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Advance Sex Reassignment Surgery Techniques​

September 12, 2018

Advance Sex Reassignment Surgery Techniques​

The Southeast Asian nation is at the forefront of the growing practice of transgender surgery, capitalizing on decades of know-how, low-cost health care, and a ready supply of surgeons trained to perform the male-to-female procedures.

Thailand is the most popular overseas destination for patients seeking sex-reassignment surgery. For some people who have no insurance–the majority of gender reassignment surgeries are not covered by insurance–and who need to have the surgery, it is the only option.

SRS is often the final stage in the physical transitioning for a male to female (MTF) or female to male (FTM) transsexual. SRS is a surgical procedure that entails removing the genitalia of one sex and constructing the genitals of the opposite sex. The procedure has very high rates of success when it is performed by responsible and experienced surgeons. However, with current surgical technology, male to female individuals usually are more satisfied with their results than female to male.

While there are no publicly available statistics on the number of people undergoing the surgery in Thailand, at least 100 Thai doctors are qualified to perform the operations, and Dr. Burin Wangjiraniran is one of them.

Dr. Burin Wangjiraniran, MD., FRCS, our SRS surgeon, has had a longstanding specialization in transgender procedures, and has been performing gender procedures since the 2000’s. He is passionate about his work and believes that SRS can improve his patients’ life. The happiness of his patients inspires him to improve his surgical techniques all the time during his 15 years of experience, and to provide the highest level of care and the most advanced techniques to achieve his patient’s goals and desires.

To be allowed to get SRS you will have to meet many requirements. Social reassignment is often highly recommended if not required before the individual commits to SRS. Also called "real life experience", it involves living and working for perhaps two years in the new gender role. This often gives some indication of the possible happiness after SRS.

Hormonal reassignment usually takes place before SRS. For male to female transsexuals, estrogen (female hormone) therapy helps suppress the physical male characteristics and encourages physical female characteristics.

How Sex Reassignment Surgery WorksThe procedure can take anywhere from three to seven hours and involves removing the penis, reshaping genital tissue to appear more female and constructing a vagina.
▪ An incision is made into the scrotum, and the flap of skin is pulled back. The testes are removed.
▪ A shorter urethra is cut. The penis is removed, and the excess skin is used to create the labia and vagina.
▪ People who have male-to-female gender-reassignment surgery retain a prostate.
▪ Following surgery, estrogen will stimulate breast development, widen the hips, inhibit the growth of facial hair and slightly increase voice pitch.

Different techniques
There are several techniques that can be used to create the vagina. The most common and least invasive technique is using the inverted skin of the penis 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.

In most techniques, a portion of the head of the penis is formed into a clitoris. This technique allows sexual stimulation and enjoyment. If the penis is long enough, no additional skin grafts will be necessary. If the penis isn't long enough then a scrotal, abdominal or thigh skin graft is often used. Scrotal skin must have had all of the pubic hair removed before sex reassignment surgery.

Another technique is to create the vagina using "full thickness" skin grafts. These grafts are obtained from hairless portions of the sides and the penile skin is then used to create the labia minora and the scrotum skin to create the labia majora. The width and dept of the vagina are usually greater than with the inverted penile skin, and so the new vagina will be less likely to shrink over time.

Rectosigmoid vaginoplasty utilizes a piece of the rectosigmoid colon instead of skin grafts or inverted penile tissue. This technique allows for the creation of a deep and lubricated vagina, but is a more invasive, dangerous and expensive surgery.

In Sex Reassignment Surgery, our surgeon’s goals are:
1) To create a natural looking vagina that is similar to the biological one,
2) To preserve all sensory nerve to provide a good touch sensation and ability to orgasm,
3) To create a long vaginal cavity that is wide and long enough for sexual intercourse,
4) To change the structures of urethral orifice to be above the vaginal opening same as female anatomical position,
5) All erectile tissue are completely removed to prevent tissue engorgement during sexual arousal.

The benefits of advance sex reassignment surgery are:
▪ Patient can get 14-17 cm vaginal depth even in patient whose penis size is small and short.
▪ Shorter surgical cut for minimal scarring
▪ The minor labia extends to the bottom of the vulva vestibule as posterior fourchette that is similar to biological one.
▪ More natural shape of vaginal opening in vertical orientation

However, the result of SRS is individual and depends on the patient’s condition.

Having been working as a consultant for transgender surgery for 10 years, I understand more about my clients’ needs. During the pre-operative consultation, I make sure that our doctor understands clearly my clients’ expectation. I also provide clients’ feedbacks to the doctor in order to improve the surgical technique for a better result.

As you begin the journey down the path of transgender surgery, you simply need a confidant and companion who knows how it all works to help you anticipate your needs at every point. Transitioning is like walking on lily pads: you have to be careful with each step or you're going to sink. It takes as lot of money, courage and a certain amount of planning. I'm just glad that I can help you walk through this journey of achieving your true self.


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