Male to Female Gender Confirmation Surgery
GCS / GRS in Male to Female transition involves conversion of the penile and scrotal tissues into female genitalia that look as natural as possible.
The aims of GCS /GRS are;
- Create a normal functioning vagina and clitoris
- Provide normal female external genitalia.
At the time of GCS /GRS, the testes are removed (orchidectomy) and the penis is excised (penectomy). The new vagina (Neovagina) is created utilising all of the penile skin and a paddle shaped flap of skin from the posterior surface of the scrotum. This is referred to as the “Peno-scrotal inversion technique” This technique ensures that the neovagina has good depth and calibre(size) to allow normal vaginal intercourse. The new urethral opening, meatus (for urinating) is fashioned and the labia are created using the anterior scrotal skin. Clitoroplasty can either be cosmetic or functioning using a “sensate glans flap” taken from the glans of the penis.
The majority of Transgender individuals will achieve a good functioning neovagina with the peno-scrotal inversion technique with a depth of up to 20 – 22cm. However, some individuals who do not have adequate penile and scrotal skin will require a colovaginoplasty which utilises a segment of the large intestine (bowel) to create the neovagina.
You should be aware that GCS / GRS once performed is totally irreversible and therefore it is our responsibility at London TransGender Surgery to ensure that GCS /GRS is always in your best interest.
Frequently Asked Questions
Who is GSC, GRS suitable for?At London Transgender Clinic we adhere to the standards of care Version 7, published by WPATH. You will require two referrals from an experienced mental health professional in order to proceed with male to female MtF gender confirmation surgery. You will be required to demonstrate a persistent gender dysphoria. You should have the capacity to make a fully informed decision and to consent for treatment. You must be over the age of 18 in the United Kingdom. Any significant medical or mental health concerns must be well-controlled. You should have had 12 continuous months of hormone therapy, and have been living in your chosen female gender for 12 continuous months.
If your goals are to remove your male genitalia and achieve a normal female genitalia with a functioning vagina, then male to female MtF, Gender confirmation surgery or affirmation surgery may be suitable for you.
How is GCS, GRS Gender Affirmation Surgery performed?At London Transgender Clinic male to female gender confirmation surgery is performed under general anaesthetic with hospital stay of 5 to 6 nights. Mr Inglefield utilises a Peno-scrotal Flap procedure to provide the optimum vaginal size and depth with full sensation. The first stage of the GCS procedure is to preserve all of the penile skin and a paddle shaped flap of scrotal skin with blood vessels and nerves preserved. The penis is removed (penectomy) preserving a small segment of the glans penis attached to the blood vessels and nerves which will be used to create the clitoris. The testes are removed (orchidectomy), followed by creation of the space for the new vagina (vaginoplasty) between the bladder in front and the rectum/bowel behind. The neovagina is then inserted into this space and held in position with stitches and a vaginal pack. The new opening for the meatus, urinary opening, is created and the neoclitoris is constructed followed by fashioning of the labia minora and majora to fashion as natural female genitalia as possible.
Does GCS, GRS require a General Anaesthetic or Hospital stay?At London Transgender Clinic your MtF GCS, GRS will be performed under general anaesthetic with an epidural or spinal anaesthetic. You will be admitted to hospital one day before your operation and be discharged on the 6th day after your MtF GCS.
How long is GCS, GRS surgery?At London Transgender Clinic, MtF GCS, GRS or Gender Affirmation Surgery usually takes 4.5 to 5 hours
How painful is GCS, GRS?Moderate to severe pain is expected in the early post operative period but you will be prescribed appropriate pain relief medication to keep you as comfortable as possible. Some patients will benefit from a pain relieving pump or an epidural infusion to ensure that they remain comfortable in the post operative period following MtF GCS,GRS.
What is the recovery?After your MtF gender confirmation surgery, the vaginal pack will be removed on day 5 followed by the bladder catheter on day six. You will start vaginal dilatation three times each day and will be instructed in performing this yourself. You will be able to leave hospital on day six and will be seen in the clinic at LTC 2 weeks after your surgery to check your recovery and for MLD treatment with our therapist Lyndsey. You should be able to return to work at 6 weeks. You must avoid strenuous exercise and sex for 3 months after your GCS.
What are the benefits of GCS, GRS?Male to female gender confirmation surgery aims to provide you with normal female genitalia and a normal functioning vagina allowing you to live comfortably in your female role without any dysphoria of your genitalia.
What are the risks of GCS, GRS?Like all the surgical procedures there are always risks associated with surgery. However major complications are uncommon even in MtF GCS, GRS. Bruising around the area may occur and may take 2 weeks to resolve, while major bleeding is rare – less than 0.1%. Infection is rare – less than 0.5% and will require appropriate antibiotics. Injury to the rectum, leading to a fistula(leak) between the rectum and vagina is rare and will require revision surgery. At LTS, this serious complication has never been seen with our MtF GCS patients. Difficulty passing urine can occur and may require a bladder catheter for 1 week. is uncommon but may affect the forehead temporarily, lasting 6 to 8 weeks. DVT/PE (clot in the lungs) is rare and you will be assessed for your individual risk before your surgery and appropriate treatment prescribed. Minor delayed wound healing is common in MtF GCS and will require dressings. Abnormal scarring, hypertrophic or keloid or stretched scars are uncommon. Reduced sensation is expected and improves from 6 weeks to 3 months following surgery.
What preparation do I need before my GCS, GRS?At LTS, you will have a pre-operative assessment 2 weeks before your MtF GCS, GRS during which all your questions will be answered, your preparation for surgery will be reviewed and information provided regarding your diet, bowel preparation and post operative care and follow up. You will be required to undergo blood tests and an ECG as appropriate. You will need to stop your hormone therapy 3 weeks before your surgery.
What reassurances for I have with GCS,GRS at London Transgender Surgery?At LTS, we understand that your desire to have MtF GCS, GRS surgery can be a daunting and anxious time for you. Our aim is to fully understand your concerns and goals and discuss all the options before agreeing a treatment plan which is in your best interest. Mr Inglefield and his teams expertise in MtF GCS, GRS surgery will ensure your safe and excellent outcome. We will provide you with all the information you need and support you before, during and after your surgery.