Sexual Reassignment Surgery
(Male to Female) Penile Inversion
If you are a guy, you usually don't think about it much. It feels normal to be male. And, for most girls, it feels very natural to be female. Most people's gender identity matches their anatomy. But people who are transgender feel different from their physical appearances. People who are transgender feel like they're living inside a body that's all wrong for them. They often say they feel "trapped in someone else's body."
Are you a good candidate?
- 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)
About SRS 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.
Preparation Before Operation
Following the HBIGDA criteria you should have :
- Two letters recommended the SRS from: 1)Therapist, 2)psychiatrist, 3)endocrinologist or your general practitioner
- 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
- 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
- Avoid smoking, aspirin, anticoagulants, ibuprofen and vitamin E at least 10 – 14 days before surgery
- HIV patient can be done but have to pay extra cost 30% for disposable instrument usage
- All documents should be sent to us 1 month before surgery
Example for 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 5 – 6 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 – 14 : take time for resting
- Day 15 : you may go out for do some activities
- Day 16 : stitches off and do the final examination
- Day 17 : transferred to the Bangkok international airport and back home safety
Result and Follow up
The surgery time is varied to the numbers of the concerned areas, approximately from 5 to 6 hours. The patient will need to undergo general anesthesia during the operation. Lab Check-up is required to the patient before the surgery.
The results of a SRS surgery are visible almost immediately, however it may take several months for your final results to fully develop. Numbness and a firm feeling over the skin’s surface will resolve over time. It may take a year or more for incisions lines to refine and fade to some degree. Although permanent, these lines can usually be hidden by most clothing and swimsuits. 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.