Sex change operation, technique of Dr.Chettawut, Bangkok, Thailand

My sex change surgery technique provides results that have the most normal anatomical and physiological characteristics in one step construction. Details of each genital female organ reconstruction are as follow:

1. Mon Veneris/ Mon Pubic:
Characteristic: The mons is sexually sensitive fatty tissue covers the pubic bone.

Technique: The mound tissue is made from neurovasucular bundle of neoclitoris which carries a special sensation to the aboved skin.

2. Clitoral hood
Characteristic: Prepuce of the clitoris covers the clitoral body.

Technique: The clitoral hood is made from dorsal neurovascular prepuce flap attached to the neoclitoris.

Dr.Chet's SRS result

3. Clitoris
Characteristic: The glans of the clitoris has many nerve endings which results in the clitoris being extremely sensitive.

Technique: This complex and specialized organ is made from dorsal part of glans penis with intact sensory nerves and vessels.

4. Clitoral frenulum
Characteristic: Each labia minora attaches to the base of the clitoral glans. The point at which they attach is called the Frenum or Frenulum.

Technique: This is junctional area of which the dorsal prepuce flap (clitoral hood) and the ventral prepuce flap (labia minora) merged the lower part of neoclitoris.

5. Labia minora (inner labia)
Characteristic: The labia minora are the inner lips of the vulva, thin stretches of tissue within the labia majora that fold and protect the vagina, urethra, and clitoris.

Technique: The innner surface of labia minora is made from originally pink coloured tissue from the neurovasculized ventral prepuce flap while the outer surface of labia minora is made from the penile skin flaps. Entire surface of labia minora is hairless and sensitive to sexual stimultion.

6. Labia majora (Outer labia)
Characteristic: The labia majora are the outer lips of the vulva, pads of fatty tissue that wrap around the vulva from the mons to the perineum.

Technique: The labia majora is made from scrotal skin flaps.

7. Vestibule of the vulva
Characteristic: The Vestibule is the triangle shaped area below the clitoris and above the vaginal introitus. The labia minora form the sides of the triangle. The urethral meatus is located within this area of the vulva.

Technique: This special sensate area is made from the combination of the two originally pinked coloured tissues which are the glans neurovascular island flap and the vascularized urethral flap.

8. Vaginal introitus
Characteristic: The entrance of vagina or vaginal opening

Technique: This area is made from the combination of perineal flap and two sliding distal penile flaps.

9. Vagina
Characteristic: The internal genital female space extends from the vaginal opening

Technique: The wall of vagina is made from scrotal skin graft and/or abdominal skin graft. Entire surface of neovagina is hairless.

Dr.Chettawut's steps for sex change operation

All cases are done under the combination of epidural block and general anesthesia.

Epidural block can help reduce the side effect of anesthetic agent and control pain after surgery.

The position is set in standard lithotomy. Your legs will be well supported and exercised at intervals for DVT prophylactic.

The triangular skin flap is made from perineal skin and will finally be joined with the bilateral sliding penile flap to form vaginal introitus.

The vaginal tunnel is created between the urethra/ prostate gland/ bladder and the rectum. The depth of this newly created space is normally between 5-7 inches from the beginning to the end of recto-vescicle pouch. (depends on the anatomy of individuals)

Bilateral orchidectomy (removal of testes and spermatic cord)

The penis is dissected into its anatomical entities: the copora cavernosa, the glans cap with neurovascular bundle, and the vascularized penile skin.

The copora cavernosa (shaft of penis) are removed up to their attachments to the pubic bones.

During clitoroplasty, all erotic sensory nerve will be well identified and meticulously preserved for a good sensation. The clitoris is set in its normal position with the clitoral hood and column.

The urethral opening is centrally located above introitus (vaginal opening) and the vascularized urethral flap is used for pink coloured vestibule construction.

The excess erectile tissue (corpus spongiosum) around the urethra is totally removed to prevent engorged erectile tissue during sexual arousal, which may result in narrowing of the vaginal introitus.

The scrotal skin flaps are converted into the outer labias. The left over scrotal skin after being fashioned the outer labia will be converted into skin graft.

The inner labias are simulataneously made from the ventral prepuce flaps (originally pink-colour skin) and penile skin attached to the gland penis), which can be stretched like a lip and long enough to cover the rethral and introitus.

The skin graft is thinned by removing of fat and some dermal layer to ensure that all hair follicles (hair roots) will be totally get rid of. The skin graft is lined along the vaginal tunnel to form a vaginal wall.

The vasaline gauze is used to secure the skin graft inside neovagina for 4-5 days.

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