Sex Reassignment Surgery (Male to Female)

It takes about 3 hours to complete the procedure

The ideal candidate to undergo the procedure should meet the following requirements:

• Be of legal age in the patient’s nation; In Thailand, the father/mother or legal custodian may give consent for patients under the age of 18.
• Ungergo 12 months of continuous hormonal therapy.
• Experience 12 months of successful continuous full time real-life experience.
• Have no serious medical/health issues.
• Must be HIV NEGATIVE
• Live with desire for being the other gender for more than 2 years.
• Take hormone therapy for at least 6 months.
• Have a recommendation from a psychiatrist or therapist.
• Have a negative attitude of their current sexual organs.
• No psychiatric illness.
• Patients must be diagnosed with at least one of the following disorders: gender identity disorder, gender dysphoria, or associated conditions (anxiety, depression).
• Patients must have undergone at least one year of antiandrogens or/and hormones.

Fianally, your surgeon will be the one to decide whether you are a good candidate to undergo the procedure or not.

The neovagina can function within 6 weeks. After the 3rd month of the surgery, you will be able to engage in normal vaginal intercourse. The vagina will need some form of lubrication. In general, you may have sexual intercourse after the sixth time of attempting sexual intercourse. You will have to take it slowly in order to enjoy the new feelings you will experience.

Return to female hormones: You can resume taking oral female hormones in 10 – 14 days after surgery, but the need for female hormones is less than prior to surgery, about 1/2 to 1/4 of preoperative doses. Before returning to oral hormones, it is recommended that you check with your surgeon first. 

While preparing for your surgery, you will be instructed to follow these guidelines:

1. The patient hould stop taking hormone pill for 2 weeks before operation.
2. The patient should eat a soft diet for 2-3 days prior to surgery to prevent the problem of defecation after operation.
3. The patient should not drink and eat food for 6 hours before the operation.
4. Patients must complete a health check up within 3 months prior to SRS.
5. 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
6. Oral tablets should be halted 2 weeks prior to surgery, and injectables should be halted four weeks prior to surgery.
7. Oral anti-androgens can be halted 3 days before surgery (4 weeks if injectables).
8. Aspirin and smoking should be halted 2 weeks before surgery.

The risks and complications related to the procedure are:

• Infections: usually only minor and do not cause pulmonary or systemic infections.

• Short Vagina: Depth usually reaches six inches and will continue to extend after 6-12 months due to the maturation of scar tissue. In case of a very short vagina, a second operation can be done after 6 months by using the sigmoid colon procedure (US $9,000).

• Rectovagina Fistula: A very serious complication of SRS, where a hole develops between the colon and the vagina. This is a very rare case.

• Urethra vaginal fistula

• Pulmonary thrombo embolism

• Extensive bleeding

• Wound disruptsions: There will be strong tension in the area around the fourchet of the new vagina perineum. Wound care will be required, but will heal within one month.

• Unable to urinate: Urination difficulty sometimes occurs after the urine catheter is removed, due to the swollen stump at the opening of the shortened urethra. In such cases, the urine catheter should be retained for several more days. Eventually urination will return to normal.

• Bleeding: You may experience oozing blood around the gauze dressing after the first day of surgery due to bleeding through the stump of the urethral opening. This may require repacking or suturing.

However, you should be aware of all the related risks and complications before deciding to undergo the surgery.

 

After the surgery, anursing team will do your cleaning and dilation. This will be done twice a day. You will experience very mild pain, without using epidural morphine. You will be able to recover quickly and return to normal life. 

After 6 weeks, you will be able to engage in neovaginal intercourse. During sexual arousal, there is some vaginal lubrication. In most cases, you 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. 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. However, it is important to avoid any strenuous activity in order to recover quickly.

After the surgery, you will have to stay in hospital for 6 days for post operative care. After the vaginal packing is removed, you will be able to walk carefully and slowly usually around 4 days. 
You are recommended to plan on an  additional 14 + days to recover. 

Vaginal dilation: It is necessary to start to gently dilate your vagina two times a day, for the first couple of months for about 1 hour each time using an adequate amount of lubricant jelly (KY in Amarica). The need to dilate becomes less frequent over time, particularly if you regularly engage in sexual intercourse. In case of no sexual intercourse after six months, the vagina will need dilation about two times a week.
Dilation is the most important thing to do to ensure the success of your surgery. If you do not dilate responsibly, this can result in the shortening of depth and vaginal stenosis, including partial to total collapse. Failure to properly dilate in the early stages can result in patients experiencing excessive vaginal pain in later times. You will be instructed on proper and gentle dilation techniques after the vaginal packing is removed. Dilation is essential for developing maximum depth and ensuring post operative functionality of your vagina.

Dilation: A few days after the packing is removed you will begin dilating your new vagina. You will be given a set of 6 dilators. (Most girls nickname them as boyfriend 1 – 6 but the foreplay is lousy!) These dilators are graduated in small increments from just under 1 inch to 11/4 inches in diameter. You start with the smallest and every week to 10 days jump to the next size up until you reach the largest size.
Dilation is 60 minutes, twice a day for the first 3 months. After that you can drop back to once a day for a few months, tapering off to 2 – 3 times a week.This is flexible and depends upon your age and if you have a sexual partner.

To prepare to dilate, urinate or have a bowel movement prior to starting can make dilation more comfortable. Once you have cleaned everything thoroughly, lay a pad or towel on the bed. Clean yourself as you were instructed by your surgeon. What works well is to place your feet about hip width apart and bend your knees. Insertion of the dilator will be most comfortable when you have the angle correct.

During the recovery period, after each dilation session:
The wound should be washed gently with Hibiscrub (pink colour) in the shower followed by douching while seated in the toilet:

1. douche proportion = 5-10 ml (cc) of Betadine solution mixed with bottled water until container is full;
2. insert the douche to full depth, squeeze and hold the container tightly;
3. while holding  the container, extract the douche;
4. keep the wound dry and apply Betadine solution with cotton balls; and
5. apply Kemicitine ointment with a cotton applicator. If there is some bleeding, press or apply pressure with a dry cotton ball to the site for 15 minutes. During the first weeks after surgery, feminine napkins (tampons) should be changed several times per day due to normal vaginal bleeding during recovery.

One month after the SRS operation, you will be required to start applying Premarin cream to your neovagina. Apply two times a day to soften your neovagina. This would generally continue for around six months.
Showering with soap is allowed to keep the wound clean. Use vaginal douche twice a day for 3 weeks. Apply the antibiotics ointment over the surgical wound, urethra and clitoris every time after showering. The external appearance will look natural like a woman after 2-6 months.

USD 3,000-13,000