Procedure

This procedure is a combination of a penile skin inversion and an immediate full thickness skin graft. The vaginal canal and opening is created beneath the urethral opening and prostate gland. Vaginal depth is of concern to most patients. The most important factor in creating this depth is the amount of penile shaft skin. Our technique lengthens the depth of the vagina by using the full thickness skin graft from the scrotal skin. Hair on the scrotum must be removed so that the skin graft is placed at the distal end of the penile skin flap. This technique can lengthen the depth at least 2 more inches. A portion of the glans (head of the penis), with its nerves and vessels, is converted into a clitoris. In so doing, the clitoris will be functional in sensation as well as in appearance. The excess erectile tissue around the urethra should be removed in order to avoid symptoms that stem from engorged erectile tissue during sexual arousal that may result in the narrowing of the vaginal opening.

Hospital Admission: Seven to ten night’s hospitalization

Anesthetic: General anesthesia (you are asleep)

Criteria: Patients must be at least 18 years old. Patients under 20 years old will require permission from parents. Patients must have approval from a psychiatrist (MD), psychiatric social worker (PhD), or clinical psychologist (PhD).

Pre-operative Care: Patients must complete a health check up within three months prior to SRS. Patients must also be confirmed by a private physician to be free from serious medical diseases and must pass the following blood tests:

• CBC, HIV Electrolytes, FBS, Creatinine Urinalysis

• Alkaline Phosphatase, Chest X-ray

• SGOT LDH EKG

Patients must discontinue hormone treatment at least fourteen days prior to surgery.
Hormones should be halted to reduce the risk of thrombosis (blood clots). Oral tablets shoud be halted two weeks prior to surgery and injectables should be halted four weeks prior to surgery. Oral antiandrogens should be halted three days before surgery (four weeks if injectables). Aspirin and smoking should be halted two weeks before surgery.

Post-operative care

Before being discharged from the hospital to the hotel, a nurse will teach you how to take care of your vagina and prescribe more medications. The stiches will be removed after seven to ten days. You will then be able to return home.

Recover: The neovagina can function within six weeks.

Results

• After six weeks, the patient should be able to engage in neovaginal intercourse.

• During sexual arousal, there is some vaginal lubrication - though in most cases the patient should apply lubricant jelly at the vaginal opening prior to intercourse (as with dilation).

• Typically during arousal, mild swelling of the urethral meatus from excess corpus spongiosum may occur which can be corrected for cosmetic improvement without additional cost if the patient returns to Thailand.

• During sex, sensation at the vaginal opening, inner labia, and neoclitoris can be comparable, and certainly more sustained after climax, than previously in the male sex.

• It is essential to avoid any strenuous activity which can complicate recovery.

Letter of Recommendation: The letter is required from foreign patients, and must be from either a medical doctor or a psychologist that states the person is a candidate for SRS.

The Costs: Price upon request

Reassignment Surgery (Male to Female)

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