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.