Choosing to affirm your gender identity through surgery can be one of the most exciting and critical steps in the transition process. Dr. Stiller's patients describe the experience  as a freedom, as they reach the point where they don't feel as though they are caught in a body that isn't theirs. 

GCS is a procedure that will make verifiably ground-breaking changes in a transgender individual's life. For those who are looking for GCS, Dr. Stiller and his team are honored to be apart of your transition process and hope to make this experience the most comfortable and empowering step in your transition. Dr. Stiller is one of the most sought after specialists for gender reassignment surgery and is the only surgeon in Washington state to perform this surgery. 

a transmasculine gender nonconforming person and transfeminine non binary person nuzzling
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What is a Vaginoplasty?

A vaginoplasty, also called sexual reassignment surgery, gender reassignment surgery, is a surgical procedure where Dr. Stiller removes the penis and scrotum to create aesthetically beautiful female genitalia. Dr. Stiller performs 3 different techniques of gender confirmation surgeries using the penis, scrotum or colon. During your consultation, Dr. Stiller will explain in great detail the procedure options, answering any and all questions to help assist you in making the best decision for yourself.    

Zero-Depth Vaginoplasty

A zero-depth vaginoplasty, or vulvoplasty, is created by removing the penis and scrotum and using those tissues to create the external female genitalia. Through this procedure the scrotum is used to create both labia while the clitoris and clitoral hood are sculpted from the head of the penis utilizing its tissue and nerves. This allows aesthetically beautiful genitals with appropriate sensations. A functioning urethral opening is also created using remaining tissues and is relocated to an appropriate female position. No vaginal canal is created which is ideal for patients who do not desire penetration.  

Recovery?

Patients usually spend no more than one night at Deaconess Hospital after a zero-depth vaginoplasty. You will stay in Spokane for 2 weeks, if traveling out of town, so Dr. Stiller can monitor your progress. At 1 week, your dressings and catheter will be removed. 

 

Penile Inversion Vaginoplasty

The penile inversion vaginoplasty consists of creating the external anatomy, similar to the zero depth, in addition to creating the vaginal canal. This procedure is performed in one stage. As mentioned above, the scrotum is used to create both labia while the clitoris and clitoral hood are sculpted from the head of the penis utilizing its tissue and nerves. A functioning urethral opening is also created using remaining tissues and is relocated to an appropriate female position is also created using remaining tissues. The former penile skin is inverted to create the lining of your vaginal canal. Scrotal skin is also used to increase the depth of the vaginal canal. The final result is an anatomically congruent, aesthetically appealing, and functionally intact vagina. The prostate gland is left intact to assimilate the sensation of the G-spot during vaginal intercourse. For this procedure, hair removal will need to be performed 6-9 months prior using electrolysis.  

Recovery?

Patients usually spend 1-2 nights at Deaconess Hospital after a penile inversion. If traveling out of town, you will stay in Spokane for 2 weeks so Dr. Stiller can monitor your progress. At 1 week, your daily dilation schedule will begin after your dressings, vaginal packing and catheter are removed. You will then follow up in another week to monitor your progress and may return home after this appointment (if traveling out of town).  

 

Colovaginoplasty

The colovaginoplasty consists of creating the external anatomy, similar to the zero depth, in addition to creating the vaginal canal. This procedure is performed in 2 surgeries 6 months apart. In the first procedure, Dr. Stiller will create the external anatomy as mentioned above. 6 months later, after the external genitalia has healed, the vaginal canal will be created using a portion of the right colon. The final result is an anatomically congruent, aesthetically appealing, and functionally intact vagina that can self-lubricate due to the use of colonic tissue. The prostate gland is left intact to assimilate the sensation of the G-spot during vaginal intercourse. Electrolysis is not needed for this procedure compared to penile inversion. This surgery is not intended for candidates who have a history of Ulcerative Colitis, Crohns or Colon Cancer.  

Recovery?

Patients usually spend no more than one night at Deaconess Hospital after a first stage colovaginoplasty to create the external anatomy. You will stay in Spokane for 2 weeks, if traveling out of town, so Dr. Stiller can monitor your progress. At 1 week, your dressings and catheter will be removed.

The second stage of your colovaginoplasty, to create the vaginal canal, will occur around the 6 month mark. You will likely spend 3-5 nights at Deaconess Hospital. If traveling out of town, you will stay in Spokane for 2 weeks so Dr. Stiller can monitor your progress. At 1 week, your daily dilation schedule will begin after your dressings and vaginal packing are removed. You will then follow up in another week to monitor your progress and may return home after this appointment (if traveling out of town). 

a transmasculine gender nonconforming person and transfeminine non binary person embracing on a bed

What is the dilation process like?

After a penile inversion or a colovaginoplasty, a daily dilation regimen will be started. Dilations are important to keep the introitus and vaginal canal open while also preventing any loss of depth. Initially, dilations can be painful but improve as swelling goes down and healing continues. 

Patients should dilate 3 times a day, for 20 minutes each session for about 6 months. After a few months dilations become much easier and becomes a simple easy routine. At the 1 year post-op, patients can decrease the amount of dilations, usually to once a day, without any loss of the vaginal canal.  

Labiaplasty/Vaginal Revisions

Wound healing can be different depending on the individual and some patients may require revisional procedures which are typically performed 1 year from the original surgery. If needed, Dr. Stiller can perform any revisions including transferring fat to the labia majora, labiaplasty to define the labia minora, clitoral or urethral resizing and scar revisions.  

Orchiectomy

During this procedure, both testicles will be removed through an incision in the scrotum. The purpose of this is to stop the flow of testosterone. Androgen-blockers will no longer be needed after this surgery. The scrotal tissue can be removed at the same time if desired but will no longer be compatible with a penile inversion vaginoplasty.  

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