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.
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.
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 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 is Sex Reassignment Surgery?
SRS - Sex Reassignment Surgery changes the patient’s physical sex from male to female. The surgery involves the use of skin, tissues and sexual sensory nerves of the patient to transform the male genitals into a female genitals. The fundamental goals of SRS are:
- To transform male genitals to be indistinguishable from female genitals.
- To create a deep of a vagina as the skin or the harvested colon / Peritoneal graft will permit. (6 inches 15 cm average)
- To leave all sexual sensory nerves intact to create a female clitoris so you can have normal sexual sensations in this area.
- To hide any scars internally so that they are not 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 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.
- The core and fascias of the penis are removed and all the arousal sensory nerves are kept for use in creating the clitoris and clitoral hood.
- The testicles are removed.
- The male urinary tract is shortened, shaped, and the spongy tissue of the corpus is removed so that urine flows out in the same manner as women.
- The external vagina including the labia majora, minor labia, urinary orifice, and clitoris are reconstructed to look beautiful and perfect and indistinguishable from a natal vagina whilst also still being able to 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 intact neuro-vascular bundle via the low transverse abdominal incision as the bikini line. The average length of the 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 time is approximately 6 hours.
b. Laparoscopic technique
The 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. The 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.
Penile-Peritoneal Vaginoplasty technique (SRS-PPV)
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 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.
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 the 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 odour 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 (davydov 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.
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.
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.
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. 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: 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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