Sex reassignment surgery refers to the surgery to align the sexual appearance according to one's sexual identity. There are two kinds of surgery. Genital surgical sex reassignment: surgery to the genitalia and/or breasts performed for the purpose of altering the morphology to approximate the physical appearance of the other sex. Non genital surgical sex reassignment: any and all other surgical procedures of non-genitalia or non-breast, conducted for the purpose of effecting a more masculine appearance in a genetic female or for the purpose of effecting more feminine appearance in a genetic male.
- Penile Skin Inverstion/Vaginal Plastry
- Sigmoid Colon/ Rectosigmoid Vaginoplasty/ Rectosigmoid Colon
- Bilateral Orchiectomy (BO)
- Aesthetic Revision
Penile Skin Inverstion/Vaginal Plastry
- Pre-surgery night, five nights recuperation in hospital
- Doctor's fee
- Clinical interview/surgical consultation
- Psycho logic (if necessary not included)
- Surgical and anesthesia fee (surgical not include if you have medical diseases such as EG, diabetes, mellitus, heart diseases which is this cover during pre-op check up)
Post Operative Care
All medicine supplies: SRS Kit, Donut pillow, two sizes of dilator, douche kit and one, medical grade lubricants. Post operative check-up at the Institute during SRS recuperation
GRS (or SRS) Certification
No doctor's fee if any correction are required. (Except medical supplies, medical treatments, anesthesia fee, operating room). All post-operative aftercare are provided without cost.
(Second stage SRS like colon transposition vaginoplasty is not considered correction, and will be separate fee).
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Fact about procedure
Dr. Preecha started SRS or GRS in 1978 about 30 years ago, all the SRS surgeons in Thailand were trained by him. Now he has done about 3,000 cases of Male to Female SRS, 130 cases of Female to Male, 350 cases of sigmoid- color vaginoplasty and many thousands of aesthetic surgery in Male Transexuals.
The technique used is Penile Skin Inversion, the sensational glans clitoris, labiaplasty and vaginoplasty in one stage with 3 different technique
- Long Penis (greater then 6 inches) = Penile Skin Inversion(PSI)
- Medium Penis (2-6 inches) = Penile Skin Inversion(PSI) with Scrotal Skin Graft(SSG)
- Short Penis (less than 2 inches) = Penile Skin Inversion(PSI) with Sigmoid Colon Graft(SCG)
Conclusion, only Penile Skin Inversion is US$6,500. With Penile Skin Inversion and Sigmoid Colon is US$8,400
Criteria of Approval
Patient must be at least age 18 years of age. Patients will require permission from parents if under 20 years old.
Patients must be diagnosed with at least one of the following disorders: gender identity disorder, gender dysphoria, or associated conditions.
Patients must have undergone at least one year of antiandrogens or/and female hormones.
Patients are required to have lived full-time in the cross-gender role for at least 1 year (supported by Identification Documents).
Patients must have approval from a psychiatrist (MD), psychiatric social worker (PhD), or clinical psychologist (PhD).
Surgery is performed by Dr. Preecha Tiewtranon M.D., Plastic and Reconstructive Surgeon, American Board Certified in 1973, Associate Professor of Plastic and Reconstructive Surgery in the King Chulalongkorn University, Faculty of Medicine in Bangkok, Thailand, also the former President of the Society of Plastic and Reconstructive Surgeons of Thailand and President of the Society of Aesthetic Surgeons of Thailand, Member of the International Society of Plastic and Reconstructive Surgery.
The M to F, SRS surgery is as followed
- Creation of vaginal space between urethra, prostate gland, bladder and rectum
- Bilateral orchietomy
- Degloved penis shaft
- Separation of urethra from penis
- Isolation glans penis with 2 dorsal nerves and vessels
- Penile skin inversion to line vaginal cavity with or without scrotal skin graft or sigmoid colon graft
- Clitoroplasty (Sensate)
- Labiaplasty, major and minor
A portion of the glans (head of the penis), with its nerves and vessels, is converted into a clitoris. In so do, 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.
Colon transposition is used for patients who need more depth (exceeding 8 inches).
As of 2002, Dr Preecha has performed over 550 of successful colon transposition operations.
There are 3 main techniques
- Penile skin Inversion (PSI) only (for the long penis)
- Penile Inversion with scrotal skin graft. (PSI plus SSG for medium size penis)
- Penile Inversion with Sigmoid Color Graft. (PSI plus SCG for Tiny, small size penis) The SSG or SCG is done in one stage with 5 days hospitalization (average).
The Male to Female SRS is done in one stage with result of:
- Sensate Glans- Clitoris
- Vulva Floor
- Labia major and minor
- Neovagina of 5-6 inches (Natural Vagina is 4.5 inches)
Duration of Operation:
2.30 - 3.00 Hours
Possible Risks and Complications
- Infection; Usually only minor wound infection. There are no pulmonary or systemic infection.
- 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.
- Short Vagina; Normally you will get the depth of 5- 6 inches, at first, 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 $8,500 with the same recovery plan.
- Rectovagima Fistula; where a hole develops between the colon and the vagina.There were 3 out of 1000 + cases all were well taken care of.
The other complications which were mentioned in the literatures such as the urethra vaginal fistula, Pulmonary thromboembolism, extensive bleeding, serious infection have never occurred in his experience.
- 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 the urine catheter to be retained of a few more days, eventually you will be able to urine normally.
- 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.
Before being discharged from the hospital to your hotel, the nurse will teach you how to take care of your vagina and prescribe some more medications. The stiches will be removed after 7- 10 days. And you will be able to return home.
You need to stay recuperate totally in Bangkok for 10-14 days at least before safely flying home. You will also require 4-6 weeks recuperate at home before returning to work. (The neovagina can function within 6 weeks).
The cost of Penile Skin Inversion's already included 5 nights free of charged in hospital private room after surgery and medical treatments, post-op cares and etcs.
You will be requested to sign in hospital consent form. Then you need five nights admission to hospital for recuperation.
General anesthesia(You are Asleep) or you can choose epidural or spiral anesthesia.
Post Operative Care
After release from hospital the patient will recover with the aid of liaison at the hotel. During recovery in the hotel, the patient must follow patient instructions, including:
- Dilating is the most important thing you can do to ensure the success of your surgery. If the patient does not dialate responsibly, this can result in the shortening of depth and width of the newly made vagina because of the scar contracture.
- 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.
- 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:
- douche solution(proportion) = 5-10 ml (cc) of Betadine solution mixed with 1L of water or until the container is full
- insert the douche to full depth, squeeze, and hold tightly the container;
- while holding tightly the container, extract the douche;
- keep the wound dry and apply Betadine solution with cotton balls; and
- 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 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.
Dr. Preecha follows the HBIGDA criteria, you should have
- One letter recommend the S.R.S. from; either i. Therapist ii. Psychiatrist iii. Endocrinologist or General Practitioner
- Discontinue hormone treatment at least 14 days prior to surgery. Hormones should be halted to reduce the risk of thrombosis (blood clots). Oral tablets should be halted two weeks prior to surgery and injectables should be halted four weeks prior to surgery. Oral antiandrogens can be halted three days before surgery (four weeks if injectables).
- 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
- E-mail the results.
- Reduced smoking, No aspirin and ibuprofen (Advil etc.) and Vit. E.
- G.R.S. date; should send the Fax, email. For appointment one month prior to surgery date and itinerary.
- 6) HIV + can be done but will cost 30% extra due to the necessity of using disposable instrument.
Surgical fee is $ 6,500 (U.S.)
If you are HIV positive, then you are a risk to hospital personnel. For this reason you need to pay an extra 30% of the original charge. Prepare cash for your personnel to stay another 5 days after surgery.(If you would like to stay at hospital hotel room for additinal night after surgery is US$ 62 per night excluded meal) about $20-40 (U.S.) per day for food expense.
Airport Tax on departure is $15 (U.S.)
Touring arrangements will be around $100 (U.S.) per day (optional)
Appointment with Surgeon
The operation can be arranged once you have all the required papers ready. Just inform us of your convenient date at least one month in advance prior to arrival.
Patients are required to submit following documents before operation: (Int.' Patient only)
- e-mail scan, fax one piece of photo identification (e.g. drivers license, Passport, etc)
- e-mail scan, fax of bank 10% wire transfers (please check at term and payment)
- e-mail scan, fax copy of the flight reservation itinerary
- original signed (hard-copy) documents of claimed diagnoses or referrals. We will collect your hard documents during consultation.
- Once the applicant has been approved for Penile Skin Inversion (MtF) Surgery, the patient can then make the flight arrangement.
Please carry only essential belonging. If the patient arrives alone, it is essential to travel with light luggage (max. 25 kgs) to avoid risking injury during the 4-6 week recovery period.
1. Arrive in Bangkok International Airport. Meet PAI staff and be escorted to the hospital.
2. Pre-surgery night in the private deluxe suite in Hospital
1. Meet with your appointment doctor for clinical interview / surgical consultation. All questions will be clarified personally and the surgery technique will be discussed and interview with Psychiatric tests (if necessary).
2. Check medical documents.
3. Admission to hospital. You will be requested to sign hospital consent forms.
4. The operation date and time will be arranged within twenty-four hours after Pre-operative consultation.
On the day:
1. The nurse will do complete enema to clean rectum.
2. Take shower.
3. Preoperative intravenous fluid and sedation.
4. In operating room under general anesthesia.
The day after: Upon waking up, 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 minimum only during the first twenty-four hours. Then subsided gradually, you can be ambulated with help daily. The dressing gauze and the catheter will be removed on the 4th- 5th days. 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.
Your doctor will remove the dressing and bandages. Upon checking the results you may leave the hospital and check in to your chosen hotel.
These five days should be spent for resting.
You may go to Sightseeing or Shopping(Depend on doctor diagnosis).
If you were at your chosen hotel. Please return to the hospital where the doctor will remove sutures from the labia and do a final examination. You will receive a final postoperative recovery check up and some medications. You will also receive a medical certificate that authenticates the surgery and recommends that you receive a legal change of sex.
Transfer to Bangkok International Airport for Departure by PAI staff.
Optional: We will provide you a mobile phone. So your relatives and your friend's able call you directly and get more closely while your trip of surgery. Nevertheless, your private room also has a phone to call and our hospital operators will assist you. After you come to our office (PAI), please ask for more information. We will collect the mobile phone back one night before your departure from Bangkok. (International patient only)
Please note that this information should be used only as a guide to your treatment. All specifics will be discussed with your Surgeon during your initial consultation.