Penile Peritoneal Vaginoplasty (SRS-PPV) is the newest and most advanced SRS technique for Gender confirmation / Sexual reassignment surgery 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 self lubricates in the same way as a cisgender vagina, it’s elastic, it doesn't need a lifetime of dilation, It has the least pain of any SRS technique and has the quickest recovery time and also the least risks. 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 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 penile and scrotal skin whilst the inner vaginal canal is made using the peritoneal.
SRS-PPV is less like having a neovagina and more like having a natal biological 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.
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 does not require dilation after a year unlike all other techniques.
● Natural lubrication is extremely similar to vaginal lubrication unlike sigmoid colon which often has an unpleasant odour.
● Recovery is significantly quicker than both penile inversion and colon vaginoplasty.
● Significantly fewer risks of intestinal issues compared to the sigmoid colon vaginoplasty.
● No visible scars on the vagina itself (it looks completely natural) and due to laparoscopic (keyhole) technique there are only 4 tiny, virtually undetectable scars from the keyhole surgery- (They look like small freckles and fade after 12 months to be more or less invisible)
● 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 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 the laparoscopic (keyhole surgery) can’t reach the correct parts.
The SRS- PPV Technique Requires:
● Hospitalization: 7 nights
● Duration time of surgery: 6 hours
● We recommend you to stay in Thailand for recovery for 3-4 weeks. We have our own hotel next to the hospital where you can recover.
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)