MTF Sex Reassignment Surgery

Sex reassignment surgery is the last procedure to help persons with mental conflict between gender perception and physical condition since they were born that is medically called Gender Dysphoria. This surgery will enable patients to have sex organs that meet with their mental condition. Consequently, they will be able to live their lives happily. As a result, sex reassignment surgery is considered as the most important surgery affecting to new way of life therefore it is necessary for persons to receive this kind of surgery to prepare themselves and seek for information on it properly before making decision, especially selecting surgeon that should be properly experienced and skillful in sex reassignment surgery. Consequently, appearance of sex organs will be in good and natural manner with the depth of vagina that meets with their bodies and respond to sexual arousal properly. Consequently, persons receiving sex reassignment surgery will have physical condition that meets with their mental condition enabling them to live in this society pleasantly.

 

 

Qualifications of Qualified Persons to Receive MTF Sex Reassignment Surgery:   

1. Person receiving sex reassignment surgery must be 20 years old completely. If such person is younger than 20 years old, he must be permitted by his mother, father, or legal parent.
2. He must take estrogen consecutively not less than 1 year.
3. He must feel that he is a woman for long period or since he can realize that feeling.
4. He must live his life as a woman not less than 1 year.
5. He must feel that his sex organ is disgusting and unwanted.
6. He must pass mental evaluation and receive certificate from a psychologist to certify that he is in normal condition that is appropriate for sex reassignment surgery.
7. He must be healthy.

 

 

The surgeon who conducts the MTF sex reassignment surgery will maintain skin, tissue, and sexual sensory nerves of person receiving surgery for decorating new female sex organ by:  

1. Making new female sex organ to look like the actual one as much as possible.
2. Providing the deepest vagina to person receiving surgery as much as possible.
3. Maintaining sexual sensory nerves and moving to clitoris for providing normal sexual arousal.
4. Conducting a surgery for decorating and hiding scars as much as possible.

 

Techniques of Sex Reassignment Surgery

1. This kind of surgery must be conducted with anesthesia provided by anesthetist.
2. New vagina will be generated by drilling muscle located between anal and urethra with the approximate depth of 6-7 inches.
3. Former skin from penis or scrotum will be transformed as vagina’s wall as same as that of actual woman.
4. Sexual sensory nerves are maintained for generating Clitoris before removing the core of penis.
5. Urethra is shortened and reconstructed to enable person receiving surgery to urinate in the same manner as actual woman. If this part is not reconstructed properly, urinating may be in opposite direction.
6. External reconstruction will be conducted including Major Labia, Minor Labia, urethra, and Clitoris to look like actual sex organ of woman with sexual arousal.

 

MTF Sex Reassignment Surgery can be conducted via 3 Vaginal reconstruction techniques as follows:  

1. Penile skin inversion (SRS I): It is inserting former skin of penis for reconstructing vagina that is considered as non-complex method with low complication and extensively preferred by most surgeons.
   Pros – it is easy and not complex that can be completed by experienced and skillful surgeon within 4 hours with 4 nights of hospital admission.

Cons - It is not suitable for any person with the length of penis shorter than 4 inches because it may give a shallow vagina (normally, the depth of vagina is equal to the length of penile skin minus with 1 inch (this 1 inch length is remained for reconstructing Minor Labia). In long term, this skin will gradually sag.

2. Penile skin inversion and scrotal skin graft (SRS 2): This technique is started from conducting penile skin inversion before ripping our scrotal skin for coating vagina’s wall in order to increase the depth of vagina as demanded and sufficient for using. In the event that this depth is insufficient, the surgeon may consider on adding skin from other areas such as skin from thigh, groin, and abdominal surface.

Pros – It gives an opportunity to person with short penis to have the depth of vagina over than 6 inches.
Cons – This technique is complex requiring longer duration of surgery. This kind of surgery can be completed by experienced and skillful surgeon within 6 hours with 6 nights of hospital admission.

3. Sigmoid Colon and Penile Skin Inversion: This technique is suitable for any person wanting to become a woman completely because colon consists of natural lubricate. In addition, this technique is also helpful for any person who already receives sex reassignment surgery but facing with vaginal stenosis hindering intercourse. In this surgery, some parts of colon, around 7-8 inches, will be reconstructed as vagina’s wall. There are 2 techniques of Sigmoid Colon and Penile Skin Inversion as follows:

 

Open Technique: After this surgery, there will be a scar along the left bikini line with the approximate length of 7 centimeters. The length of colon for reconstructing vagina’s wall is around 7-8 inches with vessels and nerves for nourishing such part. The duration of surgery is around 7 hours.

 

Laparoscopic Technique: It is the latest technique for reconstructing vagina’s wall with colon without any scar on abdomen. It is operated by a special tool that can cut colon with the length of 7-8 inches for reconstructing vagina’s wall. The duration of this kind of surgery is around 7 hours.

 

Cons

1. There may be a scar with the approximate length of 7 centimeters over the left side of Monus Pubis.
2. This kind of surgery is complex requiring preparation of colon surgery by detoxifying colon for 1 day before conducting this surgery.
3. Person receiving this surgery may have flatulence for 2-3 days after surgery.
4. Sigmoid Colon and Penile Skin Inversion is not suitable for any person with overweight or thick abdomen. BMI of person receiving this surgery should not be over than 28.5

 

Postoperative Care
The patient has to admit the hospital for at least 4-6 nights for healing operative wound. During admission, the patient must behave as follows:

1. The patient must not eat any food with fiber and fruit juice, milk, cultured milk, and yogurt during the first 2 days after surgery because it will stimulate excretion causing operative wound to be contaminated with stool.
2. The patient should sleep with turning face up and raise the hip while slightly spreading 2 legs during the first one or 2 days after surgery in order to reduce edema.
3. The patient will be able to sleep on his side on the third day after surgery.
4. The surgeon will remove blood drain tube on the fourth day after surgery and open the wound for bathing the wound before removing foley catheter. The patient receiving Penile skin inversion will be able to go home on this day and come back for total stitches off on the seventh day. The surgeon will not remove foley catheter of the patient receiving Penile skin inversion and scrotal skin graft or Sigmoid Colon and Penile Skin Inversion on this day until the sixth day after surgery.
5. The patient receiving Sigmoid Colon and Penile Skin Inversion will not consume any water and food after surgery until he farts. After farting, he will be able to sip some water and consume some liquid food. If the patient eats any food too quickly, there may be flatulence and dyspepsia. Therefore, the patient receiving Sigmoid Colon and Penile Skin Inversion must comply with suggestions of the surgeon and nurse strictly.
6. On the sixth day, the patient receiving Penile skin inversion and scrotal skin graft will get wound bathing and removal of gauzes in vagina.
7. On the seventh day, the foley catheter of the patient receiving Penile skin inversion and scrotal skin graft or Sigmoid Colon and Penile Skin Inversion will be removed and the patient will be able to go home.
8. The patient receiving Penile skin inversion, Penile skin inversion and scrotal skin graft or Sigmoid Colon and Penile Skin Inversion has to meet the surgeon again for total stitches off and expanding vagina by using Dilator prepared by the hospital in order to increase width and depth of vagina stably. The patient should expand vagina at least twice a day for 30 minutes each.
9. Person receiving this surgery must bathe the wounds and expand vagina at least twice a day until external and internal wounds are completely recovered.
10. The patient must not have any intercourse for 2 months minimally.
11. The patient must meet the surgeon as appointed every week for one month after surgery in order to inspect the operative result to be complete and similar to natural organ as much as possible.