New Technique For GCS

There is a new surgical procedure for Gender Confirming Surgery (GCS) that is all the rage in the trans community, trans women are demanding the surgery… but what is it? Is it for everyone?

There is a report [note the date of the publication, even though we just discovered the procedure but it has been around for a while] on the procedure on the NIH website PubMed…

New laparoscopic peritoneal pull-through vaginoplasty technique
By Pravin Mhatre, Jyoti Mhatre, and Rakhi Sahu
J Hum Reprod Sci. 2014 Jul-Sep; 7(3): 181–186.
doi:  10.4103/0974-1208.142478

Abstract
BACKGROUND:
Many reconstructive surgical procedures have been described for vaginal agenesis. Almost all of them are surgically challenging, multi-staged, time consuming or leave permanent scars on abdomen or skin retrieval sites.

AIM:
A new simple technique using laparoscopic peritoneal pull-through in creation of neo vagina has been described.

MATERIAL AND METHODS:
Total of thirty six patients with congenital absence of vagina (MRKH syndrome) were treated with laparoscopic peritoneal pull through technique of Dr. Mhatre between 2003 till 2012. The author has described 3 different techniques of peritoneal vaginoplasty.

RESULTS:
This technique has given excellent results over a period of one to seven years of follow-up. The peritoneal lining changes to stratified squamous epithelium resembling normal vagina and having acidic Ph.

CONCLUSION:
Apart from giving excellent normal vaginal function, as the ovary became accessible per vaginum three patients underwent ovum retrieval and pregnancy using surrogate mother, thus making this a fertility enhancing procedure.

The article goes on in great detail the steps of the procedure for women who were born without a vaginal and the authors also cover sexual satisfaction, some of the highlights were…

• Almost 90% of patients required supervised glass dilatation in the first postsurgical week.
• 100% of women required vaginal lubrication for first 3 months.
• The need for lubrication declined drastically after 6 to 9 months in the married group of patients (66.5%)
• 50% of patients complained of pain and discomfort in the early period. The pain free intercourse was usually performed after 3 to 6 months.

The conclusion of the report was,

In conclusion the new laparoscopic peritoneal pull-through vaginoplasty offers a relatively easy surgical procedure with excellent results on long term follow up. This procedure is practically devoid of morbidity associated with other techniques. Peritoneal lining having the same parentage of mullerian duct undergoes metaplasia and transforms itself in to stratified squamous epithelium resembling normal vagina. This transformation has been documented in nine patients. As the ovary became accessible per vaginum three patients underwent ovum retrieval and pregnancy using surrogate mother, thus making this a fertility enhancing procedure.

There has been discussions on the WPATH Facebook page and on their elist server. Some of the Facebook comments were:

• This is the surgery I want
• This is the most promising news in a long time for a lot of trans women, who lacked available tissues for conventional inversion/graft methods or experienced severe post-op complications.
• So exciting...can I get a redo? (Kidding...mostly)
• This sounds like a very desirable procedure.

While on the elist serve some of the emails said that the procedure looks interesting, while others question the long term impact for the long term on the peritoneum's vitality, and some see that a combination of penile inversion and with peritoneal tissue. The peritoneal tissue would add depth and lubrication.

So what is the answer should we use peritoneal tissue for GCS?

Well like all things trans we are the guinea pigs. My suggestion is do your homework, don’t just rush to have the surgery because it is the “new” wonder procedure but stop, look, and listen before proceeding. Ultimately it is your life, it is your decision to make.

My guess is that in the end it will be a combination of penile inversion and with peritoneal tissue.