MTF Sex Reassignment Surgery / Sex Change
in Bangkok, Thailand
What is Sex Reassignment Surgery?
Sex Reassignment Surgery (SRS) or Sex Change Surgery is the final step in the process of assisting people who have experienced conflicts between their sexual perceptions and their physical characteristics since birth, which in medical terminology is gender dysphoria. The sex reassignment surgery will transform the sexual organ to conform to the desired inner state of mind in order for the person to lead a happier life with the new chosen gender.
Therefore, in order to undergo Sex Reassignment Surgery (SRS), which is considered the most important surgery, paving the way to a new way of life, it is necessary to prepare individuals by seeking pertinent information about the surgery before making a decision. This is especially important when selecting the right surgeon equipped with appropriate experience and expertise in Sex Reassignment Surgery who can then create a female sexual organ which looks beautiful and natural, with a deep vagina, proportionate to the physical condition, capable of better perceiving sexual sensations. This will help the patient who has undergone surgery connect her physical and mental state of mind and be capable of leading a normal happy life.
Characteristics of those who qualify for Sex Reassignment Surgery from male to female are as follows:
1. The patient must be at least 20 years of age. For those below the age of 20, it is required that the legal parents or guardian authorize their permission to the surgery.
2. The patient must have continuously taken female hormone for at least one year.
3. The patient must have had feminine feelings for a long time or since initial/first recollections.
4. The patient must have led a woman’s life for at least one year.
5. The patient must feel disgusted with their sexual organ as if it were an excess part of their body.
6. The patient has undergone a mental test and been certified by a psychiatrist as in normal mental state and suited for the Sex Reassignment Surgery.
7. The patient must be in physically fit condition.
What to Expect from Sex Reassignment Surgery?
The plastic surgery undertaken to reassign the patient’s sex from male to female involves the use of skin, tissues and sexual sensory nerves of the patient to transform the male sexual organ into a female sexual organ that is perfect in the following ways:
1. Transform the sexual organ to that which is most similar to the female sexual organ.
2. The surgery will enable the patient to have as deep a vagina as her skin or the harvested colon graft would permit.
3. All sexual sensory nerves would remain intact in the female clitoris so as to have normal sexual sensations in this area.
4. Plastic surgery must be undertaken to hide the wound so that there is the least chance of it being visible.
Dr.Kamol’s Sex Reassignment Surgery Techniques:
1. General anesthesia is applied to the patient by an anesthesiologist.
2. A new vagina is formed between the anus and the urinary tract, approximately 5-7 inches deep.
3. The skin covering the penis is used to construct the inner labia, and a vaginal wall is consequently covered with either skin graft from scrotum or harvested sigmoid colon graft.
4. The core of the penis is removed, and the sexual sensory nerves are kept for use in creating the clitoris.
5. The testicles are removed to decrease male hormones.
6. The male urinary tract is shortened and shaped so that urine can flow out in the same manner as women. If the surgery has not been properly undertaken, urine may shoot up when urinating in sitting position.
7. The exterior parts such as the major labia, minor labia, urinary tract and clitoris are reconstructed to look beautiful and perfect as a female sexual organ which can still experience sexual sensations.
Sex Reassignment Procedures
Sex Reassignment Surgery methods available at Kamol Cosmetic Hospital to construct new vagina and clitoris are as follow
SRS-1 Vaginoplasty without vaginal depth:
SRS-2 Vaginoplasty with skin graft
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.
This technique is not suitable for those who have deficient skin. The patient might need hair removal at the penile shaft prior to surgery, to avoid intra vagina hair growth. In addition, skin graft might be added for the extra depth
SRS-3 The Sigmoid Colon Vaginoplasty:
At Kamol Cosmetic Hospital, there are two options for Sigmoid colon SRS:
a. Open technique
The sigmoid colon is cut as a pedicle flap with intact neuro-vascular bundle via the low transverse abdominal incision as the bikini line. The average length of sigmoid colon segment is approximately seven inches. The rest of colon is re-anastomosis (connected) to make normal passage of the large intestine, which will separate sigmoid and neovagina completely. The operation time is approximately six hours.
b. Laparoscopic technique
The sigmoid colon is harvested through the four small incisions by laparoscopic technique as the pedicle flap with the neurovascular bundle. The colon is re-anastomosis with the stapler tools. The sigmoid colon segment is closed at the upper end and pulled through the neovaginal canal and anastomosis to the neovaginal opening. The average length of sigmoid colon is approximately seven inches. The average operation time is six hours.
SRS-4 SRS-PPV (Penile-peritoneal vaginoplasty)
The neovagina will has self lubricate resemble to biologic female. The neovagina is less likely to shrinkage, less chance of vaginal prolaps, and needs vaginal dilation less than skin graft or colon technique due to the natural physical of the peritoneum mucosa. This technique is benefit for those who have chronic colitis (Crohn’s disease). In addition, that’s no hair growth at the deep part of the neovagina. The operation time takes 4-6 hours.
1. This technique is beneficial for patients who have previously undergone sex reassignment surgery, whose vaginas have become stricture, and are unable to perform sexual intercourse.
2. It also helps patients with very short penises. In this regard, the surgeon will have already decided that the skin graft technique cannot be performed.
3. The vagina has a natural lubricant.
4. It is possible to determine the depth of the newly constructed vagina.
Disadvantages and limitations:
1. In 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, with invasive procedures, such as cutting off parts of the colon, and the colon must be thoroughly cleansed (by an enema) one day prior to the surgery.
3. The patient may experience dyspepsia/indigestion symptoms 3-5 days after the surgery.
4. Both open and laparoscopic techniques are not suitable for those who are overweight or have fatty abdomens. The patient who requests for sigmoid colon SRS needs physical examination prior to make a final decision for surgery.
Post-Operative Care for non-colon SRS:
The patient must be hospitalized for 4-6 days depending on the technique. For the healing process to be complete and successful, patients are advised to:
1. During the first two days after surgery, patient must not take food that has fiber 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 feces.
2. During the first 1-2 days after the surgery, patient should lie on her back, with hips raised and legs slightly apart as this will help reduce swelling.
3. On the third day after the surgery, patient may lie on her side.
4. On the third day after the surgery, surgeon will remove the draining tube, open and dress the wound. Patients who have 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 then be dressed, and patient may be transferred to the serviced apartment for further recovery.
6. Patient needs dilation of the vagina using dilators. In order for the patient to maintain the width and depth of the vagina, patient should dilate the vagina at least twice a day for about half an hour each time. This process can be done at the serviced apartment.
7. The patient must clean the wound, as well as dilate the vagina at least twice a day until the external wound and that in the vagina are fully healed.
8. The patient must refrain from sexual intercourse for at least three months.
9. The patient must ensure that she keeps her appointment with the doctor once a week fo a period of one month to maintain satisfactory results of the surgery.
Post-Operative Care for SRS-Sigmoid colon:
2. Patient needs to avoid bulk food in the first month.
3. Patient can do light activity after three weeks and resume normal daily activity at the third months.
4. Patient who has sex reassignment surgery with sigmoid colon graft must refrain from drinking water or taking any food until she can pass gases. Thereafter, patient may sip a small amount of water or take soft food. If the food is taken too quickly, indigestion or dyspepsia symptoms may occur. Therefore, the patient of this technique must strictly abide by the recommendations of the doctors and nurses.
- Recto-vaginal fistula
- Poor healin
- Flap necrosis
- Vaginal and Urethral stenosis
- Unsatisfied size or shape of vaginal urethral and clitoris
- Asymmetric Labia
- Decreased Sensation
- Deep vein thrombosis
- Risk from anesthesia