Sex Change

Sexual Reassignment Surgery
(Male to Female) Penile Inversion.

Criteria of Approval

  • Patient must be at least 18 years old and if you are under 20 years old, we require permission with signature on the consent.
  • By Thailand law, patient must have approvals from two Thai psychiatrists and be diagnosed with at least one of following disorders: gender identity disorder, gender dysphoria or associated conditions.
  • Patient must have undergone at least one year of antiandrogen and/or female hormone and also have full-time living as a cross gender role.

There are 3 different kinds of SRS :

  •   Long penis: (>6inches) = penile skin inversion
  • Medium penile: (2 – 6 inches) = penile skin inversion with scrotal skin graft (SSG)
  • Short penile: (<2 inches) = penile skin inversion + sigmoid colon flap (SCF)
sex-change

Preparation Before Operation

Following the HBIGDA criteria you should have

  1. Two letters recommended the SRS from: 1)Therapist, 2)psychiatrist, 3)endocrinologist or your general practitioner
  2.  Stop treating hormone at least 2 weeks before surgery to reduce risk of blood clot: stop oral tablet 2 weeks and injectables 4 weeks before surgery, stop oral antiandrogen 3 days before surgery and 4 weeks for injectables
  3. You must have the result of physical check up within 3 months and be confirmed that you are free from serious medical diseases which have high risk for major surgery and must pass the following blood tests: CBC, anti HIV, electrolytes, blood sugar, bun, creatinine, alkaline phosphatase, chest W-Ray, ECG, SGOT, LDH
  4. Avoid smoking, aspirin, anticoagulants, ibuprofen and vitamin E at least 10 – 14 days before surgery
  5. HIV patient can be done but have to pay extra cost 30% for disposable instrument usage
  6. All documents should be sent to us 1 month before surgery

Surgery Schedule

Day 1 : arrive Bangkok

Day 2 : clinical interview with our surgeon and psychiatrist if necessary
: check for all the medical documentations
: admit in hospital, clean up all; enema for cleaning the rectum by nurse, nice shower and clean up your perineum and also preoperative intravenous fluid
: surgery will take time 3 – 4 hours

Day 3 – 5 : after surgery, you are able to have meal and move freely on bed. You may feel like having urinate all the time but don’t worry, it’s normal. You’ll have the urine catheter and blood drainage bag. Pain will gradually subside in 24 – 48 hours with pain killer medicine. The packing gauze dressing and sticky plaster will be removed in day 4 or 5 then you can take a nice shower and urinate by yourself, like a woman.

Day 6 : all packing bandage and catheter will be removed. Doctor will check the result and you can leave hospital but you still have to take rest.

Day 7 – 10 : take time for resting

Day 11 : you may go out for do some activities

Day 12 : stitches off and do the final examination

Day 13 : transferred to the Bangkok international airport and back home safety

Surgical Procedure

Sexual reassignment procedure begins with creating the vaginal cavity in the space between urethra, prostate, bladder and rectum. Cut out both side of scrotal. Peel out the skin of penile shaft and separate urethra out of penile shaft. Isolate glans penile with two dorsal nerves and vessels. Then penile skin inversion for vaginal wall lining with or without scrotal skin graft. Create space and setting the position of the sensate clitoris. Then urethroplasty and libiaplasty. (the excess skin erectile tissue around the urethra will be removed in order to avoid engorged during sexual arousal) Finally, wound packing with gauze bandage and blood drainage and urine catheter retaining.

Possible risks and complications

  • Infection : occur infrequent which is subside by wound care and antibiotics
  • Wound disruption : may happen at the base of libias cause high tension but will require wound care and body healing by 1 month
  • Short vagina : which dilating responsibly required, and in case of short vagina occur second operation can be done after 6 month by sigmoid colon procedure
  • Rectovaginal fistula :occur less than 1% but if it happened, second operation can be done
  • Bleeding : if there is bleeding at the urethral stump or other areas beside the gauze dressing areas you may need to repacking or suturing again
  • Side effects
  • Unable to urinate : happen sometime after urine catheter removed and may need more few days for urine catheter retaining
  • Bleeding : if there is bleeding at the urethral stump or other areas beside the gauze dressing areas you may need to repacking or suturing again

Recovery

After surgery you should stay in Bangkok at least 10 – 14 days and then take time at home about 4 – 6 weeks before back to work

Hospital Admission

4 – 5 nights in hospital (and need another 5 – 7 days in hotel in Bangkok)

Anesthesia

General anesthesia

Payment

  • The payment can be prepared by travel’s check in US dollars, Euro dollars, Japanese yen while you are here we will assist you in cashing out the money into Thai baht before surgery at the bank nearby.
  •  If you are HIV positive you have to pay extra cost 30% for disposable instrument usage

Preparation&Consultation

  • You can start by downloading the medical form here.
  • Our team is always ready to help you prepare yourself for the procedure. It is an easy step to e-mail us your information. We will have our medical team evaluate your case if you are a good candidate to visit us in Thailand.
  • To be safe for the operation, please inform us if there are any allergies or serious medical conditions. Also please inform us all medication that you are currently taking.
  • Inform us your arrival dates, we will arrange the consultation appointment for you.
  • Please contact us if you need any pick up on your arrival at the airport. We can help you reserve the hotel room and other arrangements if necessary.
  • Consultation is without charges.
  • The patient who is looking to undergo this procedure must have been taking hormones for at least 2 years.
  • Please note that the surgery requires 2 consent letters from 2 psychiatrists. The patient can submit the form to consult and receive the letters here in Thailand.

Post-Operative Care

  • All post-operative aftercare of a correction, if required, is provided without cost.
  • There is no restriction diet. But healthy diet with less is much suggested.
  • No smoking and drinking at least 10 days after the surgery.
  • The patient may experience some side effect due to general anesthesia after the surgery, for example, nausea and drowsiness.
  • Patients should abstain from exercise for 3 months after the surgery. Walking and mild leisure is fine.
  • Before you leave the hospital, nurse will teach you how to take care of your vagina. Stitches off can be done within 7 – 10 days.
  • Dilatation (in the correct direction) is the most thing you have to do if you don’t dilate responsibly it may cause the shorten and contracted vagina
  • Douching every time after each dilating (5 – 10 cc of betadine solution with 1L of water.
  • Feminine napkins should be changed several times a day for good hygiene.
  • After 1 month you should apply the Premarine cream to your vagina twice a day.
  • Hormonal treatment can be return after surgery 2 months with consult your endocrinologist to adjust properly dose

*Recovery times / Results can vary depending on individual

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