For people in our community who want feminizing bottom surgery, one of the available vaginoplasty techniques is a rectosigmoid procedure. This uses a part of the patient’s intestine to create a vagina.
It is not widely used because it is a more complicated surgery with more things that can go wrong.
The procedure
The procedure was first described by JF Baldwin in 1904. Other names include:
- intestinal flap method
- primary sigmoid vaginoplasty
- sigmoid vaginoplasty
- sigmoid colon vaginoplasty
- primary colon vaginoplasty
- secondary colon vaginoplasty
- colon graft technique
A loop of rectosigmoid is isolated, closed at one end, and brought down on its vascular pedicle as a neovagina and then anastomosed to the perineum.
- small intestine
- ascending colon
- sigmoid colon
can be used in the intestinal flap method, and the authors modified the operation first described by Baldwin in which
Consumer report (2003)
by Terry (2003)
Few of us are aware that a unique method for sex reassignment surgery exists in the hands of three talented surgeons in Christchurch, New Zealand. I had accidentally stumbled upon their existence while surfing websites for referrals. I had initially chosen my SRS surgeon at the beginning of my transition but changed my mind after I read about the NZ surgeons’ technique.
The name of the method is the Ascending Colon Method. Essentially, the colorectal surgeon, Dr. Richard E. Perry, removes approximately 8 inches of the ascending colon just above the appendix and reattaches the two severed ends of the intestinal tract. The removed ascending colon section, with its blood supply still intact, is rotated 180 degrees and moved toward its new position to become the vaginal lining. All of this is done by laparoscopy. Next, the urologist, Dr. Stephen D. Mark, creates a vaginal tunnel near the perineum, shortens the urethral tube and positions it in a female configuration. The vaginal lining is then positioned and attached to its proper location at the opening of the vaginal tunnel. Lastly, the plastic surgeon, Dr. E. Peter Walker, fashions the external genitalia. All three surgeons are working together and helping each other during the entire surgery. The neo-vagina is then packed with dressing and the patient is returned to her room for rest and recovery. This is a crude explanation but fairly accurate.
There are several advantages to this surgery. First, there is a quick recovery period with this method. By the second day post-op, I was encouraged to try to walk around the ward. I found that once I started, I didn’t want to stop. I ended up making three circuits around the ward and only stopped because the nurse needed to return to her duties. Also on the second day, I started back eating soft foods, and then switching to solid foods the next day. I was released from the hospital on the fourth day by my request as I felt I was strong enough to return to my motel. Pain was very minimal. Second, the neo-vagina is self-cleaning and self-lubricating. The section of the ascending colon secretes a small amount of mucus as part of its design. The downside with this is the mucus tends to have an undesirable odor to it so you need to replace your panty liner often. Shortly after the surgery, your discharge tends to be fairly heavy but tapers off within a few weeks. Third, the vaginal lining is distensible and doesn’t shrink. However, you need to perform the required dilation or the opening will try to close. Your body sees the opening as a wound and tries to close it unless to you maintain the opening by using the stents provided to you prior to your discharge from the hospital. You need to be using the largest stent by the third month, at which time the vaginal opening is not as pliant in order to increase its diameter. I found that I was able to successfully insert the largest stent in about two months after the surgery and maintaining the diameter of the vaginal opening to be fairly routine afterwards.
My experience with the personnel involved with my surgery was very good. Dr. Walker was extremely friendly throughout the entire process. Drs. Mark and Perry were very professional but somewhat distant at the consultations. However, when visiting me at the hospital following the surgery, they both were quite friendly and genuinely compassionate, ensuring that I was comfortable and healing nicely. The hospital staff was top-notch and extremely nice. I had a private nurse for approximately twelve hours following the surgery. Afterwards, the regular nurses checked in on me regularly and even took the time to chat with me for an appreciable amount of time. That was important when I came to New Zealand alone.
Finally, the cost of the surgery is comparable to those in the United States. The cost of my surgery was just over $ 17,000, excluding travel, room accommodations, meals, and miscellaneous and sundry things. In total, I ended up spending over $ 20,000 but it was worth every penny of it. Another thing to keep in mind is the amount of time required to be in New Zealand. I was required to arrive approximately two weeks prior to surgery and remain approximately four weeks after the surgery. That is a long time to be away from work and family but it is required. The first two weeks are required for consultations and having blood drawn and stored in case a transfusion is required during the surgery. The last four weeks are for check-ups and follow-ups. One important feature you need to keep in mind is the surgeons require a two-year real life test instead of the minimum one-year RLT as set forth in the Standards of Care. They are not flexible on this requirement so be prepared to do your two-year sentence. Also, my attempt to schedule my surgery was a test of patience as it took a little over a year to procure a surgery date. They only perform about twelve SRS per year so the sooner you get scheduled, the better.
I would highly recommend this surgery utilizing these surgeons for your SRS. The experience is like none other and I’m left with fond memories exclusive of the life-altering surgery.
Original URL: tsroadmap.com/physical/vaginoplasty/ascending-colon-method.html
Sigmoid Vaginoplasty: An AEGIS Medical Advisory Bulletin
American Educational Gender Information Service, Inc. (AEGIS)
P.O. Box 33724
Decatur, GA 30033-0724
Medical Advisory Bulletin — January, 1995
The Controversial Nature of Vaginoplasty Using Bowel Segments
Advisory
AEGIS recommends that for primary neovaginal construction in male-to- female transsexual persons, penile inversion, with or without use of a skin graft, should be considered the procedure of choice. We suggest that vaginoplasty using sections of large or small intestine not be considered as a primary procedure, but only as a secondary procedure in cases in which the primary surgery produces a vagina which does not meet the needs of the patient. The wishes of patients who insist on surgery using bowel segments should be honored, but because of its intrusiveness and high rate of complications, the procedure should not be advocated as a primary procedure by surgeons or other members of the treatment team.
The Problem
Currently, there is ongoing debate among surgeons as to the desirability of using rectosigmoid surgery for primary vaginoplasty. Hage, et al. (1994) have found a variety of long- term complications, including introitus stenosis, painful introital suture line, abundant mucosal discharge, and painful contractions, and have furthermore noted that the distal end of the vagina can become detached and “lost” in the abdominal cavity (Karim, et al., 1994). Some surgeons have not reported such extensive problems (cf Laub, et al., 1993).
Hage & Karim (1994) concluded “penile skin inversion is the method of choice for vaginoplasty in male-to-female transsexuals. Only when the penile skin inversion technique is impossible or has not led to satisfactory results should a rectosigmoid neocolpopoiesis be considered.”
Discussion
There are a number of techniques for creating neovaginas in male-to- female transsexual persons. The most popular procedure is penile skin inversion, in which the inverted skin of the penis is used to line the vagina. Sometimes, penile inversion is used in conjunction with split- skin or full-skin grafts (Hage & Karim, 1994).
Another procedure is rectosigmoid transplantation, in which a section of the rectosigmoid colon is used to provide a lining for the neovagina. Hage & Karim (1994) note that due to the use of antibiotics and stapler devices, this procedure is less dangerous than it once was. However, it is more intrusive than penile inversion, as the abdominal cavity is entered, requires a longer healing period, is more expensive than penile inversion, and has a variety of long-term complications not associated with penile inversion (Hage & Karim, 1994).
We believe that there is significant evidence that the advantages of rectosigmoid vaginoplasty are more than offset by its disadvantages.
References
Hage, J.J., & Karim, R.B. (1994). Vaginoplasty in male transsexuals: (Dis-) advantages of various procedures. Paper presented at The Conference of the European Network of Professionals on Transsexualism, Manchester, England, 31 August, 1994.
Hage, J.J., Karim, R.B., Asscheman, H., Bloemena, E., & Cuesta, M.A. (1994). Unfavorable longterm results of rectosigmoid neocolpopoiesis. Paper presented at The Conference of the European Network of Professionals on Transsexualism, Manchester, England, 31 August, 1994.
Karim, R.B., Hage, J.J., Questa, M.A, Eggink, W.F., Nicolai, J.P.A., & Reuvers, C.B. (1994). The vanished vagina. Paper presented at The Conference of theEuropean Network of Professionals on Transsexualism, Manchester, England, 31 August, 1994.
Laub, D.R., Laub, D.R., II, Lebovic, G.S., & van Maasdam, J. (1993). Follow-up on the safety, efficacy, and erotic aspects of the rectosigmoid neocolporraphy. Paper presented at the 13th International Symposium on Gender Dysphoria, New York City, 21-24 October.