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 sex reassignment surgeries each year. He is the chief plastic surgeon at Kamol Cosmetic Hospital in Bangkok, Thailand where he leads the team in male-to-female and female-to-male sex transitions and face feminization.
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, neo-clitoris and clitoral hood, and female urethra. This procedure is suitable for those who do not need vaginal penetration of sexual intercourse and unwanted vaginal dilation and vaginal douche for life. The vagina looks like a perfectly natural vagnina but doesn't have the vaginal canal.
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 inside the vagina. If there is not enough depth a skin graft can also be used to increase depth.
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.
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:
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 7 inches. The rest of the colon is re-anastomosis (re-connected) to make the large intestine normal, separate from the sigmoid-neovagina. The operation lasts approximately 6 hours.
Sigmoid colon is harvested through 4 small incisions using the laparoscopic technique as the pedicle flap with the neurovascular bundle. The colon is re-anastomosis (re-connected) with stapler tools. Sigmoid colon segment is closed at the upper end and pulled through the neo-vaginal canal and anastomosis (re-connected) to the neovaginal opening. The average length of sigmoid colon is approximately 7 inches. The average operation time is 6 hours.
1. This technique helps patients who have previously undergone sex reassignment surgery.
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.
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. Sigmoid Colon SRS, open or laparoscopic technique is not suitable for those who are overweight or have a fatty abdomen. Patients who request Sigmoid Colon SRS need a physical examination prior to making a final decision for surgery.
5. Can have an odor.
Post-Operative Care for SRS-Sigmoid colon:
1. During the first 3 days, the patients cannot eat or drink until the intestinal function is recovered. In this period, the patients will have fluid via intravenous lines.
2. The patient needs to avoid bulk food in the first month.
3. Patients can do light activity after 3 weeks and resume normal daily activity at the 3 months.
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) which has self- lubrication, elasticity and is easier to maintain and is more or less indistinguishable from a biological vagina. For full information on revision please see the following page See more
SRS-5 SRS-PPV Penile-Peritoneal Vaginoplasty technique:
This is the most advanced SRS technique for transwomen and Kamol hospital is one of the only hospitals in the world performing it. Peritoneal tissue is tissue that lines the abdomen. It is the most vagina like of all body tissues. It is elastic, it self-lubricates in the same way as a cisgender vagina does and without the odor associated with colon vaginoplasty, it doesn’t demand a lifetime of dilation unlike the other options of penile inversion or using the colon. It is by far the most advanced technique with many advantages over other techniques.
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 60 years. Known as the DAVIDOV 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.
In this technique the outer labia and visible vagina is made using the penis whilst the inner vaginal canal is made using a peritoneal.
The only negative aspect is that there is no long term data on the results for SRS-PPV on trans patients, however the only difference between transgender women and cis girls is that trans women need to have the vulva created and don’t have a womb. These are however medically inconsequential as making natural looking vulvas is something Dr Kamol has done many thousands of times and has a world leading reputation for. SRS-PPV is less like having a neovagina and more like having a natal vagina. It behaves the same way and no other technique comes close to the function of a biological vagina
This technique is not only the most advanced method for a realistic, functional vagina but it is also extremely good revision surgery for patients who have previously undergone sex reassignment surgery and who are unhappy with the result or who simply want a more functional realistic, elastic, self-lubricating vagina with significant advantages over other methods.
- This technique can be used as a primary or secondary neovagina reconstruction.
- This technique is beneficial for patients who have previously undergone sex reassignment surgery, penile inversion whose vaginas have developed a loss of depth and are unable to perform sexual intercourse or for those who want an “upgrade” to a more natal functional vagina with less maintenance.
- The vagina has a self-natural lubricant.
- Less likely to shrink & less chance of vaginal prolapse.
- Fewer risks of intestinal dysfunction compare to sigmoid colon.
Peritoneal tissue is elastic and does not require dilation after a year unlike all other techniques.
- Natural lubrication is extremely similar to vaginal lubrication, unlike the colon which has an odor of colon.
- Recovery is significantly quicker than both penile inversion and colon vaginoplasty.
- No visible scars in the vagina itself (it looks completely natural) and due to laparoscopic (keyhole) technique there are only 2 tiny, virtually undetectable scars from the keyhole surgery- (2 tiny freckle like scars either side of the abdomen)
- Significantly less painful than other techniques.
- Most similar functionality to a biological vagina.
- Peritoneal pull through (DAVIDOV technique) has been performed on cisgender girls for over 60 years and is well understood.
Disadvantages and limitations:
- 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.
- In the extremely rare event there is a complicated case, the patient might have the possibility of conversion to open technique or sigmoid colon neovagina reconstruction. This is more or less unheard of.
- Hospitalization: 7 nights
- Duration time of surgery: 6 hours
- We recommend you to stay in Thailand for recovery for 3-4 week
Picture 1. Shows area of the hair removal
- The patient needs hair removal around 5x6 cm at the base of the penis as in picture 1.
- The patient may experience dyspepsia / indigestion symptoms for 2-3 days after the surgery.
- This technique is not suitable for those who are overweight or have fatty abdomens due to the difficulty reaching the peritoneal.
- In a complicated case the patient might have the possibility of conversion to open technique or sigmoid colon neovagina reconstruction.
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, that 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 hospitalized 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 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.
- 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 half 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.
Criteria for Male-to-Female Sex Reassignment Surgery (SRS) in Thailand according to the Medical Council of Thailand:
- The patient must be at least 20 years of age. If aged less than 20, authorisation of their parents or guardian is required in order to have the surgery.
- The patient must have continuously taken female hormones for at least one year.
- The patient must have had feminine feelings for a long time.
- The patient must have led a woman’s life for at least one year.
- The patient must feel disgusted with their genitals as if it were an excess part of their body.
- 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 (we have our own psychiatrist)
- The patient must be in physically fit condition.
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 anesthesia
- Recto-vaginal fistula
Unfavorable results can either be from those who don’t follow postoperative care such as dilating or from 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
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: Are there any other steps required before SRS in addition to hormone therapy?
A: 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. If the age less than 20, it requires that the legal parents or guardian authorize their permission to the surgery.
2. The patient must have continuously taken the female hormone for at least one year.
3. The patient must have had feminine feelings for a long time or since the 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.
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 summarize; 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.
Video : Introduce Kamol Cosmetic Hospital
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