Kamol Hospital

MTF Reassignment Surgery

Reassignment 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 which is considered the most important surgery of all, paving the way to a new way of life, it is necessary to prepare oneself by seeking pertinent information about the surgery before making a decision. This is especially important when selecting the right surgeon equipped with the appropriate experience and expertise in Sex Reassignment Surgery. They 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 his physical and mental state of mind, and be capable of leading a normal happy life.

Characteristics of those who qualify for 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 permission for 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 1 year.
5. The patient must feel disgusted with his sexual organ as if it were an excess part of his body.
6. The patient has undergone a mental test, and been certified by a psychiatrist as in a normal mental state, and suited for the Sex Reassignment Surgery.
7. The patient must be in physically fit condition.

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 his skin 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 skin graft from scrotum.
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 the male hormones.
6. The male urinary tract is shortened and shaped so that urine can flow out in the same manner as other 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 as before.

Sex Reassignment Surgery methods available in Kamol Cosmetic Hospital in accordance with the construction procedures of the new vagina and clitoris are as follows:

1. SRS with optional procedures:

In case of deficient penile and scrotal skin or secondary SRS that limitation of skin in the genital area, optional procedures may needed.

a. Penile Skin Inversion:

This surgery involves inverting the skin of the penis to create and beautify the vagina. This is a widely popular method.

The advantage is that this method is relatively simple, not complicated. For experienced and specialized surgeons, this technique of sex reassignment surgery lasts about 4 hours.

The disadvantage is that it is not suitable for men with penises shorter than 4 inches because this will result in a vagina that is not deep enough

In general, the vagina depth is equivalent to the length of the skin covering the penis minus one inch (this includes skin required to construct the Minor Labia). Moreover, some patients may need secondary labiaplasty. Because most parts of penile skin is inverted into the vagina for the whole depth, there is insufficient skin to construct the inner labia and clitoral hood.

In this way, patients may need secondary labiaplasty and clitoral hood reconstruction.

b. SRS without skin graft:

The technique involved using penile skin and scrotum to construct the external genitalia such as inner and outer labia, neoclitoris and clitoral hood, and female urethra.  Because penile skin is used to construct the innerlabia and clitoral hood, the vaginal depth is very insufficient unless skin graft is covered intra vagina.  This procedure is suitable for who those who do not need transvagina sexual intercourse and unwanted vaginal dilation for life.

2. SRS 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 neoclitoris and scrotal skin graft to cover the vaginal wall. This results in a sufficiently deep and functional vagina as required by the patient.

If after the scrotal skin graft, 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 advantage is that this technique provides a one stage operation with full function and
aesthetic. Most patients do not need further additional touch up procedures.

The procedure enables them to possess the desired deep vagina as well.

– The disadvantage is that the surgery is difficult and complex, and is not suitable for those who have deficient skin.

For this technique, experienced and specialized plastic surgeons in sex reassignment surgery will take about 4-6 hours to complete.

The advantage is that this technique takes less operation time and less complications.

 

3. The Sigmoid Colon Vaginoplasty:

This technique is used in the case where patients have short penises, or to assist patients whose vaginas have become obstructed. This can also be used in patients who have never undergone sex reassignment surgery. The vagina which is part of the colon will have good lubricant and optimal depth.

At Kamol Cosmetic Hospital, there are 2 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 7 inches. The rest of colon is re-anastomosis (connection) to make normal passage of the large intestine, separate way from the sigmoid-neovagina. The operation time is approximately 7 hours.

b. Laparoscopic technique

The sigmoid colon is harvested through the small 4-incision 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 6-7 inches. The average operation time is 7 hours.

Advantages:

1. This technique helps patients who have previously undergone sex reassignment surgery, whose vaginas have become obstructed, 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 surgery types SRS-penile skin inversion/scrotal skin graft 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 complete with invasive procedures required such as cutting off parts of the colon, and 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. The sigmoid colon-SRS, open or laparoscopic technique is not suitable for who those who are  overweight or who have a fatty abdomen. The patients who request sigmoid colon SRS need physical examination prior to make a final decision for surgery.

Post Operative Care for non-colon SRS:

The patient must be hospitalized for at least 4-6 days. In order to look after the wound whilst recovering at the hospital, the patient must take the following actions:

1. During the first 2 days after surgery, the patient must stop taking food that has fiber content, 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. 1-2 days after the surgery, the patient should lie on his back, with hips raised and legs slightly apart as this will help reduce swelling.
3. On the third day after the surgery, the patient may lie on her side.
4. On the 4th day after the surgery, the surgeon will remove the draining tube, open and clean the wound. The urine drainage/edema tube will also be removed. Patients who have undergone Sex Reassignment Surgery with Penile Inversion Technique may return home, and come back in 7 days to remove stitches. For patients who have undergone Sex Reassignment Surgery with Skin Graft or Sex Reassignment Surgery with Colon Graft, the surgeon will not remove the urine drainage/enema tube, and the patient must remain in bed until Day 6.
5. On the 6th day, patients of Sex Reassignment Surgery with  Skin Graft surgery will have their urine drainage removed.  The wound will then be cleaned, and the patient may return home.
6. Patients of Sex Reassignment Surgery must come back for removal of stitches, and dilation of the vagina using the Dilator which is available at the hospital. In order 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.
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 2 months.
9. The patient must ensure that she keeps her appointment with the doctor once a week for a period of one month, in order for the results of the surgery to be perfect and naturally beautiful.

The specific post op care for SRS-sigmoid colon vaginoplasty Patients who have undergone surgery Sex Reassignment Surgery must refrain from drinking water or taking any food until she has broken wind from the body first. Thereafter, she  may sip a small amount of water, or take soft food. If the food is taken too quickly, indigestion  or dyspepsia symptoms may be found. Therefore, the patient of this technique must strictly abide  by the recommendations of the doctors and nurses.

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 patients need 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.

Visit our gallery to view MTF sex reassignment before and after photo: