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 for the person to lead a happier life with the newly chosen gender.
Therefore, to undergo Sex Reassignment Surgery (SRS), which consider 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 operation before making a decision. This decision is especially important when selecting the right surgeon equipped with appropriate experience and expertise in Sex Reassignment Surgery. The surgeon can create a female sexual organ that looks beautiful and natural, with a deep vagina, proportionate to the physical condition, capable of better perceiving sexual sensations. The surgeon will help the patient who has undergone surgery connect her physical and mental state of mind and be capable of leading a happy life.
Characteristics of those who qualify for Sex Reassignment Surgery from male to female are as follows:
- 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.
- The patient must have continuously taken the female hormone for at least one year.
- The patient must have had feminine feelings for a long time or since the initial/first recollections.
- The patient must have led a woman’s life for at least one year.
- The patient must feel disgusted with their sexual organ 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.
- 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:
- Transform the sexual organ to that which is most similar to the female sexual organ.
- The surgery will enable the patient to have as deep a vagina as her skin or the harvested colon graft would permit.
- All sexual sensory nerves would remain intact in the female clitoris to have normal sexual sensations in this area.
- 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:
- General anesthesia is applied to the patient by an anesthesiologist.
- A neovagina cavity dissection is performed between the rectum and the urinary tract along the Denonvilliers’ fascia, approximately 5-7 inches in depth.
- The skin is covering the penis used to create the inner labia. Dr.Kamol offers many options for the coverage of the vaginal wall, such as scrotal skin graft, penile skin, peritoneum, and sigmoid colon, depends on the individual’s desire and optimism.
- The core and fascias of the penis remove, and all the arousal sensory nerves are kept for use in creating the clitoris and clitoral hood.
- The testicles remove to decrease male hormones.
- The male urinary tract shortens, shaped, and the spongy tissue of the corpus remove so that urine can flow out in the same manner as women. If this part has not undertaken correctly, urine may shoot up when urinating in a sitting position.
- The exterior parts, such as the major labia, minor labia, urinary orifice, 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 the case of scrotal skin deficiency, the vagina depth is still not satisfactory to the patient. Then the plastic surgeon will consider using a skin graft from other areas such as the groin or lower abdomen to increase the depth of the vagina further. The operation time generally takes about 4-6 hours to complete.
This technique provides a one-stage operation with full function and aesthetic. Most patients do not need more additional touch up procedure. The procedure enables them to possess the desired deep vagina as well.
This technique is not suitable for those who have deficient skin. The patient might need hair removal at the penile shaft and the area around the neovaginal entrance before surgery, to avoid the intra vagina hair growth. Also, skin graft from the groins might add for the extra depth in the case of post-orchiectomy.
SRS-3 Sigmoid Colon Vaginoplasty:
a. Open technique
The sigmoid colon is cut as a pedicle flap with an intact neuro-vascular bundle via the low transverse abdominal incision as for the bikini line. The average length of the sigmoid colon segment is approximately seven inches. The rest of the colon is re-anastomosis (connected) to make standard passage of the large intestine, which will separate sigmoid and neovagina. The operation time is approximately six hours.
b. Laparoscopic technique
The sigmoid colon is harvested through the 4-port laparoscopic. The sigmoid colon is isolated as a 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, then pulled through the neovaginal canal and anastomosed to the penile skin at the neovaginal opening. The average length of the sigmoid colon is approximately seven inches. The average operation time is six hours.
Penile-Peritoneal Vaginoplasty technique (SRS-PPV)
The neovagina will have self lubricate resemble the biologic female. The neovagina is less chance of shrinkage, less chance of vaginal prolapse. It needs vaginal dilation less than skin graft or colon technique due to the nature of the peritoneum mucosa. This technique is a benefit for those who have chronic colitis (Crohn’s disease) or chronic diverticulitis. Also, that's no hair growth at the deep part of the neovagina. Using combined penile skin and peritoneal mucosa technique will decrease excessive mucous and less chance of prolapsed penile flap. The operation time takes 4-6 hours.
- This technique can use 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 become a loss of depth, and are unable to perform sexual intercourse.
- The vagina has a self-natural lubricant.
- Easier to do vaginal dilation than skin graft technique.
- Fewer risks of intestinal dysfunction compare to the sigmoid colon.
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 a complicated case, the patient might have the possibility of conversion to open technique or sigmoid colon neovagina reconstruction.
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.
- The patient needs to keep clean the surgical wound, as well as dilate the vagina at least twice a day until the surgical wound is healing well.
- 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 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 the intestinal function recover. In this period, the patients will have fluid via intravenous lines.
- The patient needs to avoid bulk food in the first month.
- The patient can do light activity after three weeks and resume regular daily activity during the third month.
- 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 gases. After that, the patient may sip a small amount of water or take soft food. If the food takes 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.
Risk and Complication
The patient individuals should be aware of all the likely and rare complications of sex reassignment surgery. Nevertheless, the rates of complications operated by Dr.Kamol are very low.
The possible complications are minor degree and not as dangerous as the follows:
- Poor healing
- Flap necrosis
The rare complication rate is very low; usually, less than 1% as follows:
- Urethral stenosis
- Decreased Sensation
- Deep vein thrombosis
- Risk from anesthesia
- Recto-vaginal fistula
Unfavorable results are varying in each individual depends on those how who have expectations or self postoperative care as follows:
- Unsatisfied size or shape of vaginal urethral and clitoris
- Asymmetry of the labia
- Loss of vaginal depth
- Vaginal stricture