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MTF Surgery Procedures ยป MTF Vaginoplasty

Introducing Olmec Sigma-Lead Vaginoplasty

Dr. Narendra Kaushik

In an effort to reduce complications following Vaginoplasty, Dr. Narendra Kaushik, founder of the Olmec Transgender Surgery Institute in Delhi, India, began investigating the potential of a procedure that uses both penile skin and a rectosigmoid colon graft. The resulting technique, Olmec Sigma-Lead Vaginoplasty, minimizes the potential for scar contraction and stricture of the vaginal opening, which can prevent sexual intercourse.

How Olmec Sigma-Lead Vaginoplasty is Performed

The penile skin is pedicled to create the sensate labia majora, labia minora, clitoral hood and clitoris, as well as the first 2-3" of the neovagina. Because the more reddish colon graft is not used for this, there is no cosmetic compromise in creating the external genitalia. For extra depth, the penile skin is then sutured to the rectosigmoid colon graft using a star-shape pattern which reduces the risk of scar contraction at this site. Vaginal depths of 7 to 12 inches can be achieved.

While dilation is still required to maintain vaginal depth, this technique requires less dilation than others due to how the junction between the grafts is created. The fully functional, self-lubricating vagina enables natural orgasms during masturbation and sexual intercourse. In Dr. Kaushik's practice, the Olmec Sigma-Lead technique has consistently delivered superior aesthetic and functional results for his patients.

In 2019, Dr. Kaushik published a study about the Sigma-Lead technique. Between April 2007 and April 2017, he performed 386 Sigma-Lead Vaginoplasties for transsexual patients.

Seventy-eight (20.2%) patients had complications, majority being minor (97.4%). Forty-four (11.4%) required resurgeries, 10 (2.6%) were corrective for introital stricture and mucosal prolapse, whereas 34 (8.8%) opted for optional minor esthetic enhancement. The overall satisfaction rate for cosmetic and functional outcomes was 4.7 out of 5.

Source: Sigma-lead Male-to-Female Gender Affirmation Surgery: Blending Cosmesis with Functionality. Kaushik, Narendra MBBS, MS, MCh, DNB; Jindal, Omi MBBS, MS, MCh; Bhardwaj, Devendra K. MBBS, MS. Plastic and Reconstructive Surgery, April 2019, Volume 7, Issue 4.

Complications & Risks

All Vaginoplasty techniques carry the risk of complications. Narrowing of the vagina, changes in urine stream and heightened risk of urethral infection are common complications. Rare but serious complications include tissue necrosis, rectal injuries, fistulas, deep vein thrombosis and pulmonary embolism.

When using a Rectosigmoid Colon graft, diversion colitis, adenocarcinoma of neovagina, introital stenosis, mucocele and constipation have been reported, although with a low incidence. Patients may also experience some degree of abdominal muscle weakness due to the incision used to access the abdominal cavity.

Contraindications to Vaginoplasty

In patients who have had any type of radical prostatectomy for prostate cancer it can be difficult to create the vaginal canal because critical tissues have been radiated. These patients can get a MRI to evaluate the area to see if Vaginoplasty remains an option and if not, can choose to proceed with Vulvoplasty instead.

Smoking increases the risk of poor wound healing significantly. Most surgeons require smoking cessation before surgery and some also order a pre-operative nicotine test to confirm cessation.

In general, obesity has been shown to be a risk factor for surgical complications, including delayed wound healing, infection and postoperative venous thromboembolic events (VTEs). Those who have a BMI of more than 35 or 40 may also have a harder time accessing the vaginal area for post-operative dilation. Both of these factors can lead to a less than satisfactory Vaginoplasty result. However, relying on BMI as a sole selection criteria for surgical candidacy is falling out of favor.

How to Choose?

There are many factors to consider when choosing a Vaginoplasty technique including surgeon experience with a particular technique, your anatomy, and most importantly, your goals. Learning about the basics of each technique will help you formulate questions to ask at your consultation and make a more informed decision about which Vaginoplasty method is right for you.

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Last updated: 09/28/23