SRS Male to Female (MTF): Penile Skin Inversion / Vaginal Plasty
USD 6,000
 
(click picture to enlarge)
The price includes;
Doctor's fee
Surgical Consultation
General Anesthesia
Hospitalize: 7 nights pre and post surgery in VIP private room
Medical treatment and supplies
Post operative care and check-up at Bangkok 9 hospital
Please note that the second stage of SRS like colon transposition vaginoplasty is not considered a correction. If a patient need one, separate fee will be collected.
The price does not include;
1. Management of pre-existing medical problems such as diabetes, heart disease, renal insufficiency. An extra charge of treatment during the operation will be imposed on case by case basis.
2. Disposable medical supplies for HIV positive patient. An extra charge is 30% of original price.
Fact about SRS
There are 3 different techniques used for Penile Skin Inversion, the sensational glans clitoris, labiaplasty and vaginoplasty in one stage for 3 different types of Penis;
1. Long Penis (>6 inches) = Penile Skin Inversion(PSI)
2. Medium Penis (2-6 inches) = Penile Skin Inversion(PSI) with Scrotal Skin Graft(SSG)
3. Short Penis (<2 inches) = Penile Skin Inversion(PSI) with Sigmoid Colon Graft(SCG)
Criteria of Approval for Surgery
- Patient must be at least age 18 years of age and if patient is under 20 years old, parent permission will be required.
- Patient must be diagnosed with at least one of the following disorders: Gender identity
disorder, gender dysphoria, or associated conditions.
- Patient must have undergone at least one year of anti-androgens or/and female hormones.
- Patient is required to have lived full-time in the cross-gender role for at least 1 year (supported by Identification Documents).
- Patient must receive an approval from a psychiatrist (MD), psychiatric social worker (PhD), or clinical psychologist (PhD).
Surgical Procedure
The Male to Female, SRS surgery is as followed
1. Creation of vaginal space between urethra, prostate gland, bladder and rectum
2. Bilateral orchietomy
3. Degloved penis shaft
4. Separation of urethra from penis
5. Isolation glans penis with 2 dorsal nerves and vessels
6. Penile skin inversion to line vaginal cavity with or without scrotal skin graft or
sigmoid colon graft
7. Clitoroplasty (Sensate)
8. Urethropalsty
9. Labiaplasty, major and minor
A portion of the glans (head of the penis) with its nerves and vessels, will be converted into
a clitoris, which will serve as a sensational function and as an 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, which may
result in the narrowing of the vaginal opening.
Colon transposition will be used for patients who need more depth (exceeding 8 inches).
Results
The Male to Female SRS is done in one stage with creation of Sensate Glans- Clitoris, Neourethra, Vulva Floor, Labia major and minor, and Neovagina of 5-6 inches (Natural Vagina is 4.5 inches)
Duration of Operation
3.00 – 3.30 Hours
1. Infection; Usually only minor wound infection. There is no pulmonary or systemic infection.
2. Wound disruption; Only at the fourchet of the new vagina perineum due to high tension at the area, will require only wound care and heal spontaneously in one month.
3. Short Vagina; at first, you will generally get the depth of 5- 6 inches. Depth will be deeper after 6- 12 months due to the maturation of scar and yield more elasticity.
In case of very short vagina, the second operation can be done after 6 months by using the sigmoid colon procedure, which will cost USD 6,500 with the same recovery plan.
4. Rectovagina Fistula; where a hole develops between the colon and the vagina, which is a rare case.
Side Effects
1. Unable to urinate, it can occur sometime after removing the urine catheter, due to the swollen stump at the opening of the shortened urethra which will need to retain the urine catheter for a few more days. Eventually you will be able to urine normally.
2. Bleeding, you may experience oozing blood around the gauze dressing the first day after surgery due to bleeding thru the stump of urethral opening, may require repacking or suturing.
After Care
Before being discharged from the hospital, the nurse will teach you how to take care of your vagina and prescribe some more medications. The stitches will be removed after 2 weeks and you will be able to return home. Patient can walk comfortably after taking off pads and catheter on last day in hospital.
Recovery Time
You need to stay in Bangkok for at least 10-14 days before flying safely home. You will also need 4-6 weeks break to recuperate at home before returning to your occupation. (The neovagina can function within 6 weeks)
Intercourse:
After the 8th week of surgery, you should be able to engage in neo-vaginal intercourse. The neo-vagina will need some form of lubrication. In general, patients may have sexual intercourse after they successfully dilate the neovagina to the last size of the vaginal dilators.
Post Operative Care
During recovery in the hotel, the patient must follow doctor instructions, including:
1. Dilating, which is the most important thing you can do to ensure the success of your surgery. If the patient does not dilate regularly as instructed, the result can be a short in depth and width of the newly made vagina because of the scar contracture.
2. Failure to dilate properly can result in serious injury. You will be instructed to gently dilate into the right direction after the vaginal packing is removed.
3. Dilation can be painful for the first weeks, but is essential for developing maximum depth and ensuring post operative functioning of the neovagina.
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:
a. douche solution(proportion) = 5-10 ml (cc) of Betadine solution mixed with 1L of water or until the container is full
b. insert the douche to full depth, squeeze, and hold tightly the container;
c. while holding tightly the container, extract the douche;
d. keep the wound dry and apply Betadine solution with cotton balls
e. 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 knapkins (tampons) should be changed several times per day due to normal vaginal bleeding during recovery.
After one month of SRS operation, you will be required to start applying Premarin cream to your neo-vagina. Apply two times a day to soften your neo-vagina. This would generally take around six months.
Patient can return to female hormones as before surgery after two months. You should consult your endocrinologist to re-adjust the dosage. A sudden change in hormone levels, for some individuals, may result in the fluctuation of emotion.
Preparation before Operation
- According to the Harry Benjamin International Gender Dysphoria Association (HBIGDA) criteria; that you should have: One letter recommendation the S.R.S. from; either a. Therapist b. Psychiatrist c. Endocrinologist or d. General Practitioner
- Discontinue hormone treatment at least 14 days prior to surgery. Hormones should be stopped to reduce the risk of thrombosis (blood clots). Oral tablets should be stopped two weeks before surgery and injectable should be stopped four weeks before surgery. Oral antiandrogens can be stopped three days before surgery (four weeks if injectable).
- Have your private doctor performed preoperative physical 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
and e-mail the results to us at consult@thaisurgerytravel.com
- Reduced smoking, no aspirin, Vitamin E and ibuprofen for at least 7-10 days
- SRS date and itinerary should be sent to us by fax or email. Appointment needs to be made one month in advance.
Schedule Guideline
DAY 1
Arrive in Bangkok International Airport. Meet our staff and be escorted to the hospital. If you arrive in the morning, you can have an interview with Dr. Tawisak (on advance arrangement). If your flight is in the evening or late at night, we will give you free pre surgery night private room in the Bangkok 9 Hospital.
DAY 2
A clinical interview or a surgical consultation with your appointed surgeon. All questions will be clarified personally and the surgery technique will be discussed and interview with Psychiatric tests (if necessary). Your medical documents will be checked.
On this day;
1.The nurse will do complete enema to clean rectum.
2. Let you take a shower.
3. Preoperative intravenous fluid and sedation.
4. Then you will be brought to operating room under general anesthesia.
DAY 3 to 5
Upon waking up, you will be able to have regular meal, and move freely in bed. Do not be alarmed by the catheter for urine and drainage tube full of blood, this is normal at first, it will
stop in twenty-four hours. You may feel like you want to urinate, but it is not, due to the urine catheter irritation. Pain is usually minor only during the first twenty-four hours. Then it will subside gradually. You can get help with ambulated daily. The dressing gauze and the catheter will be removed on Day 4 – Day 5. You can urinate take a shower and to be discharged back to hotel on the 5th day. A nurse will come and bath you twice a day and change your bedding as often as necessary.
DAY 6
Doctor will remove the dressing and bandages. By checking the results, you may leave the hospital and check in to your chosen hotel.
DAY 6 to 10 (Either in the hospital or a hotel depending on your choice and your condition)
These five days should be spent for resting
DAY 11
You may go to Sightseeing or Shopping depending on surgical evaluation and clearance.
DAY 12
A day for your doctor to remove sutures from the labia and does a final examination. You will receive a final post-operative recovery check up and some medications and will receive a medical certificate that certifies the surgery and recommends that you receive a legal change of sex.
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