Gender Reassignment Surgery / SRS

Gender Affirmation Surgery or Sex Reassignment Surgery

With so many advances in gender-affirming surgeries in recent years, many debuted right here; gender dysphoria need not be a lifetime of struggle and depression and is, in fact, a highly treatable condition. A combination of therapy and surgeries can help assure a happy and whole life for those born in the wrong body. Our compassionate staff, expertise, and reasonable prices at the Komal Cosmetic Hospital will make dreams a reality. We have performed over ten thousand gender affirmation surgeries, and our facilities are purpose-built for our client’s comfort. 

Since 1997, Dr. Kamol has performed over 10,000 cosmetic procedures on patients and over 5,000 gender affirmation surgeries. He is recognized and respected throughout the medical community as one of the most experienced surgeons working in gender reassignment care. Dr. Kamol currently performs more than 500 male-to-female gender reassignment surgeries each year. He is the chief plastic surgeon at Kamol Cosmetic Hospital in Bangkok, where he leads the team.

See more of Dr. Kamol's Profile

Sexual function and sensation by Dr. Kamol's techniques.

1. Background: The nerve ending to the clitoris and the glans penis are similar, with approximately 8,000 nerve endings.
2. Dr. Kamol technique uses surgical techniques to identify and preserve all the nerves from glans penis precisely and creates 4 points of special
   sexual arousal as follows:
   a.The first point is the neo-clitoris.
   b.The second area, located at the inner sides of the labia minora, contains the additional nerve ending from the nerve trunk.
   c.The third point is the bilateral ridge of the neo-urethral plate that Dr. Kamol creates from the skirt of the glans penis containing the nerve ending.
   d.The fourth spot is at the bulbourethral glands before the prostate glands. Dr. Kamol always keeps the bulbourethral glands containing the nerve ending and mucous secretion.¹
   e.The fifth spot (G-spot) is at the lower part of the prostate glands and consists of sensory nerve endings. Dr. Kamol creates the neo-vagina very close to the surface of the prostate glands.²
3. Some surgeons claim their technique is the only one (in the world) that preserves the erotic nerve ending to the neo-vagina, but this is not true. 
4. Schematic of the glans penis and the areas are moved to reconstruct the neo vagina (Figure 1)
5. Dr. Kamol creates a minimal-short scar comparison to other conventional techniques (Figure 2).

 

The area from the glans penis to the neo-vagina

Figure 1. The areas from the glans penis make the neo-vagina,
the tip of the glans penis makes the neo clitoris (1),
skirt of the glans penis makes the second spot sensation (2).

 

Figure 2. Dr. Kamol’s technique (Short-scar)

 

Figure 3. Other techniques (Long-scar)

 

Sex Reassignment Procedures:

Kamol Cosmetic Hospital provides many techniques for male-to-female sex reassignment surgery. We create and design neovagina for transwomen exclusively by their biological structure. They are unique and need different methods. 

SRS-1 Vaginoplasty without vaginal depth:

The technique involves using penile and scrotal skin to construct the external genitalia, such as inner and outer labia, clitoris, clitoral hood, and female-located urethra. This procedure is suitable for those who do want or need vaginal penetration. The vagina looks like a perfectly natural vaginal but doesn't have a vaginal canal. This technique has a quick recovery.

SRS-2A Vaginoplasty with penile skin inversion:

This surgery involves inverting the skin of the penis to create the vagina. This oldest method was the standard procedure until newer techniques emerged.

The operation time is around 4 hours.

The disadvantage is that it is not suitable for people with deficient penile skin because this will result in a vagina that is not deep enough. The patient might also need hair removal on the penile shaft before surgery to avoid hair deep inside the vaginal canal where removing it is difficult. A skin graft can also increase depth if there is not enough depth. We prefer to use the skin graft technique below as the hairs are removed and the depth is sufficient in this technique.

SRS-2B Vaginoplasty with scrotal skin graft:

This technique involves using the skin covering the penis to construct the inner labia, parts of the glans penis to create the neo-clitoris, and scrotal skin graft to cover the vaginal wall. This results in a sufficiently deep and functional vagina. Hairs are removed during the surgery.

In case of scrotal skin deficiency, if the vagina depth is still not satisfactory to the patient and then the plastic surgeon will consider using a skin graft from other areas, such as the groin or lower abdomen, to further increase the depth of the vagina.

The operation time generally takes about 4-6 hours to complete.

SRS-3 The Sigmoid Colon Vaginoplasty:

Using a sigmoid colon provides a vagina with sufficient depth and also a self-lubricant. At Kamol Cosmetic Hospital, there are 2 options for Sigmoid Colon SRS:

         Open Technique:

         The surgery is done via a 6-7 cm incision at the bikini line. The average length of the sigmoid colon segment vaginal canal is approximately 7 inches. The rest of the colon is re-anastomosis (re-connected) to make the large intestine normal. The operation lasts approximately 6 hours.

         Laparoscopic Technique:

         The sigmoid colon is harvested through 4 small incisions using the laparoscopic technique (keyhole surgery). The average length of the sigmoid colon is approximately 8-9 inches. The average operation time is 6 hours. 

         Advantages of Sigmoid Colon Vaginoplasty:

1. This technique helps patients who have previously undergone sex reassignment surgery and who want a deeper vaginal canal.
2. This technique can be used in patients who have a very short penis.
3. The vagina has a natural lubricant.
4. It is possible to pre-determine the depth of the newly constructed vagina. This method provided the deepest vaginal canal of any technique.
5. This technique provides a very strong and tough vaginal canal and doesn't require lifetime dilation.
6. This is a well-understood technique performed for many years.
7. Contrary to rumor, the sigmoid colon vagina doesn't smell. Less than 4% can experience an odor, which is fixed with improved hygiene.

        Disadvantages and limitations:

1. In the open technique, a scar can be visible at the bikini line, just above the left side of the pubis.
2. The surgery is more complicated to complete with invasive procedures required, such as cutting off parts of the colon. The colon must be thoroughly cleansed (by an enema) 1 day before the surgery.
3. The patient may experience dyspepsia/indigestion symptoms 3-5 days after the surgery.
4. The recovery is slightly slower by about one week when a soft diet must be had.

SRS-4 Revision Vaginoplasty:

We perform hundreds of revision surgeries annually on patients that have received poor results elsewhere or from patients that want to “upgrade to a newer technology such as PPV (below) or sigmoid colon which has self-lubrication, elasticity and is easier to maintain. For complete information on revision, please see the following page   See more

SRS-5 SRS-PPV Penile-Peritoneal Vaginoplasty technique:

Penile Peritoneal Vaginoplasty (SRS-PPV) is the newest SRS technique. Kamol Cosmetic Hospital is one of the few hospitals in the world performing it. Peritoneal tissue is the tissue that lines the abdomen. It is wet, elastic, and self-lubricated. The healing is generally quick with minor pain.

The procedure uses a small amount of penile inversion combined with a peritoneum pull-through technique to create the neovaginal canal. Using a peritoneal pull-through to make the vaginal canal is not new, it’s just new for transgender women. This technique has been used in cisgender girls for over 45 years. Known as the Davydov technique, it is the only treatment for girls born without a vaginal canal, known as “MRKH Syndrome.” This congenital disability affects a huge one in 4500 girls. Peritoneal tissue is the only tissue used to make a vagina canal connect the vulva to the womb of girls with MRKH. After 9 months in cis girls, this peritoneal tissue is indistinguishable from vaginal tissue under a microscope.

With the PPV technique, the outer labia and visible vagina are made using penile and scrotal skin, while the inner vaginal canal is made using the peritoneal.

This technique is also perfect for revision surgery for patients who have previously undergone gender reassignment surgery and who are unhappy with the result or who want a more functional, realistic, elastic, self-lubricating vagina.

       Advantages of Penile Peritoneal Vaginoplasty SRS-PPV:

1. The vagina has a self-natural lubricant with no unpleasant odor.
2. The vagina is elastic and stretches like a biological vagina
3. Less chance of vaginal prolapse and shrinkage compared to all other types of SRS.
4. The vagina is elastic, and dilation can be reduced after a year.
5. Natural lubrication is similar to vaginal lubrication.
6. Recovery is quick, with fewer risks than the sigmoid colon.
7. Peritoneal pull-through (Davydov technique) has been performed on cisgender girls for over 40 years and is well understood.

       Disadvantages and limitations of Penile Peritoneal Vaginoplasty SRS-PPV:

1. The patient may experience dyspepsia/indigestion symptoms 2-3 days after the surgery.
2. This technique is not suitable for overweight people or those with fatty abdomens, as visceral fat (internal fat) makes the surgery difficult.
3. Not suitable for patients with a very small penis.
4. No long-term data on this surgery on transgender patients.
5. If dilation is not performed as directed in the first year, the joint between the penile and peritoneal skin can fail and require revision surgery.

Why are BMI and weight important for SRS?

Surgery risks are increased due to obesity. Obesity can pose additional challenges in surgery. It can increase the risks of complications such as infections, blood clotting, unsuccessful surgery, delayed wound healing, and respiratory issues. The optimal weight and BMI can decrease risks and complications. Weight and other factors, including aging and medical illness, increase the likelihood of intra and Post-operative complications. The patient must inform the doctor of the medical background before making the operative schedule.

Accepted for surgery in case of:

SRS- PPV Penile-Peritoneal Vaginoplasty technique                     BMI Less than 30 and Weight Less than 90

SRS- The Sigmoid Colon Vaginoplasty Laparoscopic technique    BMI Less than 30 and Weight Less than 90

SRS- Vaginoplasty with scrotal skin graft                                       BMI Less than 30 and Weight Less than 90                 

SRS- The Sigmoid Colon Vaginoplasty Open technique                 BMI Less than 26 and Weight Less than 80

Why genital hair removal is important for SRS?

      Kamol Cosmetic Hospital provides many procedures for sex reassignment surgery/SRS. However, not all procedures require genital hair removal to be done. We recommend:

1. SRS without a vaginal cavity, this procedure does not need to do genital hair removal.
2. SRS skin inversion: this technique requires genital hair removal in areas 1,2,3 in picture 1.
3. SRS skin graft technique needs to remove the hair at around 5x6 cm at the base of the penis, as in picture 1.
4. SRS with colon graft, we need the patient removes the hair at the vaginal entrance at around 5x6 cm at the base of the penis as in picture 1.
5. SRS-PPV, the patient needs to remove the hair in areas of 1,2,3 in picture 1.

Picture 1. Shows the area of the hair removal

1. The patient needs hair removal around 5x6 cm at the base of the penis, as in picture 1.
2. The patient may experience dyspepsia/indigestion symptoms for 2-3 days after the surgery.
3. This technique is not suitable for those who are overweight or have fatty abdomens due to the difficulty reaching the peritoneal.
4. In a complicated case, the patient might be able to convert to an open technique or sigmoid colon neovagina reconstruction.

Post-operative Care for non-colon SRS:

Depending on the technique, the patient must be hospitalized for 4-6 days. For the healing process to be complete and successful, patients are advised to:

1. During the first two days after surgery, the patient must not eat food that has fiber or beverages such as fruit juice, milk, and yogurt, as these will trigger waste excretion. This may lead to contamination of the wound by the face.
2. During the first 1-2 days after the surgery, the patient should lie on her back, with her hips raised and legs slightly apart, as this will help reduce swelling.
3. The patient may lie on her side on the third day after the surgery.
4. On the third day after the surgery, the surgeon will remove the draining tube, open the wound, and dress it. The patient who has undergone Sex Reassignment Surgery with Skin Graft or Sex Reassignment Surgery with Colon Graft must remain in bed until day six, when the urine catheter will be removed.
5. On the sixth day after surgery, patients of Sex Reassignment Surgery with Skin Graft surgery will have their urine catheter removed. The wound will be dressed, and the patient may be transferred to the serviced apartment for further recovery.
6. The patient needs dilation of the vagina using dilators. For the patient to maintain the width and depth of the vagina, the patient should dilate the vagina at least twice a day for about an hour each time. This process can be done at the serviced apartment, where we have nurses to help.
7. The patient needs to keep the surgical wound clean.
8. The patient must refrain from sexual intercourse for at least three months.
9. The patient must keep her appointment with the doctor once a week for one month to maintain satisfactory results from the surgery.

Post-operative Care for SRS-Sigmoid Colon:

1. During the first three days, the patient cannot eat or drink until intestinal function recovers. In this period, the patients will have fluid via intravenous lines.
2. The patient must avoid eating large meals in the first month.
3. After three weeks, the patient may do light activity and resume regular daily activity after three months.
4. The patient who has sex reassignment surgery with a sigmoid colon graft must refrain from drinking water or eating until she can pass gas. After this, the patient may sip a small amount of water or consume soft food. If the food is eaten too quickly, indigestion or dyspepsia symptoms may occur. The patient using this technique must strictly abide by the recommendations of the doctors and nurses.

Risks and Potential Complications for SRS

Although it is a highly safe surgery, patients should be aware of all the likely and rare complications of sex reassignment surgery. Complications by Dr. Kamol are exceptionally low.

Rare but minor complications that are not considered dangerous:

• Swelling
• Bruising
• Hematoma
• Bleeding
• Infection
• Poor healing
• Flap necrosis

Infrequent complications - less than 1%:

• Urethral stenosis
• Decreased Sensation
• Deep vein thrombosis
• Risk from anesthesia
• Recto-vaginal fistula

Unfavorable results can be from those who don’t follow postoperative care, such as dilating, or those with unrealistic expectations. Unfavorable results could be as follows:

• Unsatisfied size or shape of vaginal urethral and clitoris
• Asymmetry of the labia
• Loss of vaginal depth
• Vaginal stricture

See more

 

Please take a look at the results of vaginoplasty.

 

Why Kamol Cosmetic Hospital is the best choice for Gender-Affirming Vaginoplasty?