MTF Sex Reassignment Surgery / Sex Change in Bangkok, Thailand
Gender Reassignment Surgery
Being born in the wrong body is something that often causes significant suffering, stress, unhappiness and internal conflict for transgender people. Knowing that you should have been born with a female body is something trans women suffer with throughout their lives. Gender dysphoria doesn't get better with age and if anything the need to end the relentless pantomime of living in a sex that you are simply not gets stronger and stronger until one day transition becomes the only choice for happiness.
Sex Reassignment Surgery (SRS) is usually the final step in the process of gender transition. It makes the person feel complete and happy within themselves. Having the body you should have been born with is a feeling that is hard to describe. Its part elation, part relief and just a deep sense of tranquility within yourself at being physically what you've always been mentally. Gender dysphoria gets better when you physically match your brain.
Since 1997 Dr Kamol has performed over 10,000 procedures on transgender patients and over 5,000 sex reassignment surgeries (SRS). Recognized and respected throughout the medical community as one of the most experienced surgeons working in gender reassignment surgery in the world 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, Thailand where he leads the team.
Sex Reassignment Procedures:
SRS-1Vaginoplasty 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 vagnina but doesn't have the 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 is the oldest method and was the standard procedure until newer techniques emerged.
The surgery lasts about 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 prior to surgery to avoid hair deep inside the vaginal canal where removing it is difficult. If there is not enough depth a skin graft can also be used to increase depth. We prefer to use the skin graft technique below as in this technique the hairs are removed and the depth is sufficient.
SRS-2B Vaginoplasty with scrotal skin graft:
This technique involves using the skin covering the penis to construct the inner labia, parts of glans penis to construct 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, the vagina depth is still not satisfactory to the patient and then the plastic surgeon will consider using 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 sigmoid colon provides a vagina with sufficient depth and also with a self-lubricant. At Kamol Cosmetic Hospital, there are 2 options for Sigmoid Colon SRS:
The surgery is done via a 6-7 cm incision at the bikini line. The average length of sigmoid colon segment vaginal canal 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.
Sigmoid colon is harvested through 4 small incisions using the laparoscopic technique (keyhole surgery) The average length of 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 andwho 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 and has been performed for many years.
7. Contrary to rumour the sigmoid colon vagina doesn't smell. Less than 4% can experience an odour and this 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 prior to 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 where a soft diet must be had.
SRS-4 Revision Vaginoplasty
We perform hundreds of revision surgeries a year on patients that have received poor results elsewhere or from patients that simply want to “upgrade to a newer technique such as PPV (below) or sigmoid colon which has self- lubrication, elasticity and is easier to maintain. For full 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 hospital is one of the few hospitals in the world performing it. Peritoneal tissue is tissue that lines the abdomen. It is wet, elastic and self lubricates. The healing is generally quick with little 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 create the vaginal canal is not in fact 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 defect affects a huge one in 4500 girls. Peritoneal tissue is the only tissue used to make a vagina canal to connect the vulva to the womb of girls with MRKH. After 9 month in cis girls this peritoneal tissue is indistinguishable from vaginal tissue under a microscope.
With the PPV technique the outer labia and visible vagina is made using penile and scrotal skin whilst the inner vaginal canal is made using the peritoneal.
This technique is also extremely good for revision surgery for patients who have previously undergone gender reassignment surgery and who are unhappy with the result or who simply want a more functional realistic, elastic, self lubricating vagina.
Advantages or Penile Peritoneal Vaginoplasty SRS-PPV:
● The vagina has a self-natural lubricant with no unpleasant odour.
● The vagina is elastic and stretches like a biological vagina
● Less chance of vaginal prolapse and shrinkage compared to all other types of SRS.
● Vagina is elastic and dilation can be reduced after a year.
● Natural lubrication is similar to vaginal lubrication.
● Recovery is quick and there are less risks compared to sigmoid colon.
● Peritoneal pull through (davydov technique) has been performed on cisgender girls for over 40 years and is well understood.
Disadvantages and limitations Penile Peritoneal Vaginoplasty SRS-PPV:
● The patient may experience dyspepsia / indigestion symptoms 2-3 days after the surgery.
● This technique is not suitable for those who are overweight or have fatty abdomens as visceral fat (internal fat) makes the surgery difficult.
● Not suitable for patients with very small penis.
● No long term data of this surgery on transgender patients.
● If dilation is not performed as directed in the first year the joint between the penile skin and the peritoneal skin can fail and require revision surgery.
Sexual function and sensation using Dr Kamols techniques.
- Background: The nerve ending to the clitoris and the glans penis is similar with approximately 8,000 nerve endings.
- Dr. Kamol technique uses the surgical techniques to precisely identify and preserve all the nerves from glans penis and creates 4 points of special
sexual arousal as the follows:
a.The first point is the neoclitoris.
b.The second area located at the inner sides of the labia minora, contained 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 glans penis containing the nerve ending.
d.The fourth spot is located at the bulbourethral glands in front of the prostate glands. Dr. Kamol always keeps the bulbourethral glands contained the nerve ending and mucous secretion.1
e.The fifth spot (G-spot) is at the most lower part of the prostate glands which consist of sensory nerve endings. Dr. Kamol creates the neo vagina very close to the surface of the prostate glands.2
- Some surgeons claimed his/her technique is the only one (in the world) who preserve the erotic nerve ending to the neo vagina but this is simply not true.
- Schematic of glans penis and the areas are moved to reconstruct the neo vagina (Figure 1)
- Dr. Kamol creates the minimal-short scar comparison to other conventional techniques (Figure 2).
Figure 1. The areas from the glans penis to the neo vagina, tip of glans penis to neo clitoris (1), skirt of glans penis to the second spot sensation (2).
Figure 2. Dr. Kamol’s technique (Short-scar)
Figure 3. Other techniques (Long-scar)
Post-Operative Care for non-colon SRS:
The patient must be hospitalised for 4-6 days, depending on the technique. For the healing process to be complete and successful, patients advise to:
- During the first two days after surgery the patient must not take food that has fibre contents and beverages such as fruit juice, milk, and yogurt as these will trigger waste excretion. It may lead to contamination of the wound by the faeces.
- During the first 1-2 days after the surgery the patient should lie on her back, with hips raised and legs slightly apart as this will help reduce swelling.
- On the third day after the surgery the patient may lie on her side.
- On the third day after the surgery the surgeon will remove the draining tube, open and dress the wound. 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.
- 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.
- 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.
- The patient needs to keep the surgical wound clean.
- The patient must refrain from sexual intercourse for at least three months.
- The patient must ensure that she keeps her appointment with the doctor once a week for one month in order to maintain satisfactory results of the surgery.
Postoperative Care for SRS-Sigmoid colon:
- 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.
- The patient needs to avoid eating large meals in the first month.
- The patient may do light activity after three weeks and may resume regular daily activity after 3 months.
- The patient who has sex reassignment surgery with a sigmoid colon graft must refrain from drinking water or taking any food 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 of this technique must strictly abide by the recommendations of the doctors and nurses.
Risks and potential Complications:
Although an extremely 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:
● Poor healing
● Flap necrosis
Very rare complications - less than 1%:
● Urethral stenosis
● Decreased Sensation
● Deep vein thrombosis
● Risk from anaesthesia
● Recto-vaginal fistula
Unfavourable results can either be from those who don’t follow postoperative care such as dilating or from those with unrealistic expectations. Unfavourable results could be as follows:
● Unsatisfied size or shape of vaginal urethral and clitoris
● Asymmetry of the labia
● Loss of vaginal depth
● Vaginal stricture
Frequently asked Questions for Sex Reassignment Surgery
Q: Do I need to take hormone therapy before SRS and how long does it take to see the desired results?
A: The patient must have continuously taken the female hormone for at least one year.
Q: When can I start having SRS after my hormone therapy? How long will the operation take?
A: The patient must have continuously taken the female hormone for at least one year and after that you can have the surgery. The surgery time is 5-6 hours
Why Thailand is a plastic surgery destination?
Thailand has a reputation for being an open society for transgender people and this has led to hospitals becoming experts in surgery to make them physically complete. Thailand offers first class hospital treatments with highly experienced top class surgeons who perform hundreds of SRS surgeries a year who have perfected the surgery. Thailand has the huge advantage that the country is in general significantly cheaper than other countries and so the surgery is also comparatively a lot cheaper than other destinations. To summarise; we have a super modern, luxury hospital and a modern luxurious serviced apartment hotel in which to recover and yet its still significantly cheaper than other hospitals around the world.
Why Kamol Cosmetic Hospital, Thailand?
Kamol Cosmetic Hospital has become one of the world’s best destinations for gender confirmation surgery on the back of having consistently good results. We have our own large modern hospital and don’t rent hospital beds in other hospitals like others. We are at the forefront of the newest and best techniques such as SRS-PPV which most plastic surgeons can’t do because a specialist abdominal surgeon is needed to work in conjunction with the plastic surgeon and this eats into their profits so they simply maintain older significantly inferior techniques. We are accredited by the Joint Commission International (JCI), the gold standard in global healthcare. Our surgeons have been recognized as the most skilled and experienced in the industry since our opening in 2012. Dr Kamols technique hides the scars in the labia unlike nearly every other surgeon performing SRS. This makes it look more or less cis. It is very very difficult to see that it's not biological from birth. Within reason Dr Kamol can make the vulva / vagina look how you like.
Video : Introduce Kamol Cosmetic Hospital
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