain why that is so.

Dr. Burou's penile inversion concept created the vulva - clitoris, labia majora, a hint of labia minora and vaginal entrance - and the neovagina IN ONE SURGERY OUT OF ONE SKIN GRAFT, the penile skin.

That's why from this point onwards all TS women seeking GRS/SRS thought a genital reassignment surgery had to be this way: vulva and vagina get created in ONE surgery and that creating the vulva and the neovagina is inextricably connected and formed out of out of one skin graft.

This circumstance is the trap that wants to be revealed and avoided at all cost!

You see, women suffering from MRKH (Mayer-Rokitansky-Kuester-Hauser Syndrome) suffer from only one of the two aspects we suffer from: theses women have the proper vulva - their outer genitals were created perfectly.
But due to epigenetic failure - some kind of genetic transcription misinterpretation while reading the genetic code to manifest the genetic information into forming fetal tissue - causes the absence of the proper vagina that should have come with the newly formed female fetus, the yet unborn female girl.

Oftentimes not before puberty, the absence of the vagina - termed vaginal agenesis - goes unnoticed. Only when menstruation fails to happen, vaginal agenesis gets noticed. Or menstruation creates often painful issues because the egg cell along with the bleeding mucosal tissue can't be discharged caused by the non-existent vagina, which can also cause further sometimes dangerous issues. At this point, it will be discovered that this young woman is suffering from MRKH syndrome and that she has a vagina which failed to fully develop.

In the past, surgeons tried to fix this issue of an absent vagina by using skin grafts from the thighs of these young women - but skin grafts utterly failed to deliver satisfactorily results in terms of function, sensation, and aftercare.
In terms of creating a neovagina all TS women and women suffering from MRKH syndrome are in one and the same position.
To avoid all skin graft related flaws surgeons were looking for better options and they began to use pieces of the colon to create a proper neovagina to come as close as possible to a natural vagina as possible. The colon segment was created to work inside the body and is fully equipped with mucosa which will allow for lubrication upon sexual arousal and it also serves as a self-cleaning mechanism. The colon walls are sturdy, yet flexible and have a proper diameter. On top of that the nerves that are connected to the colon pieces belong to the same nerve branch that innervates the vagina in CIS women.

The results of these vaginoplasties were and are very good compared to the skin graft vaginoplasty results, documented by countless medical reports and medical research papers available on the topic worldwide.

Unfortunately, so far this highly important information hasn't made it into the TS community to be common knowledge.
The strange idea of using a colon and possible complications that might arise out of this procedure seem to be the most obvious obstacle.
Actually, exactly the opposite is true nowadays.

Surgical techniques have advanced so far that removing a part of the colon and connecting the colon pieces again - termed anastomosis - is a standard procedure that hardly poses risks anymore. In the case of vaginal cavity preparation, this surgical technique even has a great advantage.
Should the colon be cut in some way while preparing the vaginal cavity, then the colon graft piece will seal the area of the created fistula all by itself. Should this happen during a skin graft SRS, the surgery will have to be aborted and the fistula needs to be closed first before the surgery can advance any further. All patients who experienced the surgeon moving on with a skin graft SRS despite the fistula created know what a painful and never-ending story such an issue can be.

The skin graft SRS moves tissue at a location that it wasn't made for and that is why problems arise. The skin cells function in the same way as before - with sweat glands producing, sweat and sebaceous glands producing their secretions - causing some pus-like discharge which usually gets diagnosed as a bacterial infection - yet the cause of the infection being the skin graft itself is usually unkown and goes unrecognized.

Also the shrinking process of the graft and it's limited elasticity oftentimes create rough patches of skin or further scarring inside the vagina - sometimes even years after SRS  - which will make dilation or sexual intercourse painful or up to extremely painful - like in my case. Although Dr. Chettawut inspected the vaginal tissue claiming "everything is ok" 2 years after my initial SRS, the reality was different.

Also the immense and intense hours of dilation after the SRS skin graft surgery are downright troublesome.

After colon surgery, dilation time will usually be 1 x 15-20 minutes per day for up to 4-5 months - and then dilation can be considered a thing of the past - thanks to the form, shape and inherent properties of the colon graft.

There are a number of different varieties of colon surgeries available out there - be sure to check them out!

I also believe that there will be further improvements due to laparoscopic surgical improvements and other medical improvements we can't even think about yet.

Maybe some day a stem-cell bread vagina will be available for GCS/SRS also, but whenever that will be the case we should talk about it.

As of now, I believe a colon surgery is the best approach in our time and my personal favorite is the Sigma-Lead approach by Dr. Kaushik, who performed my corrective Sigma-Lead SRS in February 2017.
All skin graft inherent issues are taken care of now because of it, thank goodness.

monamtb,

Thank you for this information.  I was not aware that using a colon segment was even possible, but it makes sense based on your description.  I am curious about the long term health care, and is this colon segment still susceptible to colon cancer?  As you have educated yourself on this procedure, have you seen any information that addresses the risk of cancer?

I'm not an expert, but the most recent articles on sigmoid vaginoplasty do not seem that positive.

Long-Term Follow-Up of Transgender Women After Secondary Intestinal Vaginoplasty
http://www.jsm.jsexmed.org/article/S1743-6095(16)00085-0/fulltext

This article found of 24 sigmoid vaginoplasty cases (between 1970 and 2000), "intestinal neovaginas were surgically removed" in ~10% of cases. ~80% needed additional surgeries.

Of the cases who filled out the detailed survey, self-reported outcomes were fine, but not better than what is observed among penile-inversion cases (see Lawrence 2006).

Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics.
https://www.ncbi.nlm.nih.gov/pubmed/26632208

This article studying 34 sigmoid vaginoplasty cases, found that post-surgery, cases tended to clinically resemble those with diversion colitis. Diversion colitis is usually asymptomatic, but it can result in "a foul smelling, mucous rectal discharge may develop from the inflamed mucosa of the distal, unused colon." (https://en.wikipedia.org/wiki/Diversion_colitis)

That doesn't sound too good...

I didn't cherry-pick studies. I used pubmed (https://www.ncbi.nlm.nih.gov/), and searched:
"Sex Reassignment Surgery"[Mesh]

Sorting by most recent, these are the first two studies that came up that looked at sigmoid vagnioplasty (see items 8 and 20). Both published in 2016.

This study is more positive:

Long-Term Outcomes of Rectosigmoid Neocolporrhaphy in Male-to-Female Gender Reassignment Surgery
https://www.ncbi.nlm.nih.gov/pubmed/26218383

QuoteThis study is one of the largest and longest reported series of rectosigmoid transfers for vaginoplasty in transsexual patients. Rectosigmoid neocolporrhaphies have many times been recommended for secondary or revision surgery when other techniques, such as penile inversion, have failed. However, the authors believe the rectosigmoid transfer is safe and efficacious, and it should be offered to male-to-female patients for primary vaginoplasty.

And here's a study that actually reviewed the literature and compared the two surgical options:

Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques
https://www.ncbi.nlm.nih.gov/pubmed/25817066

It suggests that sigmoid vaginoplasty is less studied than penile inversion, but does not "seem to be inferior."

Is one method better than the other? I don't know. But it seems to me that you are comparing apples and oranges.. Vaginoplasty for sufferers of vaginal agenesis has some significant differences to vaginoplasty for trans people. Firstly, it may be that the agenesis patient has part of her vagina, not all cases demonstrate a complete lack of vagina. Secondly, even when the vagina is completely absent, many of the support structures are still there and useable - it's this issue that also complicates uterine transplants for MtF people.

There are still surgeons who do (or know how to do) vaginoplasty using a colon graft. Yes, the "penile inversion" technique is more common, but few, if any, still do the procedure in the traditional way. It is still done with skin grafts, but in a more diverse and creative way.

You said it yourself--there is no "general best option". 

Having said it, however, you seem to think that sigmoid transfer is vastly superior to other approaches. 

I think it is an option.  The physician in me, however, feels compelled to say that entering the abdomen does entail additional risk.  Caveat emptor.

Quote from: monamtb on May 04, 2017, 10:18:01 AM
It's actually the historic development of GRS/SRS surgery that created the largest pitfall that most TS women fall into when they begin research before they have GRS/SRS performed - me included.
This trap is set up in a deceiving way to leave you with a cosmetic result of your vulva that might be good or even great - but it leaves the TS woman with an often poorly functioning vagina that oftentimes has flaws so gravely that quite a number of girls wish they had never gone through with GRS/SRS.

One has to understand that GRS/SRS undergoes permanent development.
There is no "general best option" or "general best surgeon" but only a "best GRS/SRS option at a specific time in history for an individual".

When Dr. Burou's genius invented the penile inversion concept in 1956 it was the only viable option for us TS women - and this genius is also responsible for the pitfall that nearly all TS women in our time fall into - making a poor choice for their GRS/SRS surgery in our century.
Let me explain why that is so.

Dr. Burou's penile inversion concept created the vulva - clitoris, labia majora, a hint of labia minora and vaginal entrance - and the neovagina IN ONE SURGERY OUT OF ONE SKIN GRAFT, the penile skin.

That's why from this point onwards all TS women seeking GRS/SRS thought a genital reassignment surgery had to be this way: vulva and vagina get created in ONE surgery and that creating the vulva and the neovagina is inextricably connected and formed out of out of one skin graft.

This circumstance is the trap that wants to be revealed and avoided at all cost!

You see, women suffering from MRKH (Mayer-Rokitansky-Kuester-Hauser Syndrome) suffer from only one of the two aspects we suffer from: theses women have the proper vulva - their outer genitals were created perfectly.
But due to epigenetic failure - some kind of genetic transcription misinterpretation while reading the genetic code to manifest the genetic information into forming fetal tissue - causes the absence of the proper vagina that should have come with the newly formed female fetus, the yet unborn female girl.

Oftentimes not before puberty, the absence of the vagina - termed vaginal agenesis - goes unnoticed. Only when menstruation fails to happen, vaginal agenesis gets noticed. Or menstruation creates often painful issues because the egg cell along with the bleeding mucosal tissue can't be discharged caused by the non-existent vagina, which can also cause further sometimes dangerous issues. At this point, it will be discovered that this young woman is suffering from MRKH syndrome and that she has a vagina which failed to fully develop.

In the past, surgeons tried to fix this issue of an absent vagina by using skin grafts from the thighs of these young women - but skin grafts utterly failed to deliver satisfactorily results in terms of function, sensation, and aftercare.
In terms of creating a neovagina all TS women and women suffering from MRKH syndrome are in one and the same position.
To avoid all skin graft related flaws surgeons were looking for better options and they began to use pieces of the colon to create a proper neovagina to come as close as possible to a natural vagina as possible. The colon segment was created to work inside the body and is fully equipped with mucosa which will allow for lubrication upon sexual arousal and it also serves as a self-cleaning mechanism. The colon walls are sturdy, yet flexible and have a proper diameter. On top of that the nerves that are connected to the colon pieces belong to the same nerve branch that innervates the vagina in CIS women.

The results of these vaginoplasties were and are very good compared to the skin graft vaginoplasty results, documented by countless medical reports and medical research papers available on the topic worldwide.

Unfortunately, so far this highly important information hasn't made it into the TS community to be common knowledge.
The strange idea of using a colon and possible complications that might arise out of this procedure seem to be the most obvious obstacle.
Actually, exactly the opposite is true nowadays.

Surgical techniques have advanced so far that removing a part of the colon and connecting the colon pieces again - termed anastomosis - is a standard procedure that hardly poses risks anymore. In the case of vaginal cavity preparation, this surgical technique even has a great advantage.
Should the colon be cut in some way while preparing the vaginal cavity, then the colon graft piece will seal the area of the created fistula all by itself. Should this happen during a skin graft SRS, the surgery will have to be aborted and the fistula needs to be closed first before the surgery can advance any further. All patients who experienced the surgeon moving on with a skin graft SRS despite the fistula created know what a painful and never-ending story such an issue can be.

The skin graft SRS moves tissue at a location that it wasn't made for and that is why problems arise. The skin cells function in the same way as before - with sweat glands producing, sweat and sebaceous glands producing their secretions - causing some pus-like discharge which usually gets diagnosed as a bacterial infection - yet the cause of the infection being the skin graft itself is usually unkown and goes unrecognized.

Also the shrinking process of the graft and it's limited elasticity oftentimes create rough patches of skin or further scarring inside the vagina - sometimes even years after SRS  - which will make dilation or sexual intercourse painful or up to extremely painful - like in my case. Although Dr. Chettawut inspected the vaginal tissue claiming "everything is ok" 2 years after my initial SRS, the reality was different.

Also the immense and intense hours of dilation after the SRS skin graft surgery are downright troublesome.

After colon surgery, dilation time will usually be 1 x 15-20 minutes per day for up to 4-5 months - and then dilation can be considered a thing of the past - thanks to the form, shape and inherent properties of the colon graft.

There are a number of different varieties of colon surgeries available out there - be sure to check them out!

I also believe that there will be further improvements due to laparoscopic surgical improvements and other medical improvements we can't even think about yet.

Maybe some day a stem-cell bread vagina will be available for GCS/SRS also, but whenever that will be the case we should talk about it.

As of now, I believe a colon surgery is the best approach in our time and my personal favorite is the Sigma-Lead approach by Dr. Kaushik, who performed my corrective Sigma-Lead SRS in February 2017.
All skin graft inherent issues are taken care of now because of it, thank goodness.

https://www.newscientist.com/article/dn25399-engineered-vaginas-grown-in-women-for-the-first-time/amp/




Sent from my iPhone using Tapatalk

And this: http://transascity.org/the-truth-about-the-lab-grown-vaginas/


Sent from my iPhone using Tapatalk

So, you had issues with a graft-based SRS that were resolved with a colon-based revision. That's great, but this entire  thread smells like someone with an agenda.

Would I suggest that using a colon-graft is better? No, no more than I would argue that a skin-graft is superior. I do think that more options are good, but that should be tempered with the knowledge that there is no approach that is perfect for all.

Quote from: kelly_aus on May 05, 2017, 05:04:56 AM
So, you had issues with a graft-based SRS that were resolved with a colon-based revision. That's great, but this entire  thread smells like someone with an agenda.

Would I suggest that using a colon-graft is better? No, no more than I would argue that a skin-graft is superior. I do think that more options are good, but that should be tempered with the knowledge that there is no approach that is perfect for all.

Kelly,

    Well said.  This is true of any surgery where there are multiple methods of accomplishing a desired result.  I've had a couple of inguinal hernia repairs which has multiple repair methods, and I can't see myself picking and choosing a surgeon based upon what technique they use.  I would on the other hand choose a surgeon who is current and trained on the various techniques so that they can provide me options, and they can choose the correct method once they've opened me up, seen what's there and are making me whole again.

Hey Mona,

I hope you are well. I completely agree with your evaluation and know from personal experience because Kauhsik did my GCS and all is well. Thanks for putting this info on here. I understand that heaps of the girls on here go to Thailand because they think it's where the best GCS surgeons are, but i really don't think that's the case. It's really sad when i read on here that girls are having trouble with dilation and keeping depth or when they mention their exhausting dilation schedules. There's nothing wrong with providing information to help the girls make an informed decision.

Kelly - What is the agenda that you speak of?

I am happy you got a better result from colon surgery than you did from your initial SRS, and I will agree with you that lining the vagina with skin grafts has issues and frankly leaves a lot to be desired. However, there is a reason most SRS doctors consider consider colon vaginoplasty to be a back-up or even last resort choice. No matter where you take the graft from in there, you are cutting into your abdomen and removing a piece of a critical internal organ, then stapling it back together. This is clearly a pretty invasive action, and the literature is full of complications like colitis, bleeding, excessive mucous production, digestive issues, etc. There are not a lot of long-term follow-ups, and findings like "does not seem to be inferior" is hardly a ringing endorsement. It does sound a bit like you're heavily promoting this specific doctor as the best choice for everybody, but obviously there are very valid reasons to avoid colon surgery as well so remember that what worked best for YOU might not work best for somebody else with different needs and priorities.

I'd never consider surgery in Thailand if not for the hundreds of independant reviews from women who been there. There's been thousands of western women who've had surgery there and it's possible to have a good degree of certainly in what you getting into, both good and bad. That doesn't currently apply to India and won't for some years to come - in my opinion it's highly risky at the moment. Risk as in uncertainty about the outcome.

Theres a bit more info about SRS in Australia (my home), though not enough to make me comfortable. USA is pretty clear what your getting for some surgeons, but there's also lot of new ones. Europe no.

Thanks to whoever removed the all CAPs title (nothing turns me off a discussion faster than shouting :-().

While I appreciate the OP's point of view, taking absolutist warnings to heart doesn't come naturally to me and if any single quandary faces women considering surgical transitions, it would be the combination of poor scientific data and all too available anecdotal data.

I'm extraordinarily happy with my results (all of 9 days post op) and a couple of my personal reasons for never wavering far from the PI method are already born out -- when dilating I can feel skin sensation all the way to full depth -16cm- verifying that maintaining the original nerve connections has been achieved. I don't much know how that's going to play over the long run but it's definitely a welcome start.

I considered sigmoid as well as the Thai methods, discounted the latter for concerns of longer healing times and the former on aesthetic grounds. The presence of lubrication has been the main advantage cited for the sigmoid with the downside that it's continuous and I didn't like the idea of my vagina weeping continuously.

The vaginal lining in natal women is in fact skin, not mucosa. However that skin is special in natal females and the self lubricating (especially on arousal) properties aren't something we get with GCS.

Doubtless I'm an example of survivorship bias and goddesses knows I'm sure there's time and opportunity for some things to go wrong. Still for now things look good and I'm glad my plan A is so far working out..

Yes, I agree with Kelly that this OP may actually reflect the trap that a lot of trans women fall into: assuming their process or surgeon was the best possible for everyone. The penile inversion versus non-inversion wars have gone on for years, and this merely adds the colon proponents to the battlefield.

Personally, I was happy with the less invasive surgery that I had, and I did not have any of the issues cited as drawbacks for non-colon surgery (including that tests of the vagina showed mucosal tissue with normal vaginal flora and no weird "pus-like" discharges). I'm even down to dilating once every few months. That doesn't mean I think my method was best for everyone, but I do think it was best for *me.* I was perfectly well aware of all of the current options, and I chose the one that seemed most in line with my own priorities. I would venture to guess that the same is true of most women seeking surgery (and those priorities may include things like cost or travel time, of course, so not everyone is making "perfect vagina" [versus "good enough"] the first item on their list in any case).

The sad truth is that there aren't enough solid scientific studies on GRS options, much less meta-studies, to draw a conclusion about what would be best for everyone... and that conclusion usually comes as a result of one of the options being notably inferior, in any case. The discovery that a type of knee surgery produced outcomes no better than a placebo? It's obvious that the surgery is pointless. Two methods of surgery that both have advantages and disadvantages, though? The advice in that case is generally to choose what best fits the patient and their circumstances. (I'm a science librarian in my day job, so digging up data like this for people is literally what I do, although I'm not going to use my employer's database access to search this topic.) Heck, there are trans women who don't want a vagina created at all, and that's as valid an option as any.

Thank you once again for sharing that info, monamtb. I told you thank you for the other info you provided in my topic as well. ^_^

The average depth of an *aroused and stretched* cis woman is about 4.5-5", so I'm perfectly happy to consider that comparable to my standard depth as an "unstretchable" trans woman... and in fact, my wife can't accommodate the width of my largest dilator or reach the depth I can even when aroused and fully stretched, so I have personal experience with a vagina more "tiny" than mine. She never had any trouble comfortably having sex with me, either.

Penile inversion was not an option for me. I had 3/4 inch in length and about  1 inch in diameter. My whole penile gland was used for the clitoris( I was told I was lucky because I would retain all the nerves). I never considered colon because what I read was not favorable. So thank you to the OP for presenting some new information.

I have some scarring in the vaginal canal and I am treating it. I have 5 or 5.5 inches of depth at my last doctors visit.

Mona is telling her story based on her experience <with>Thai surgeons and <then> having to get corrective surgery by Dr Kaushik. I could not imagine having to go through vaginal problems and search endlessly for a solution. It'd be horrible. All Mona is doing is refuting the common misconceptions about the colon technique such as a weeping vagina, smelly vagina and aesthetic etc. and offering an alternative to the current go-to surgeons which are promoted on here a whole lot and no one says anything about agendas or any of that when they are.

I'd be telling people about my surgeon too if he fixed what other surgeons couldn't. 

Moderator's Edit: I removed an incendiary phrase.

Yeah a lot of the girls push the girls away from having colon type surgery based on what they 'heard' (from girls who had their surgery years ago) or the fact that it's not 'popular'. It makes me angry because i've had the surgery (this year) and the misinformation about the post-op experience are rife here. Like the things said here like smelly vagina, continuous weeping vagina, digestive issues and things like this just aren't true, at least not with Kaushik's technique. Only problem i had was my own laziness when it comes to dilating lol but luckily for me losing depth and a closing vagina is not a problem i have to worry about.