SRS(Sexual Reassignment Surgery)

Why sex reassignment surgery at Nida Esth?

• An expertise of Dr. Piya Rungruxsiri, M.D. who has long experiences in gender reassignment surgery (GRS) for more than 19 years. 
• At Nida Esth’ we provide anesthesiologists and professional nurse team who can deliver full customer services, trusted both in Thailand and other countries. 
• After sex reassignment surgery, you will be receiving the professional care from nurse team.

Who is the suitable candidate for sex reassignment surgery?

• Older than 18 years old. If younger than 20, permission from the parent is required.
• Been living like a female for longer than 1 year.
• Accepted by surrounding people and felt happy without any pressure   while living like a female.
• Take female hormone orally or injected for longer than 1 year.
• Diagnosed as gender identity disorder, or gender dysphoria.
• Psychology evaluation result is normal and certified by a psychologist   for readiness for surgery

Processes of sex reassignment surgery

• General anesthesia is involved in MtF gender reassignment surgery
• A vagina will be created near urethra and glands; a vagina will be approximately 1.5-2 inch wide
• Penile skin will be used to create vaginal wall; vagina’s depth will be as deep as a patient’s original penis
• Another technique to create a vagina is to trim a penis and build a function for patients to be able to urinate in a sitting position. Any mistake might result in complication in a urinal process
• For vaginal appearance, a surgeon will use different techniques to create a satisfying vagina. Scrotum will be used to create Labia Majora and Labia Minora while two testicles will be removed 
• Clitoris will be created as well for sexual sensation
• The procedure takes 3-4 hours 
• Patients have to be admitted at hospital for 4-5 days

Which sex reassignment surgery technique suit you best?

This surgery involves changing the male genitals into a form with the appearance of, and, as far as possible, the function of female genitalia where we – Dr. Piya Rungruxsiri, M.D. at Nida Esth, Bangkok Thailand – mainly have 3 techniques.

Penile Skin Inversion without Skin Graft

This type of technique is the least invasive technique is to line the newly created vaginal cavity. An incision is made from the base to the head of the penis, and the skin is peeled away from the shaft. This technique is suitable for patient with sufficient penile skin length and diameter, and patients who are uncircumcised. 

Penile Skin Inversion with Skin Graft

This technique is the most common male to female SRS technique and is usually recommended to patients with insufficient skin length to create the vaginal cavity. In this case a skin graft will be necessary; the most common skin graft area is the scrotal skin.

Sigmoid Colon Vaginoplasty

This technique utilizes sigmoid colon to create the vaginal cavity instead of skin graft or penile skin inversion. It will result to deep and lubricated vagina. In this type of vaginoplasty, 2 teams of surgeons will be need; colorectal surgeons and plastic surgeons. 

Contraindications for Sigmoid Colon Vaginoplasty are:

• history of intestinal malignancy
• inflammatory bowel disease
• extensive abdominal surgery
• Smoking
• Obesity (BMI greater than 30 kg/m2).

Pre and Post Care for Sex Reassignment Surgery

How to Start?

1. Patients need to pass psychology evaluation test
2. Inform the surgeon any particular drug and food allergies you have
3. Stop taking female hormone for 2 weeks if taken orally and 4 weeks if taken by injection
4. Plan 3-4 weeks off from work 
5. Consume soft food for 2-3 days before the procedure
6. Prepare an amount of sanitary pads for post-operation
7. Wear loose skirt to prevent friction
8. Cleanse your body before the procedure since you are not allowed to take a shower for 5 days
9. Shave off pubic hair before the surgery
10. On the surgery day, any illness may result in postponement of the surgery
11. Any sexual transmitted diseases found may result in postponement for a cure; patients must be healthy to receive undergo the treatment

Post Care for Sex Reassignment Surgery

• Stop high-fiber foods and beverages that stimulate excretion for 2 days to lessen chances of infection On the first day after the surgery, pain might be unbearable. A surgeon usually prescribes painkillers to relieve the pain
• On the first 2-3 days, patients must be on bed and place a pillow between their legs to prevent friction 
• A recent vagina should be hygienic by cleansing with antibacterial liquid or saline to prevent infection
• Patients should not walk for at least 5 days
• On the fifth day, a surgeon will take off bandages and a urinary catheter. Patients can immediately go back home if there is no complication. If the urinary catheter is clotted, patients are necessary to continue having the urinary catheter. If scrotum is used to extend the length of a vagina, this skin will be completely healed 4 days afterwards
• Once removed the bandages, on the first day, urination can be difficult. Once removed the urinary catheter, patients are still not able to urinate by themselves, hospital admission extension may be needed. Once patients have urinal problems, immediately call a surgeon which may result in one more week of urinary catheter may be needed
• Vaginal cleansing after 5 day of the surgery with antibacterial liquids or saline twice a day is important by utilizing Betadine or 5 cc of Dettol mixed with one liter of water for 3 weeks. Cottons with Betadine - Povidone-iodine – in case of bleeding immediately call a surgeon
• On the first week, 2-3 sanitary pads per day are necessary 
• To prevent contraction of a vagina, a dilator can be inserted in the vagina twice a day, 30 minutes each time, start after operation 10 days at least.
• No sexual intercourse for 2 months after the surgery
• Start orally take female hormone 2 weeks afterwards
• After 8 weeks of sex reassignment surgery, use Dettol – antibacterial soap – mixed with a liter of water to spray in a vagina for cleansing

Sexual Sensation after Sex Reassignment Surgery

After sex reassignment surgery, patients would live a happier life with a new satisfying vagina that can deliver the same sexual sensation as women’s.

A vagina is developed from a penis; its structure and nervous systems are indeed different from women’s. Commonly, sexual sensation depends on professional and techniques of a surgeon. A clitoris is a spot that is a center of se3xual sensation should be placed at the top of urethra. Patients may not have natural lubrication as well as women’s vagina so lubricant is needed.

Complication after Sex Reassignment Surgery 

Wound Split

At the lower part, a wound can be split which is can be treated with Betadine - Povidone-iodine for approximately a month in case of wound split.

Vaginal Contraction

After the surgery, a vagina will be 5-6 inch deep and after 4-6 months. The depth may increase for an inch in case that the vagina is too shallow. Additional surgery can be done 6 months afterwards, if needed.

Urinal Problems

It might happen after removal of urinary catheter or urethritis. The solution is to use a urinary catheter for 3-7 more days until the swollen is gone. 

Bleeding

On the first 3-5 days after a bandage removal, bleeding may occur, mixing with urine. If there is still bleeding, sanitary pads can be used to press the wounds. Commonly, the bleeding would eventually stop.