About Male to female SRS procedure:

The M to F, 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, 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).

Possible Risks and Complications:

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.

Risks and risk rates vary from patient to patient depending on a range of factors. The risks listed below are possible risks associated with this type of surgery and are mentioned regardless of how remote the possibility

Possible risks and complications of Male to Female SRS Surgery
include:

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.
• Infection; Usually only minor wound 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.
• 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.
• Other complications such as urethra-vaginal fistula, pulmonary thromboembolism, extensive bleeding, serious infection is very rare

Surgery: time required 2.5 – 3 hours

 My Recovery:

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 stitches will be removed after 7- 10 days. And you will be able to return home.

 During recovery in the hotel, the patient must follow all the instructions, including:

1). Dilating is the most important thing you can do to ensure the success of your surgery. If the patient does not dilate regularly, this can result in the shortening of 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:

(i) douche solution(proportion) = 5-10 ml (cc) of Betadine solution mixed with 1L of water or until the container is full

(ii) insert the douche to full depth, squeeze, and hold tightly the container;

(iii) while holding tightly the container, extract the douche;

(iv) keep the wound dry and apply Betadine solution with cotton balls; and

(v) 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.

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.

Male to Female SRS recovery time:

Flying back home: You need to stay recuperate totally in Bangkok for at least 10-14 days before flying back home
Back to work: You will also require 4-6 weeks recuperate at home before returning to work.
Functioning of your new vagina: After 6 weeks